II. Indications

  1. Reduces Stomach distention
  2. Reduces risk of aspiration (but does not eliminate aspiration risk)
  3. Prolonged Positive Pressure Ventilation

III. Precautions

  1. Nasogastric Tube placement can induce Nausea and Vomiting
    1. Functional equipment (e.g. yanker suction) for immediate suctioning should be available on NG placement
  2. Thick or semisolid gastric contents will not be suctioned by a Nasogastric Tube (with risk of Emesis)

IV. Contraindications

  1. Cribriform plate Fracture (use Orogastric Tube instead)
  2. Maxillofacial Trauma

V. Preparation: Tube Size

  1. Size
    1. Child: 10-14 French
    2. Adult: 14-18 French
  2. NEX Method of estimating length
    1. Bridge of nose to earlobe to xyphoid process
    2. Note centimeter mark at this point of tube
  3. Scalzo method of estimating length
    1. Nasal Insertion Length: (0.25 x height in cm) + 13

VI. Preparation: Pre-medication

  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
    5. References
      1. Gallagher (2004) Ann Emerg Med 44:138-41 [PubMed]
  3. Anxiolysis
    1. Midazolam 2 mg IV before procedure
      1. Significantly reduces pain with the procedure and eases placement
      2. Although 1 mg was also trialed in age over 60 years old, it was not effective
      3. Manning (2016) Acad Emerg Med 23(7):766-71 +PMID:26990304 [PubMed]

VII. 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

VIII. Causes: Blood in gastric aspirate

  1. Upper gastrointestinal Hemorrhage
  2. Oropharyngeal blood (swallowed)
  3. Traumatic insertion
  4. Upper gastrointestinal tract injury (from insertion)

IX. Complications: Nasogastric or nasoduodenal Feeding Tubes

  1. General
    1. Self-extubation (common)
    2. Increased secretions and need for suctioning
    3. Increased need for repositioning
    4. Clogged or kinked Feeding Tube
    5. Secondary mechanical obstruction from Feeding Tube (pylorus obstruction or Small Bowel Obstruction)
  2. Nasopharyngeal Trauma
    1. Epistaxis
    2. Otitis Media
    3. Sinusitis
    4. Nasopharyngeal erosions
  3. Trachea, Bronchi and lung
    1. Post-cricoid perichondritis
    2. Misdirected tube into airway (with risk of infusion directly into lung)
    3. Tracheoesophageal fistula
    4. Pneumothorax
    5. Gastric aspiration with secondary pneumonitis
    6. Lung Abscess
    7. Tracheobronchial perforation
    8. Airway obstruction
  4. Esophagus
    1. Esophageal bleeding
    2. Esophageal or duodenal perforation
    3. Esophageal Stricture
    4. Esophagitis or Esophageal reflux
    5. Rupture of Esophageal Varices

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Ontology: Nasogastric tube (C0085678)

Definition (UMD) Tubes designed to access the stomach through the nose, nasopharynx, and esophagus for examination, treatment, or other purposes. These devices typically consist of a single-lumen rubber or plastic tube of 14 to 18 French diameter with circular markings that serve as insertion guides; the tube is inserted through the nose, down the throat, and through the esophagus; its tip is positioned in the stomach. Nasogastric tubes can be used to remove air and liquids from the stomach (decompression) by connection to intermittent suction units and as temporary feeding tubes; they are used frequently for very ill or comatose patients. Nasogastric tubes are intended only for short-term use; keeping in place for more than two weeks can cause nasal septum necrosis. Dedicated tubes used for decompression, both single- and double-lumen, and small-bore tubes intended for feeding are also available.
Definition (NCI_NCI-GLOSS) A tube that is inserted through the nose, down the throat and esophagus, and into the stomach. It can be used to give drugs, liquids, and liquid food, or used to remove substances from the stomach. Giving food through a gastric feeding tube is a type of enteral nutrition.
Definition (SPN) A gastrointestinal tube and accessories is a device that consists of flexible or semi-rigid tubing used for instilling fluids into, withdrawing fluids from, splinting, or suppressing bleeding of the alimentary tract. This device may incorporate an integral inflatable balloon for retention or hemostasis. This generic type of device includes the hemostatic bag, irrigation and aspiration catheter (gastric, colonic, etc.), rectal catheter, sterile infant gavage set, gastrointestinal string and tubes to locate internal bleeding, double lumen tube for intestinal decompression or intubation, feeding tube, gastroenterostomy tube, Levine tube, nasogastric tube, single lumen tube with mercury weight balloon for intestinal intubation or decompression, and gastro-urological irrigation tray (for gastrological use).
Concepts Medical Device (T074)
SnomedCT 17102003
LNC LP7439-5, MTHU001087
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Spanish sonda nasogástrica (objeto físico), sonda nasogástrica, tubo nasogástrico