Nasogastric tube placement: Difference between revisions
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#Provide relief from discomfort | #Provide relief from discomfort | ||
#*Topical vasoconstrictors to both nares | #*Topical vasoconstrictors to both nares | ||
#**Oxymetazoline or [[phenylephrine]] | #**[[Oxymetazoline]] or [[phenylephrine]] | ||
#*Topical Anesthetics (5 min prior to procedure) | #*Topical Anesthetics (5 min prior to procedure) | ||
#**Benzocaine, tetracaine, nebulized [[lidocaine]] (4 or 10%), lidocaine jelly | #**[[Benzocaine]], [[tetracaine]], nebulized [[lidocaine]] (4 or 10%), lidocaine jelly | ||
#**Anesthetize oropharynx, as well, to prevent gagging | #**Anesthetize oropharynx, as well, to prevent gagging | ||
#*Antiemetics | #*Antiemetics | ||
#**[[ | #**[[Ondansetron]] or [[metoclopramide]] 15 min prior may reduce gagging and nausea | ||
#Insert tube along floor of nose under inferior turbinate | #Insert tube along floor of nose under inferior turbinate | ||
#Pause when NGT is in OP | #Pause when NGT is in OP | ||
#Flex neck to decrease chance of tracheal passage | #Flex neck to decrease chance of tracheal passage | ||
#Advance into esophagus | #Advance into esophagus | ||
#*Sipping water may aid in | #*Sipping water may aid in esophageal passage | ||
#*Withdraw to OP promptly if excessive coughing, gagging, choking or voice change | #*Withdraw to OP promptly if excessive coughing, gagging, choking or voice change | ||
#Once NGT is in esophagus, rapidly insert rest of tube to | #Once NGT is in esophagus, rapidly insert rest of tube to pre-measured length | ||
#Confirm placement | #Confirm placement | ||
#*Insufflate air while listening over stomach | #*Insufflate air while listening over stomach | ||
Revision as of 23:45, 14 September 2019
Indications
- Gastric decompression
- Post-intubation
- Bowel obstruction/ileus
- Acute gastric distension
- Aspiration of gastric contents (e.g. for diagnosis/therapy of GI bleed)
Contraindications
- Severe facial trauma (due to possible cribiform plate disruption)
Relative Contraindications
- Severe Coagulopathy
- Gastric bypass and lap band procedures
- Esophageal varices/strictures
- History of alkali ingestion
Equipment Needed
- PPE
- NG Tube- typically a 16F or 18F Sump
- Syringe/Bulb - 50-60cc
- Tape
- Emesis basin
- Cup of water with straw
Procedure
- Consent by informing patient of risk, benefits, and alternatives
- Position patient upright
- Place towel over patient's gown and emesis basin in lap
- Estimate length of insertion
- A standard of 56cm is reasonable[1])
- Alternatively measure from tip of nose to earlobe to xyphoid and then add 15cm
- Check nares for obstruction and pass through the most widely patent nare
- Provide relief from discomfort
- Topical vasoconstrictors to both nares
- Topical Anesthetics (5 min prior to procedure)
- Benzocaine, tetracaine, nebulized lidocaine (4 or 10%), lidocaine jelly
- Anesthetize oropharynx, as well, to prevent gagging
- Antiemetics
- Ondansetron or metoclopramide 15 min prior may reduce gagging and nausea
- Insert tube along floor of nose under inferior turbinate
- Pause when NGT is in OP
- Flex neck to decrease chance of tracheal passage
- Advance into esophagus
- Sipping water may aid in esophageal passage
- Withdraw to OP promptly if excessive coughing, gagging, choking or voice change
- Once NGT is in esophagus, rapidly insert rest of tube to pre-measured length
- Confirm placement
- Secure to patients nose with tape
- Attach to desired suction, not to exceed 120 mmHg
Complications
- Pulmonary placement
- Intracranial placement
- Increased cervical and cranial pressures with gagging/vomiting
- Epistaxis
- Invagination of stomach lumen into eyes of ngt
See Also
- Upper gastrointestinal bleeding
- Small bowel obstruction
- EBQ:Nasogastric aspiration and lavage in emergency department patients with hematochezia or melena without hematemesis
References
- ↑ Phillips DE, Sherman IW, Asgarali S, and Williams RS. How far to pass a nasogastric tube? Particular reference to the distance from the anterior nares to the upper oesophagus. J R Coll Surg Edinb. 1994; 39(5):295-296.
- ↑ Neumann MJ, Meyer CT, Dutton JL, et al. Hold that x-ray: aspirate pH and auscultation prove enteral tube placement. J Clin Gastroenterol. 1995; 20(4):293-295.
- ↑ Christensen M. Bedside methods of determining nasogastric tube placement: a literature review. Nurs Crit Care. 2001; 6(4):192-199.
- ↑ Boeykens K, Steeman E, Duysburgh I. Reliability of pH measurement and the auscultatory method to confirm the position of a nasogastric tube. Int J Nurs Stud. 2014; 51(11):1427-1433.