The Hong Kong Polytechnic University (PolyU) School of Nursing developed a computerized haptic system for nasogastric tube (NGT) placement training, letting nursing students to practice NGT insertion in a simulated virtual environment. The school says it’s the first computerized haptic system developed for training nurses in clinical skills in Hong Kong.

Nasogastric intubation, through the nostril and the throat, is an essential clinical procedure for inserting a plastic tube into the stomach for feeding or drainage. Placement training is important because placing the tube is a blind process in which the tube could be misplaced and lead to unexpected complications or fatal incidents. Hence,

Conventional NGT placement training includes classroom lectures followed by small-group clinical teaching with instructors demonstrating the practical skills. The hands-on learning of skills is usually conducted on low-fidelity mannequins that cannot respond to the user, render human anatomy realistically or provide the actual sense of insertion forces.

To address these limitations, the school’s new system simulates an NGT insertion and gives feedback through a haptic device. Two methods were used to calculate the force needed for insertion. The Engineering Mechanics method involves the numerical calculation of the forces between the NGT and the nasogastric passage as if they were structures in engineering design. The Expert System method leverages the knowledge and experience of expert nursing professionals to compute the forces. With these methods, the system can simulate the insertion forces at different locations along the nasogastric passage, as well as the static and dynamic friction between the NGT and the nasogastric passage during the insertion process.

This computerized simulation provides students with safe, standardized, repeatable and self-paced training with interactive feedback like gag and coughing reflexes of the simulator during NGT insertion for more realistic experiential learning and performance evaluation. A graphical user interface is built in the system to visually and virtually display the tube’s position inside the body to facilitate the cognitive and psycho-motor training for the blind process. Quantitative measurements, in terms of completion time and insertion force applied during the virtual NGT placement, provide students with feedback of how well they perform the NGT placement.

PolyU is planning to conduct a pilot run in the 2016/17 academic year for students to use this system as a supplementary training platform to the conventional training approach to evaluate its effectiveness. The research team plans to enhance the features of the system by adding other simulated insertion outcomes such as the coiling of NGT inside the mouth during insertion, and rigorous body responses and movements of the virtual patient and to develop another high-fidelity simulator for the training of urinary catheter insertion.