Procedure
Nasogastric Tube
search
Nasogastric Tube
, Gastric Catheterization, NG tube, Nasogastric Feeding Tube
See Also
Enteral Nutrition
Enteral Tube
Orogastric Tube
Enterostomy Tube
Indications
Reduces
Stomach
distention
Reduces risk of aspiration (but does not eliminate aspiration risk)
Prolonged
Positive Pressure Ventilation
Precautions
Nasogastric Tube placement can induce
Nausea
and
Vomiting
Functional equipment (e.g. yanker suction) for immediate suctioning should be available on NG placement
Thick or semisolid gastric contents will not be suctioned by a Nasogastric Tube (with risk of
Emesis
)
Contraindications
Cribriform plate
Fracture
(use
Orogastric Tube
instead)
Maxillofacial Trauma
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
Scalzo method of estimating length
Nasal Insertion Length: (0.25 x height in cm) + 13
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
Lidocaine
nasal spray 4% by atomizer
Preservative-free
Lidocaine
10% by nebulizer
Lidocaine
10% 4 ml (400 mg total)
Nebulize by
Face Mask
Do not use if
Asthma
history
Combination 1:
Lidocaine
jelly, Cetacaine Spray
Lidocaine
2% intranasal jelly
Tetracaine-Benzocaine (Cetacaine) pharyngeal spray
Combination 2:
Lidocaine
atomizer and jelly
Preservative-free
Lidocaine
4% by atomizer
Spray 4% once in nostril (1.5 ml)
Spray 4% twice at posterior pharynx (3 ml)
Lidocaine
2% Jelly
Sniff 5 ml
Lidocaine
into nostril and swallow
References
Gallagher (2004) Ann Emerg Med 44:138-41 [PubMed]
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]
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
Causes
Blood in gastric aspirate
Upper gastrointestinal
Hemorrhage
Oropharyngeal blood (swallowed)
Trauma
tic insertion
Upper gastrointestinal tract injury (from insertion)
Complications
Nasogastric or nasoduodenal
Feeding Tube
s
Gene
ral
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
)
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
References
Finucane (1999) JAMA 282:1368 [PubMed]
Li (2002) Am Fam Physician 65(8):1605-10 [PubMed]
Type your search phrase here