Nasogastric Tube insertion

Indication:

  • Aspiration of stomach contents to decompress the stomach of fluid, air, or blood.
  • Introducing fluids to the stomach such as charcoal, enteral feeding and oral contrast media.
  • Reducing the risk of vomiting or aspiration such as in bowel obstruction
  • Sometimes used to in still air into the stomach to detect a gastric perforation on erect CXR

Contraindications

  • Caustic ingestion or esophageal strictures (risk of perforation)
  • Coagulopathy (epistaxis risk)
  • Base of skull fracture
  • Severe mid-face trauma (risk of cribriform plate disruption with NGT entering the brain!)

Handy hints:

  • Coagulopathy or facial trauma, consider an orogastric tube placement.
  • Ameliorate the pain and gagging associated with tube placement by using vasoconstrictors (e.g. 0.05% oxymetolazine spray), topical anesthetics, and antiemetics — ALWAYS use these if time permits.
  • Withdraw the tube promptly into the oropharynx if the patient has excessive choking, gagging, coughing, a change in voice, or the appearance of condensation on the inner aspect of the tube
  • Suspect an esophageal location if the patient immediately burps upon insufflation when checking position.
  • Do not attempt to re-use a NGT that has already used for a failed insertion. Use a fresh tube from the fridge (the colder the better), as these are more rigid and less pliable, and are therefore easier to pass.
  • Nebulised lignocaine (4 mL of 10%) or lignocaine lubricating gel should be administered prior to insertion of the tube to reduce discomfort and increase patient compliance.
  • DO NOT use the NGT for any fluid administration until CXR confirmation of position.
  • If the tube continually curls up in the pharynx, flex the patient’s neck as much as possible and re-insert, which may change the angle sufficiently to pass an obstruction
  • Options if unable to place NGT (unconscious patient)
    • Use McGills forceps
    • Use ETT with a slit in the lesser curvature as guide
    • Use soft well lubricated NPA
    • Anterior manipulation of laryngeal cartilage
    • Fibreoptic scope placement using guidewire

Nasogastric tube images

Correct nasogastric placement

Coiled oesophageal nasogastric tube

NGT coiled in Hiatus Hernia

NGT in right main bronchus (RMB)

NGT in lateral ventricles

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