Overview
Background
Gastric intubation via the nasal passage (ie, the nasogastric route) is a common procedure that provides access to the stomach for diagnostic and therapeutic purposes. A nasogastric (NG) tube is used for the procedure. The placement of an NG tube can be uncomfortable for the patient if the patient is not adequately prepared with anesthesia to the nasal passages and specific instructions on how to cooperate with the operator during the procedure.
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Indications
Diagnostic indications for NG intubation include the following:
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Evaluation of upper gastrointestinal (GI) bleeding (ie, presence, volume)
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Aspiration of gastric fluid content
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Identification of the esophagus and stomach on a chest radiograph
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Administration of radiographic contrast to the GI tract
Therapeutic indications for NG intubation include the following:
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Gastric decompression, including maintenance of a decompressed state after endotracheal intubation, often via the oropharynx
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Relief of symptoms and bowel rest in the setting of small-bowel obstruction
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Aspiration of gastric content from recent ingestion of toxic material
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Administration of medication
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Feeding
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Bowel irrigation
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NG tube can be kept following corrosive ingestion for the development of a tract in the esophagus that subsequently can be used for balloon dilatation
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Contraindications
Absolute contraindications for NG intubation include the following:
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Severe midface trauma
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Recent nasal surgery
Relative contraindications for NG intubation include the following:
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Coagulation abnormality
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Esophageal varices (usually, a Sengstaken-Blakemore tube is introduced, but an NG tube can be used for lower-grade varices) or stricture
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Recent banding of esophageal varices
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Alkaline ingestion (the tube may be kept if the injury is not severe)
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Media Gallery
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Equipment for nasogastric intubation.
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Aspiration of viscous lidocaine into a syringe.
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Instillation of viscous lidocaine 2%.
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Estimation of nasogastric tube length from nostril to stomach.
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Nasogastric tube lubrication with water-based lubricant.
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Patient flexing his neck and drinking water while a nasogastric tube is inserted.
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Auscultation over the stomach.
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Secured nasogastric tube.
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Nasogastric tube in lung.
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Nasogastric tube insertion.
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