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".