Nasogastric tube placement: Difference between revisions
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== Indications == | == Indications == | ||
#Aspiration of stomach contents (poor sens and spec for UGI bleed) | #Aspiration of stomach contents (poor sens and spec for UGI bleed) | ||
#Vomiting likely to be dangerous or recurrent | #Vomiting likely to be dangerous or recurrent | ||
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== Contraindications == | == Contraindications == | ||
#Facial fx involving cribriform plate | #Facial fx involving cribriform plate | ||
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== Equipment Needed == | == Equipment Needed == | ||
#PPE including gown for practitioner and pt | #PPE including gown for practitioner and pt | ||
#NG Tube- typically a 16F or 18F Sump | #NG Tube- typically a 16F or 18F Sump | ||
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== Procedure == | == Procedure == | ||
#Inform pt of R/B/A | #Inform pt of R/B/A | ||
#Position pt upright | #Position pt upright | ||
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#Secure to patients nose with tape | #Secure to patients nose with tape | ||
#Attach to desired suction, not to exceed 120 mmHg | #Attach to desired suction, not to exceed 120 mmHg | ||
== Complications == | == Complications == | ||
#Pulmonary placement | #Pulmonary placement | ||
#Intracranial placement | #Intracranial placement | ||
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#Epistaxis | #Epistaxis | ||
#Invagination of stomach lumen into eyes of ngt | #Invagination of stomach lumen into eyes of ngt | ||
== Source == | == Source == | ||
#Roberts: Clinical Procedures in EM, 5th ed | #Roberts: Clinical Procedures in EM, 5th ed | ||
[[Category:Procedures]] [[Category:GI]] | [[Category:Procedures]] [[Category:GI]] | ||
Revision as of 17:27, 16 January 2013
Indications
- Aspiration of stomach contents (poor sens and spec for UGI bleed)
- Vomiting likely to be dangerous or recurrent
- Bowel obstruction
- Paralytic ileus
- Acute gastric dilatation
- Stomach decompression prior to surgery or peritoneal lavage
Contraindications
- Facial fx involving cribriform plate
Relative Contraindications
- Severe Coagulopathy
- Gastric bypass and lap band procedures
- Esophageal strictures/hx of alkali ingestion
Equipment Needed
- PPE including gown for practitioner and pt
- NG Tube- typically a 16F or 18F Sump
- Syringe/Bulb- 50-60cc
- Tape
- Emesis basin
- Towels
- Cup of water with straw
Procedure
- Inform pt of R/B/A
- Position pt upright
- Place towel over pt's gown and emesis basin in pt's lap
- Estimate length of insertion
- 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
- Oxymetazoline or phenylephrine
- Topical Anesthetics (5 min prior to procedure)
- Benzocaine, tetracaine, nebulized lidocaine (4 or 10%), lidocaine jelly
- Anesthetize OP, as well, to prevent gagging
- Antiemetics
- Zofran and reglan 15 min prior may reduce gagging and nausea
- Topical vasoconstrictors to both nares
- Insert tube along floor of nose under inferior turbinate
- Pause when NGT is in OP
- Flex the pt's neck to decrease chance of tracheal passage
- Advance into esophagus
- Having the pt sip water may aid in esphageal passage
- Withdraw to OP promptly if excessive coughing, gagging, choking or voice change
- Once NGT is in esophagus, rapidly insert rest of tube to premeasured length
- Confirm placement
- Insufflate air while listening over stomach
- Obtain radiograph
- Check pH of aspirate (pH<4 there is a 95% chance the aspirate is gastric)
- 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
Source
- Roberts: Clinical Procedures in EM, 5th ed