Poster The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Blood Pressure Changes in Nasogastric Tube Insertion in Stroke Patients (#184)

Jack Stapleton 1 , Muhammad Zubair 1 , David Blacker 1 2 , Angela Jacques 1 3 , Kathryn Hird 4
  1. Sir Charles Gairdner Hospital, NEDLANDS, WA, Australia
  2. Perron Institute, Perth, WA, Australia
  3. Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
  4. School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia

Background: Blood pressure (BP) fluctuations during acute stroke can be harmful. Nasogastric tube (NGT) insertion is believed to cause BP fluctuations.

Aims: To determine if NGT insertion is associated with significant BP fluctuation and define the characteristics of patients with BP variations. 

Methods: We performed a single centre, prospective review of 54 patients with stroke requiring NGT insertion. Data was collected regarding demographics, BP, anti-hypertensive management, stroke severity, stroke type (haemorrhagic,  ischaemic) interventionist experience, and time since stroke. An average of 3 BP readings, taken 5 minutes apart, was used as the baseline. Subsequent measurements were taken during NGT insertion, and at six 5-minute intervals after the procedure.

Results: The mean age was 72.9 years (SD = 13.9), 49% were male. NGT insertion was associated with an increase in both systolic (SBP) and diastolic blood pressure (DBP) during insertion and at 5 minutes post. During NGT insertion, BP (SBP/DBP) increased by 16.7/10.1mmHg (95% CI 12.5-20.8/6.9-13.2) from 151.2/77.8mmHg (146.4-156.1/74.2-81.3) to 167.9/87.8mmHg (163.1-172.8/84.3-91.3); and at 5 minutes post insertion it was 8.5/4.5mmHg (4.35-12.65/1.4-7.6) higher than baseline at 159.8/82.2mmHg (154.9-164.7/78.7-85.8). There was no association between other measured variables and BP fluctuation. BP readings taken from 10 to 30 minutes post NGT insertion did not show any difference from baseline.

Conclusion: Our study found that NGT insertion in stroke patients is associated with a significant increase in BP at the time of insertion and at 5 minutes post. This has implications for patient selection and timing of NGT insertion, particularly in haemorrhagic stroke, where BP variations are believed to be particularly harmful.