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Introduction

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Enteral feeding may be performed using a standard nasogastric or a nasoduodenal tube. The latter is a small bore tube advanced through the stomach, into the duodenum, and used specifically for feeding.

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Definitions and Terms

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  • ▪  Postpyloric tube: Nasal feeding tube with the distal type beyond the pyloric valve—typically in the duodenum.
  • ▪  Nasoenteric tube: Tube passing through the nose into the gut.

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Techniques

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  • ▪  Indications:
    • —Long-term enteral feeding in a patient who requires total or supplementary enteral feeding, and for whom gastric feeding is inappropriate.
  • ▪  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.
    • —Nasoduodenal tubes are typically narrow, flexible (Figure 43-1), and equipped with a wire to stiffen tube during passage, which is subsequently removed—the tip may be weighted to facilitate tube advancement.
    • —Fluoroscopic assistance may be used to facilitate correct positioning of tube (Figure 43-2).
    • —Lubricate enteral tube and advance into nose, aiming for the ear (Figures 43-3 and 43-4).
    • —As the tip of the 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 a straw during the procedure.
    • —Advance tube to premeasured depth corresponding to gastric position of tip.
    • —Verify tube position by audible bubbling on auscultation over stomach when air injected into tube and/or abdominal flat plate x-ray (Figure 43-5).
    • —Secure nasogastric tube (NG) tube to nose with tape.
  • ▪  Complications:
    • —Epistaxis
    • —Perforation of cribriform plate
    • —Esophageal perforation
    • —Tracheal intubation with NG tube (Figure 43-6)
    • —Pneumothorax

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Figure 43-1.
Graphic Jump Location

Nasoenteral feeding tube.

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Figure 43-2.
Graphic Jump Location

Fluoroscope for positioning.

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Figure 43-3.
Graphic Jump Location

Nasal tube prior to insertion.

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Figure 43-4.
Graphic Jump Location

Insertion of nasoenteric tube into nose.

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Figure 43-5.
Graphic Jump Location

Abdominal x-ray showing post-pyloric position of feeding tube tip.

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Figure 43-6.
Graphic Jump Location

Chest x-ray showing feeding tube in right lower lobe.

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Clinical Pearls and Pitfalls

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  • ▪  When the tube is positioned in stomach but the tip cannot be advanced manually past pyloric valve, a promotility agent such as erythromycin may ...

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