Chapter 42. Nasogastric Tube Insertion

Introduction

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

Definitions and Terms

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

Techniques

• ▪  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

Clinical Pearls and Pitfalls

• ▪  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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