II. Indications
- Reduces Stomach distention
- Reduces risk of aspiration (but does not eliminate aspiration risk)
- Prolonged Positive Pressure Ventilation
III. Precautions
IV. Contraindications
- Cribriform plate Fracture (use Orogastric Tube instead)
- Maxillofacial Trauma
V. Preparation: Tube Size
- Size
- Child: 10-14 French
- Adult: 14-18 French
- NEX Method of estimating length
- Bridge of nose to earlobe to xyphoid process
- Note centimeter mark at this point of tube (insertion may be a few cm beyond this point)
- Scalzo method of estimating length
- Nasal Insertion Length: (0.25 x height in cm) + 13
VI. Preparation: Pre-medication
-
Topical Decongestant (decreases Epistaxis risk)
- Oxymetazoline (Afrin) 0.05% nasal spray or
- Phenylephrine (Neo-Synephrine) 0.5% nasal spray
- Topical Anesthesia options
- Anxiolysis
- Midazolam 2 mg IV before procedure
- Significantly reduces pain with the procedure and eases placement
- Although 1 mg was also trialed in age over 60 years old, it was not effective
- Manning (2016) Acad Emerg Med 23(7):766-71 +PMID:26990304 [PubMed]
- Midazolam 2 mg IV before procedure
VII. Technique
- Don Personal Protective Equipment (gloves, gown, Eye Protection)
- Position patient
- Elevate the patient's head of bed to 45 to 90 degrees
- Raise bed to appropriate height for the person performing the procedure
- Identify the patient's most patent nare
- Drape the patient's chest with an absorbent pad (e.g. chux pad)
- Preparation of the tube
- Select the proper tube size (see above)
- Estimate the insertion length (see above)
- Consider taping the insertion distance on the tube
- Lubricate the insertion tip of the NG tube (distal 2 to 4 cm)
- Salem Sump Tube has 2 ports
- The shorter, clear port has an adapter for suction
- The longer, blue port is an air vent (entrains air and prevents vacuum effect)
- Keep the blue tubing above the level of the Stomach to prevent gastric fluid leakage
- Anti-reflux valve can be attached to the blue port
- Tube insertion
- Insert the tube into the nare and begin to advance
- Patient flexes their neck forward as the tube enters the nasopharynx
- As the tube enters the throat, have the patient attempt to swallow
- Consider having the patient take small sips of fluid during this time to facilitate Swallowing
- Advance the tube carefully but steadily to avoid prolonging patient discomfort
- Never force the tube
- Consider twisting the tube during insertion
- Stop the procedure and withdraw the tube if patient begins to cough or tube coils in the back of the throat
- Secure the tube
- Typically apply specific fabric tape over the tip of the nose to anchor the tube
- Confirm correct placement
- Chest XRay
- Confirm placement
- Gastric Tube aspirate pH
- pH < 5.5 is an accurate confirmation of proper Gastric Tube placement
- Auscultate over Stomach while insufflating
- Commonly used, but misses most tube misplacements
- Chest XRay
- Apply Suction
- Use low intermittent suction
- Continuous suction risks injury to the gastric mucosa
- Resources
- How To Insert a Nasogastric (NG) Tube; Measurement, Placement & Insertion (Lecturo)
VIII. Protocol: Discontinuing in Resolving Ileus (Adults)
- Instill Milk of Magnesia 3 ounces via NG tube
- Clamp Nasogastric Tube for 8 hours
- Unclamp tube and aspirate residual Stomach contents
- Discontinue NG tube if Residual Volume <120 cc
- Stomach normally secretes several liters in a day
- Small Residual Volume suggests adeguate drainage
IX. Causes: Blood in gastric aspirate
- Upper gastrointestinal Hemorrhage
- Oropharyngeal blood (swallowed)
- Traumatic insertion
- Upper Gastrointestinal Tract injury (from insertion)
X. Complications: Nasogastric or nasoduodenal Feeding Tubes
-
General
- Self-Extubation (common)
- Increased secretions and need for suctioning
- Increased need for repositioning
- Clogged or kinked Feeding Tube
- Secondary mechanical obstruction from Feeding Tube (pylorus obstruction or Small Bowel Obstruction)
- Increased Intracranial Pressure (gagging or Vomiting)
- Provide adequate anxiolysis and sedation
- Nasopharyngeal Trauma
- Epistaxis
- Otitis Media
- Sinusitis
- Nasopharyngeal erosions
- Trachea, Bronchi and lung
- Post-cricoid perichondritis
- Misdirected tube into airway (with risk of infusion directly into lung)
- Tracheoesophageal fistula
- Pneumothorax
- Gastric aspiration with secondary pneumonitis
- Lung Abscess
- Tracheobronchial perforation
- Airway obstruction
-
Esophagus
- Esophageal bleeding
- Esophageal or duodenal perforation
- Esophageal Stricture
- Esophagitis or Esophageal Reflux
- Rupture of Esophageal Varices
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Related Studies
| Definition (UMD) | Tubes designed to access the stomach through the nose, nasopharynx, and esophagus for examination, treatment, or other purposes. These devices typically consist of a single-lumen rubber or plastic tube of 14 to 18 French diameter with circular markings that serve as insertion guides; the tube is inserted through the nose, down the throat, and through the esophagus; its tip is positioned in the stomach. Nasogastric tubes can be used to remove air and liquids from the stomach (decompression) by connection to intermittent suction units and as temporary feeding tubes; they are used frequently for very ill or comatose patients. Nasogastric tubes are intended only for short-term use; keeping in place for more than two weeks can cause nasal septum necrosis. Dedicated tubes used for decompression, both single- and double-lumen, and small-bore tubes intended for feeding are also available. |
| Definition (NCI_NCI-GLOSS) | A tube that is inserted through the nose, down the throat and esophagus, and into the stomach. It can be used to give drugs, liquids, and liquid food, or used to remove substances from the stomach. Giving food through a gastric feeding tube is a type of enteral nutrition. |
| Definition (SPN) | A gastrointestinal tube and accessories is a device that consists of flexible or semi-rigid tubing used for instilling fluids into, withdrawing fluids from, splinting, or suppressing bleeding of the alimentary tract. This device may incorporate an integral inflatable balloon for retention or hemostasis. This generic type of device includes the hemostatic bag, irrigation and aspiration catheter (gastric, colonic, etc.), rectal catheter, sterile infant gavage set, gastrointestinal string and tubes to locate internal bleeding, double lumen tube for intestinal decompression or intubation, feeding tube, gastroenterostomy tube, Levine tube, nasogastric tube, single lumen tube with mercury weight balloon for intestinal intubation or decompression, and gastro-urological irrigation tray (for gastrological use). |
| Concepts | Medical Device (T074) |
| SnomedCT | 17102003 |
| LNC | LP7439-5, MTHU001087 |
| English | Nasogastric tube, Nasogastric Tube, NASOGASTRIC TUBE MISC. EACH, NASOGASTRIC TUBE @ @ EACH, NASOGASTRIC TUBE EACH, Tubes, Nasogastric, TUBE, NASOGASTRIC, Nasogastric tube, device, NASOGASTRIC TUBE MISCELL EACH, NASOGASTRIC TUBE@@MISCELL@EACH, nasogastric tubes, nasogastric tubing, nasogastric tube, Nasogastric Tubes, NG Tubes, NG tube, gastric feeding tube, NG - Nasogastric tube, NGT - Nasogastric tube, Nasogastric tube, device (physical object) |
| Spanish | sonda nasogástrica (objeto físico), sonda nasogástrica, tubo nasogástrico |
