eMedicine Specialties > Clinical Procedures > Gastrointestinal Procedures

Nasogastric Tube

Author: Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Coauthor(s): Nirav R Shah, MD, MPH, Assistant Professor and Associate Director for Research, Division of General Internal Medicine, New York University, School of Medicine; Associate Investigator, Center for Health Research, Geisinger Health
Contributor Information and Disclosures

Updated: Nov 9, 2009

Introduction

Gastric intubation via the nasal passage (ie, 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.

Indications

  • Diagnostic
    • Evaluation of upper gastrointestinal (GI) bleed (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

    • 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

Contraindications

  • Absolute contraindications
    • Severe midface trauma
    • Recent nasal surgery
  • Relative contraindications
    • Coagulation abnormality
    • Esophageal varices or stricture
    • Recent banding or cautery of esophageal varices
    • Alkaline ingestion

More on Nasogastric Tube

Overview: Nasogastric Tube
Treatment & Medication: Nasogastric Tube
Multimedia: Nasogastric Tube
References
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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. Aug 2004;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. Oct 2003;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. May 1991;99(5):1093-6. [Medline].

  4. West HH. Topical anesthesia for nasogastric tube placement. Ann Emerg Med. Nov 1982;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. May 2000;35(5):421-5. [Medline].

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

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

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

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

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Further Reading

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Keywords

nasogastric tube, NG tube insertion, pass NGT, pass NG tube, NGT insertion, NGT, NG tube, NG intubation, nasogastric intubation, gastric intubation, nasal intubation, nasogastric route

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Contributor Information and Disclosures

Author

Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Gil Z Shlamovitz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Nirav R Shah, MD, MPH, Assistant Professor and Associate Director for Research, Division of General Internal Medicine, New York University, School of Medicine; Associate Investigator, Center for Health Research, Geisinger Health
Nirav R Shah, MD, MPH is a member of the following medical societies: American College of Physicians, New York Academy of Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Medical Editor

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, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Luis M Lovato, MD, Associate Clinical Professor, David Geffen School of Medicine at UCLA; 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, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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