Gastric Catheterization

1. Indications
   1. Reduces Stomach distention
   2. Reduces risk of aspiration
   3. Prolonged Positive Pressure Ventilation
2. Contraindications
   1. Cribriform plate Fracture
   2. Maxillofacial trauma
3. Tube Measurement (estimating length)
   1. NEX Method
      1. Bridge of nose to earlobe to xyphoid process
      2. Note centimeter mark at this point of tube
   2. Scalzo method
      1. Nasal Insertion Length: (0.25 x height in cm) + 13
4. Preparation
   1. Topical Decongestant (decreases Epistaxis risk)
      1. Oxymetazoline (Afrin) 0.05% nasal spray or
      2. Phenylephrine (Neo-Synephrine) 0.5% nasal spray
   2. Topical Anesthesia options
      1. Lidocaine nasal spray 4% by atomizer
      2. Preservative-free Lidocaine 10% by nebulizer
         1. Lidocaine 10% 4 ml (400 mg total)
         2. Nebulize by face mask
         3. Do not use if Asthma history
      3. Combination 1: Lidocaine jelly, Cetacaine Spray
         1. Lidocaine 2% intranasal jelly
         2. Tetracaine-Benzocaine (Cetacaine) pharyngeal spray
      4. Combination 2: Lidocaine atomizer and jelly
         1. Preservative-free Lidocaine 4% by atomizer
            1. Spray 4% once in nostril (1.5 ml)
            2. Spray 4% twice at posterior pharynx (3 ml)
         2. Lidocaine 2% Jelly
            1. Sniff 5 ml Lidocaine into nostril and swallow
   3. References
      1. Gallagher (2004) Ann Emerg Med 44:138-41
5. Protocol: Discontinuing in Resolving Ileus (Adults)
   1. Instill Milk of Magnesia 3 ounces via NG tube
   2. Clamp Nasogastric Tube for 8 hours
   3. Unclamp tube and aspirate residual Stomach contents
      1. Discontinue NG tube if Residual Volume <120 cc
      2. Stomach normally secretes several liters in a day
      3. Small Residual Volume suggests adeguate drainage