- Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Vikram Kate, MBBS, PhD, MS, FRCS, FRCS(Edin), FRCS(Glasg), FACS, FACG, FIMSA, MAMS, MASCRS more...
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.
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
- 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
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)
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].
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].
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].
West HH. Topical anesthesia for nasogastric tube placement. Ann Emerg Med. 1982 Nov. 11(11):645. [Medline].
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].
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].
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].
Fan L, Liu Q, Gui L. Efficacy of Non-swallow Nasogastric Tube Intubation: a Randomized Controlled Trial. J Clin Nurs. 2016 May 24. [Medline].
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].
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].
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].
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].
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].
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].
Reichman EF, Simon RR, eds. Emergency Medicine Procedures. Columbus, OH: McGraw-Hill Professional; 2004.