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Introduction

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A nasogastric tube is inserted in the intensive care unit (ICU) for a variety of reasons including gastric emptying, drainage, and feeding.

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Definitions and Terms

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  • ▪  Nasogastric tube (NG): A tube passing through the nose, pharynx, and esophagus, with the distal tip in the stomach.

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Techniques

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  • ▪  Indications:
    • —Nasogastric drainage in various setting:
      • • Ileus
      • • Following abdominal surgery
      • • To prevent regurgitation
    • —Administration of certain drugs directly into the stomach:
      • • Activated charcoal in the event of a drug ingestion
    • —Diagnosis of ingested substance (ie, when it is unclear what patient has ingested).
    • —Enteral feeding:
      • • In a patient with an endotracheal tube.
      • • In a patient who is unable to protect airway.
  • ▪  Contraindications:
    • —Coagulopathy
    • —Sinusitis
    • —Head trauma
    • —Esophageal surgery or stricture
    • —Deviated septum
  • ▪  Technique:
    • —When possible identify more patent nasal passage by having patient sniff through each nasal passage.
    • —Position patient:
      • • If awake, the patient should be placed in a head-up position.
      • • If unconscious, the patient should be placed in a supine position.
    • —Lubricate NG tube and advance into nose, aiming for the ear.
    • —As tip of tube passes into nasopharynx, encourage awake patient to swallow to facilitate passage of tube into esophagus—it may be appropriate to have patient drink through straw during the procedure.
    • —Advance tube to premeasured depth corresponding to mid gastric position of the tip (Figure 42-1).
    • —Verify tube position by aspiration of gastric contents, audible bubbling on auscultation over stomach when air injected into tube, and/or abdominal flat plate x-ray (Figure 42-2).
    • —Secure NG tube to nose with tape.
  • ▪  Complications
    • —Epistaxis:
    • —Perforation of cribriform plate
    • —Esophageal perforation
    • —Tracheal intubation with NG tube (Figure 42-3)
    • —Pneumothorax

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Figure 42-1.
Graphic Jump Location

Graphic showing NG tube position in stomach.

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Figure 42-2.
Graphic Jump Location

Abdominal flat plat showing NG tube coiled in stomach.

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Figure 42-3.
Graphic Jump Location

Chest x-ray showing NG tube in right lung.

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Clinical Pearls and Pitfalls

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  • ▪  NG tube should be very well lubricated to prevent mucosal abrasion.
  • ▪  Patient should be able to speak following placement—if unable, NG tube may be between vocal cords.
  • ▪  In unconscious patients, tube insertion may be guided with fingers, laryngoscopy, or laryngeal manipulation.
  • ▪  Do not tape tube too tightly to nose to prevent alar injury.

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Suggested Reading

Thomsen TW, Shaffer RW, Setnik G. Videos in clinical medicine. Nasogastric intubation. N Engl J Med. 2006;354:e16.

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