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Nasogastric Intubation

  • Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Vikram Kate, MBBS, PhD, MS, FRCS, FRCS(Edin), FRCS(Glasg), FACS, FACG, FIMSA, MAMS, MASCRS  more...
 
Updated: Jul 26, 2016
 

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:

  • Evaluation of upper gastrointestinal (GI) bleeding (ie, presence, volume)
  • Aspiration of gastric fluid content
  • Identification of the esophagus and stomach on a chest radiograph
  • Administration of radiographic contrast to the GI tract

Therapeutic indications for NG intubation include the following:

  • Gastric decompression, including maintenance of a decompressed state after endotracheal intubation, often via the oropharynx
  • Relief of symptoms and bowel rest in the setting of small-bowel obstruction
  • Aspiration of gastric content from recent ingestion of toxic material
  • Administration of medication
  • Feeding
  • Bowel irrigation
  • 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:

  • Severe midface trauma
  • Recent nasal surgery

Relative contraindications for NG intubation include the following:

  • Coagulation abnormality
  • Esophageal varices (usually, a Sengstaken-Blakemore tube is introduced, but an NG tube can be used for lower-grade varices) or stricture
  • Recent banding of esophageal varices
  • Alkaline ingestion (the tube may be kept if the injury is not severe)
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Contributor Information and Disclosures
Author

Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC

Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association

Disclosure: Nothing to disclose.

Coauthor(s)

Nirav R Shah, MD, MPH SVP and COO, Kaiser Permanente Southern California

Nirav R Shah, MD, MPH is a member of the following medical societies: American College of Physicians, New York Academy of Medicine, Society of General Internal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center

Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Vikram Kate, MBBS, PhD, MS, FRCS, FRCS(Edin), FRCS(Glasg), FACS, FACG, FIMSA, MAMS, MASCRS Professor of General and Gastrointestinal Surgery and Senior Consultant Surgeon, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), India

Vikram Kate, MBBS, PhD, MS, FRCS, FRCS(Edin), FRCS(Glasg), FACS, FACG, FIMSA, MAMS, MASCRS is a member of the following medical societies: American College of Gastroenterology, American College of Surgeons, American Society of Colon and Rectal Surgeons, Royal College of Surgeons of England, Royal College of Physicians and Surgeons of Glasgow, Royal College of Surgeons of Edinburgh

Disclosure: Nothing to disclose.

Additional Contributors

Andrew K Chang, MD Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center

Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
  1. Cullen L, Taylor D, Taylor S, Chu K. Nebulized lidocaine decreases the discomfort of nasogastric tube insertion: a randomized, double-blind trial. Ann Emerg Med. 2004 Aug. 44(2):131-7. [Medline].

  2. Ducharme J, Matheson K. What is the best topical anesthetic for nasogastric insertion? A comparison of lidocaine gel, lidocaine spray, and atomized cocaine. J Emerg Nurs. 2003 Oct. 29(5):427-30. [Medline].

  3. Middleton RM, Shah A, Kirkpatrick MB. Topical nasal anesthesia for flexible bronchoscopy. A comparison of four methods in normal subjects and in patients undergoing transnasal bronchoscopy. Chest. 1991 May. 99(5):1093-6. [Medline].

  4. West HH. Topical anesthesia for nasogastric tube placement. Ann Emerg Med. 1982 Nov. 11(11):645. [Medline].

  5. Wolfe TR, Fosnocht DE, Linscott MS. Atomized lidocaine as topical anesthesia for nasogastric tube placement: A randomized, double-blind, placebo-controlled trial. Ann Emerg Med. 2000 May. 35(5):421-5. [Medline].

  6. Uri O, Yosefov L, Haim A, Behrbalk E, Halpern P. Lidocaine gel as an anesthetic protocol for nasogastric tube insertion in the ED. Am J Emerg Med. 2011 May. 29(4):386-90. [Medline].

  7. Santos SC, Woith W, Freitas MI, Zeferino EB. Methods to determine the internal length of nasogastric feeding tubes: An integrative review. Int J Nurs Stud. 2016 Jun 15. 61:95-103. [Medline].

  8. Fan L, Liu Q, Gui L. Efficacy of Non-swallow Nasogastric Tube Intubation: a Randomized Controlled Trial. J Clin Nurs. 2016 May 24. [Medline].

  9. Bennetzen LV, Håkonsen SJ, Svenningsen H, Larsen P. Diagnostic accuracy of methods used to verify nasogastric tube position in mechanically ventilated adult patients: a systematic review. JBI Database System Rev Implement Rep. 2015 Feb 13. 13 (1):188-223. [Medline].

  10. Chun DH, Kim NY, Shin YS, Kim SH. A randomized, clinical trial of frozen versus standard nasogastric tube placement. World J Surg. 2009 Sep. 33(9):1789-92. [Medline].

  11. Moharari RS, Fallah AH, Khajavi MR, Khashayar P, Lakeh MM, Najafi A. The GlideScope facilitates nasogastric tube insertion: a randomized clinical trial. Anesth Analg. 2010 Jan. 110(1):115-8. [Medline].

  12. Bourgault AM, Halm MA. Feeding tube placement in adults: safe verification method for blindly inserted tubes. Am J Crit Care. 2009 Jan. 18(1):73-6. [Medline].

  13. Metheny NA, Stewart BJ, Mills AC. Blind insertion of feeding tubes in intensive care units: a national survey. Am J Crit Care. 2012 Sep. 21(5):352-60. [Medline].

  14. Appukutty J, Shroff PP. Nasogastric tube insertion using different techniques in anesthetized patients: a prospective, randomized study. Anesth Analg. 2009 Sep. 109(3):832-5. [Medline].

  15. Reichman EF, Simon RR, eds. Emergency Medicine Procedures. Columbus, OH: McGraw-Hill Professional; 2004.

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Equipment for nasogastric intubation.
Aspiration of viscous lidocaine into a syringe.
Instillation of viscous lidocaine 2%.
Estimation of nasogastric tube length from nostril to stomach.
Nasogastric tube lubrication with water-based lubricant.
Patient flexing his neck and drinking water while a nasogastric tube is inserted.
Auscultation over the stomach.
Secured nasogastric tube.
Nasogastric tube in lung.
Nasogastric tube insertion.
 
 
 
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