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.
- ▪ 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
- ▪ Indications:
- —Long-term enteral feeding in a patient who
requires total or supplementary enteral feeding, and for whom gastric
feeding is inappropriate.
- ▪ Contraindications:
- —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
- ▪ Complications:
- —Perforation of cribriform plate
- —Esophageal perforation
- —Tracheal intubation with NG tube (Figure 43-6)
Nasoenteral feeding tube.
Fluoroscope for positioning.
Nasal tube prior to insertion.
Insertion of nasoenteric tube into nose.
Abdominal x-ray showing post-pyloric position of feeding
Chest x-ray showing feeding tube in right lower lobe.
Clinical Pearls and Pitfalls
- ▪ When the
tube is positioned in stomach but the tip cannot be advanced manually
past pyloric valve, a promotility agent such as erythromycin may
be administered to encourage gastric propulsion of tube tip into
- ▪ Nasoduodenal