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Transcript

Nasogastric

Tube

Chelsea Kumabe OMSIII

Indications:

The Basics of NGT

Can you think of any complications from the placement of the NGT?

  • Tx of ileus or bowel obstruction
  • Administration of meds
  • Enteral nutrition (either gastric or post-pyloric feeding)
  • Stomach lavage

Contraindications:

  • Pt with esophageal strictures
  • Pt with basilar skull fracture or facial fracture
  • Pt with esophageal varices

NGT Placement

Confirmation of placement

  • Radiographic: CXR
  • always before tubes used for formula or meds, less necessary for GI decompression
  • children, infants, intubated patients
  • Clinical Confirmation:
  • once tube is placed, then main lumen is aspirated showing gastric contents
  • auscultation for air from tube

Tips and Specifics for Patients

  • Alert Patient: can assist you in drinking water, may consider local anesthetic spray*

  • Intubated Patient: consider avoid blind NGT placement due to risk of improper placement

*Gallagher, EJ. Nasogastric tubes: hard to swallow. from Ann Emerg Med. 2004. Aug; 44(2): 138-41.

(Discusses nebulized lidocaine decreases the discomfort of nasogastric tube insertion: a randomized double-blind trial

  • Even though patients without NGT has increased vomiting and abdominal distention, other parameters improved (fever, atelectasis, pneumonia, decreased days in advancing diet)

"A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy." Cheatham ML, Chapman WC, Key SP, Sawyers JL. Ann Surg. 1995

Shift away from NGT

  • Prophylactic placement for gastric decompression s/p surgeries:
  • "Routine nasogastric tubes are not required following cystectomy with urinary diverse: a comparative analysis of 430 patients" Inman BA, J Urology 2003.
  • NGT prolonged GI recovery, hence cannot leave hospital
  • "Meta-analysis of the need for nasogastric or nasojejunal decompression after gastrectomy for gastric cancer." Yang Z, Zheng Q, Wang Z. Br J Surg 2008.
  • Time to oral diet was shorter in patients with no decompression
  • "Omission of nasogastric tube application in postoperative care of esophagectomy." Daryaei P et al. World J Surg 2009.
  • Incidence of anastomosis leak was significantly higher in NG-tube group

Changing standards of care

Other Uses:

  • Gastric Lavage: previously used in routine treatment of poisoning, also used to evaluate hematochezia when no hematemesis
  • Enteral Nutrition: was often used even after GI decompression is D/C to deliver meds or enteral nutrition

Gastrointestinal:

Gastrointestinal:

Continued

  • Esophageal Sphincter:
  • NGT impairs normal function of lower esophageal sphincter
  • May cause esophagitis, GI bleed, pulmonary aspiration, GERD
  • May consider PPIs
  • GI bleed noted when blood is noted or guiac positive test
  • Esophageal bezoar
  • Malposition
  • Coiling or knotting
  • Locations: pharynx, pyriform sinus, esophagus, stomach, duodenum
  • Endoscopy or fluoroscopy may be used to remove a knotted tube

Nose:

Pulmonary:

  • Nasal alar ulceration or necrosis:
  • improperly securring the tube or too large of tube
  • frequent re-taping may help decrease pressure
  • Aspiration PNA
  • Improper placement into the bronchial tree
  • Tracheal perforation
  • Pneumothorax

Complications of NGT

The NG Tube was invented by Abraham Louis Levin M.D., published in JAMA in 1921 "A new gastroduodenal catheter".

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