Chapter 43. Nasoduodenal Feeding Tube

Introduction

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.

Definitions and Terms

• ▪  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.

Techniques

• ▪  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

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 duodenum.
• ▪  Nasoduodenal feeds ...