Nasogastric intubation is a medical process involving the insertion of a plastic tube (nasogastric tube, NG tube) through the nose, past the throat, and down into the stomach.

Technique

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The end of the tube is lubricated and inserted into a nostril, it is then moved through the nasal cavity and down into the throat, often when the tube is in the throat the patient will gag, in this situation the patient is given water to drink and further advancement of the tube is commended as the patient swallows. Once the tube is past the larynx, it is rapidly inserted down into the stomach.

During the tube's insertion, great care must be taken to ensure that it has not passed through the windpipe and down into the lungs. To ensure proper placement it is recommended (though not unequivocally confirmed) that injection of air into the tube be performed, if the air is detected in the stomach with a stethoscope, then the tube is in the correct position. Another method is to aspirate fluid from the tube with a syringe. This fluid is then tested with pH paper (note not litmus paper) to determine the acidity of the fluid. If the pH is 5.5 or below then the tube is in the correct position. If this is not possible then correct verification of tube position is obtained with an xray of the chest/abdomen. If the tube is to remain in place then a tube position check is recommended before each feed and at least once per day.

Indications

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The main use of a nasogastric tube is for feeding and for administrating drugs and other oral agents (such as activated charcoal and radiographic contrast material). For drugs and for minimal quantities of liquid, a syringe is used for injection into the tube. For continuous feeding, a gravity based system is employed, with the solution placed higher than the patient's stomach. If accrued supervision is required for the feeding, the tube is often connected to an electronic pump which can control and measure the patient's intake and signal any interruption in the feeding.

Nasogastric aspiration (suction) is the process of draining the stomachs contents via the tube. Nasogastric aspiration is mainly used to remove gastric secretions and swallowed air in patients with gastrointestinal obstructions. Nasogastric aspiration can also be used in poisoning situations when a potentially toxic liquid has been ingested, for preparation before surgery under anaesthesia, and to extract samples of gastric liquid for analysis.

If the tube is to be used for continuous drainage, it is usually appended to a collector bag placed below the level of the patients 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 Britain, nasogastric tubes were used for the force feeding of prisoners who were on hunger strikes as a result of the Cat and Mouse Act.

Contraindications

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Nasogastric intubation is contraindicated in patients with facial trauma, esophageal abnormalities, and altered mental status or an impaired airway.

Complications

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Minor complications include nose bleeds, sinusitis, and a sore throat. Sometimes more significant complications occur including erosion of the nose where the tube is anchored, esophageal perforation, aspiration, a collapsed lung, or intracranial placement of the tube.

References

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Medical equipment | Enteral feeding