Nasogastric tube placement: Difference between revisions
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==Indications== | ==Indications== | ||
[[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]] | |||
[[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]] | |||
[[File:Illu esophagus.jpg|thumb|Esophagus anatomy and nomenclature based on two systems.]] | |||
*Gastric decompression | *Gastric decompression | ||
**Post-intubation | **Post-[[intubation]] | ||
**Bowel obstruction/ileus | **[[Bowel obstruction]]/[[ileus]] | ||
**Acute gastric distension | **[[acute gastric dilation|Acute gastric distension]] | ||
*Aspiration of gastric contents | *Aspiration of gastric contents | ||
**Diagnosis/therapy of [[GI bleed]]) | |||
**Gastric lavage in [[Toxicology|acute poisonings]] (largely abandoned due to lack of efficacy) | |||
==Contraindications== | ==Contraindications== | ||
*Severe facial trauma (due to possible | *Severe [[facial trauma]] (due to possible cribriform plate disruption) | ||
===Relative Contraindications=== | ===Relative Contraindications=== | ||
*Severe | *Severe [[coagulopathy]] | ||
*Gastric bypass and lap band procedures | *[[gastric bypass surgery|Gastric bypass]] and [[lap band complications|lap band procedures]] | ||
*Esophageal varices/strictures | *[[Esophageal varices]]/strictures | ||
*History of alkali ingestion | *History of [[caustic ingestion|alkali ingestion]] | ||
==Equipment Needed== | ==Equipment Needed== | ||
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==Procedure== | ==Procedure== | ||
[[File:ETTubeandNGtubeMarked.png|thumb|Nasogastric tube below the diaphragm and in the stomach in correct position as seen on [[CXR]] (bottom arrow).]] | |||
#Consent by informing patient of risk, benefits, and alternatives | #Consent by informing patient of risk, benefits, and alternatives | ||
#Position patient upright | #Position patient upright | ||
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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 | ||
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*Intracranial placement | *Intracranial placement | ||
*Increased cervical and cranial pressures with gagging/vomiting | *Increased cervical and cranial pressures with gagging/vomiting | ||
*Epistaxis | *[[Epistaxis]] | ||
*Invagination of stomach lumen into eyes of | *Invagination of stomach lumen into eyes of NGT | ||
==See Also== | ==See Also== | ||
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*[[Small bowel obstruction]] | *[[Small bowel obstruction]] | ||
*[[EBQ:Nasogastric aspiration and lavage in emergency department patients with hematochezia or melena without hematemesis]] | *[[EBQ:Nasogastric aspiration and lavage in emergency department patients with hematochezia or melena without hematemesis]] | ||
==External Links== | |||
*[https://litfl.com/nasogastric-and-orogastric-tubes/ LITFL: Nasogastric and Orogastric Tubes] | |||
*[https://www.merckmanuals.com/professional/gastrointestinal-disorders/how-to-do-gastrointestinal-procedures/how-to-insert-a-nasogastric-tube?query=nasogastric%20tube Merk Manual - How To Insert a Nasogastric Tube] | |||
===Videos=== | |||
*Insertion | |||
**Tulane (2:55) https://www.youtube.com/watch?v=1OakmxZDa5c | |||
*Unclogging NG Tube: | |||
**Providence Health (3:53) https://www.youtube.com/results?search_query=unclogging+g+tube+emergency+medicine | |||
==References== | ==References== | ||
Latest revision as of 22:33, 7 February 2024
Indications
- Gastric decompression
- Aspiration of gastric contents
- Diagnosis/therapy of GI bleed)
- Gastric lavage in acute poisonings (largely abandoned due to lack of efficacy)
Contraindications
- Severe facial trauma (due to possible cribriform 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
Nasogastric tube below the diaphragm and in the stomach in correct position as seen on CXR (bottom arrow).
- 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
External Links
Videos
- Insertion
- Tulane (2:55) https://www.youtube.com/watch?v=1OakmxZDa5c
- Unclogging NG Tube:
- Providence Health (3:53) https://www.youtube.com/results?search_query=unclogging+g+tube+emergency+medicine
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.