II. Indications
- Reduces Stomach distention
- Reduces risk of aspiration (but does not eliminate aspiration risk)
- Prolonged Positive Pressure Ventilation
III. Precautions
IV. Contraindications
- Cribriform plate Fracture (use Orogastric Tube instead)
- Maxillofacial Trauma
V. Preparation: Tube Size
- Size
- Child: 10-14 French
- Adult: 14-18 French
- NEX Method of estimating length
- Bridge of nose to earlobe to xyphoid process
- Note centimeter mark at this point of tube
- Scalzo method of estimating length
- Nasal Insertion Length: (0.25 x height in cm) + 13
VI. Preparation: Pre-medication
-
Topical Decongestant (decreases Epistaxis risk)
- Oxymetazoline (Afrin) 0.05% nasal spray or
- Phenylephrine (Neo-Synephrine) 0.5% nasal spray
- Topical Anesthesia options
- Anxiolysis
- Midazolam 2 mg IV before procedure
- Significantly reduces pain with the procedure and eases placement
- Although 1 mg was also trialed in age over 60 years old, it was not effective
- Manning (2016) Acad Emerg Med 23(7):766-71 +PMID:26990304 [PubMed]
- Midazolam 2 mg IV before procedure
VII. Protocol: Discontinuing in Resolving Ileus (Adults)
- Instill Milk of Magnesia 3 ounces via NG tube
- Clamp Nasogastric Tube for 8 hours
- Unclamp tube and aspirate residual Stomach contents
- Discontinue NG tube if Residual Volume <120 cc
- Stomach normally secretes several liters in a day
- Small Residual Volume suggests adeguate drainage
VIII. Causes: Blood in gastric aspirate
- Upper gastrointestinal Hemorrhage
- Oropharyngeal blood (swallowed)
- Traumatic insertion
- Upper Gastrointestinal Tract injury (from insertion)
IX. Complications: Nasogastric or nasoduodenal Feeding Tubes
-
General
- Self-Extubation (common)
- Increased secretions and need for suctioning
- Increased need for repositioning
- Clogged or kinked Feeding Tube
- Secondary mechanical obstruction from Feeding Tube (pylorus obstruction or Small Bowel Obstruction)
- Nasopharyngeal Trauma
- Epistaxis
- Otitis Media
- Sinusitis
- Nasopharyngeal erosions
- Trachea, Bronchi and lung
- Post-cricoid perichondritis
- Misdirected tube into airway (with risk of infusion directly into lung)
- Tracheoesophageal fistula
- Pneumothorax
- Gastric aspiration with secondary pneumonitis
- Lung Abscess
- Tracheobronchial perforation
- Airway obstruction
- Esophagus
- Esophageal bleeding
- Esophageal or duodenal perforation
- Esophageal Stricture
- Esophagitis or Esophageal reflux
- Rupture of Esophageal Varices