Nasogastric intubation
Nasogastric intubation | |
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ICD-9-CM | 96.07, 96.6 |
Nasogastric intubation is a medical process involving the insertion of a plastic tube (nasogastric tube or NG tube) through the
Uses
A nasogastric tube is used for feeding and administering drugs and other oral agents such as
Nasogastric aspiration (suction) is the process of draining the stomach's contents via the tube. Nasogastric aspiration is mainly used to remove gastrointestinal secretions and swallowed air in patients with
If the tube is to be used for continuous drainage, it is usually appended to a collector bag placed below the level of the patient's stomach; gravity empties the stomach's contents. It can also be appended to a suction system, however this method is often restricted to emergency situations, as the constant suction can easily damage the stomach's lining. In non-emergency situations, intermittent suction is often applied giving the benefits of suction without the untoward effects of damage to the stomach lining.[4]
Suction drainage is also used for patients who have undergone a pneumonectomy in order to prevent anesthesia-related vomiting and possible aspiration of any stomach contents. Such aspiration would represent a serious risk of complications to patients recovering from this surgery.
Types
Types of nasogastric tubes include:
- Levin catheter, which is a single lumen, small bore NG tube. It is more appropriate for administration of medication or nutrition.[5] This type of catheter tends to be more prone to suctioning against the stomach lining, which can cause damage and interfere with future function of the tube.[4]
- Salem Sump catheter, which is a large bore NG tube with double lumen. This avails for aspiration in one lumen, and venting in the other to reduce negative pressure and prevent gastric mucosa from being drawn into the catheter.[5]
- Dobhoff tube, which is a small bore NG tube with a weight at the end intended to pull it by gravity during insertion. The name "Dobhoff" refers to its inventors, surgeons Dr. Robert Dobbie and Dr. James Hoffmeister, who invented the tube in 1975.[6]
Materials
Nasogastric tubes are available in a variety of different materials, each with their own unique properties.
- Polypropylene - This material is most common. It is less likely to kink, which can be beneficial for placement, but its rigidity makes it less suitable to be used for long term feeding.[4]
- Latex - These tubes tend to be thicker and can be difficult to place without proper lubrication. Latex tends to break down at faster rates compared to other materials. Allergies to latex are relatively common and latex tubes are more likely to be recognized as a foreign object by the body.[4]
- Silicone - Especially useful in patients with known latex allergies. Silicone tubes tend to be thinner and more pliable. This can be useful in some situations but can also be more prone to rupture under stress.[4]
Technique
Before an NG tube is inserted, it must be measured from the tip of the patient's nose, loop around their ear and then down to roughly 3–5 cm (1–2 in) below the
Another securement device is a nasal bridle, or a device that enters one nare, around the nasal septum, and then to the other nare where it is secured in place around the nasogastric tube. There are two ways a bridle is put into place. One method, according to the Australian Journal of Otolaryngology, is performed by a physician to pull a material through the nares and then tied with the ends shortened to prevent removal of the tube.[8] The other method is a device called the Applied Medical Technology, or AMT, bridle. This device uses a magnet inserted into both nares that connects at the nasal septum and then pulled through to one side and tied. This technology allows nurses to safely apply bridles.[8] Several studies have proven the use of a nasal bridle prevents the loss of the NG placement that provides necessary nutrients or suctioning. A study conducted in the UK from 2014 through 2017, determined that 50% of feeding tubes secured with tape were lost inadvertently.[9] The use of bridle securement decreased the percentage of NGs lost from 53% to 9%.[9]
Great care must be taken to ensure that the tube has not passed through the
Only smaller diameter (12
Function of an NG tube properly placed and used for suction is maintained by flushing. This may be done by flushing small amounts of saline and air using a syringe[12] or by flushing larger amounts of saline or water, and air, and then assessing for the air to circulate through one lumen of the tube, into the stomach, and out the other lumen. When these two techniques of flushing were compared, the latter was more effective.[13]
Contraindications
The use of nasogastric intubation is
Alternative measures, such as an orogastric intubation, should be considered under these circumstances, or if the patient will be incapable of meeting their nutritional and caloric needs for an extended time period (usually >24 hours).[citation needed]
Complications
Complications with nasogastric intubation can occur due to incorrect initial placement of the nasogastric tube or due to changes in tube position that go unrecognized. Nasogastric tubes mistakenly placed in the trachea or lungs can lead to aspiration of enteral feeds or medications administered through the NG tube. This can also lead to pneumothorax or pleural effusion, which often requires a chest tube to drain.[14][4] Nasogastric tubes can also be mistakenly placed within the intracranial space; this is more likely to occur in patient who already have specific types of skull fractures.[4]
Other complications include clogged or nonfunctional tubes, premature removal of the tube, erosion of the nasal mucosa, esophageal perforation esophageal reflux, nose bleeds, sinusitis, sore throat and gagging.[14][4]
See also
- Force feeding
- Feeding tube
References
- ^ "Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition". NICE. August 2017. Retrieved 30 January 2018.
- ^ S2CID 220046454.
- ^ Mulholland, Michael W., Lillemoe, Keith D., Doherty, Gerard M., Upchurch, Gilbert R., Alam, Hasan B., Pawlik, Timothy M. eds. Greenfield's Surgery: Scientific Principles and Practice. 6th Edition. Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103:Lippincott Williams & Wilkins; 2017.
- ^ ISBN 978-0-323-35478-3.
- ^ a b Nasogastric Tube. Last authored: Dec 2009, David LaPierre
- ISBN 978-1-4511-5324-8.
- PMID 26990304.
- ^ .
- ^ S2CID 52917586.
- PMID 8992337.
- ^ "Confirmation of Nasogastric/Orogastric Tube (NGT/OGT) Placement". Cincinnati Children's Hospital Medical Center. August 22, 2011.
- ISBN 978-0-323-06805-5.
- PMID 26617465.
- ^ PMID 33439952.
- ^ Aitken, Peter (29 April 2022). "Health tech company in talks with FDA about device that may have caused injury, death". foxnews.com. Retrieved 28 November 2022.
- ^ "Avanos Medical Recalls Cortrak*2 Enteral Access System for Risk of Misplaced Enteral Tubes Could Cause Patient Harm". fda.gov. Retrieved 28 November 2022.