Diferencia entre revisiones de «Nasogastric tube placement»

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== Indications  ==
<languages/>
#Aspiration of stomach contents (poor sens and spec for UGI bleed)
<translate>
#Vomiting likely to be dangerous or recurrent
##Bowel obstruction
##Paralytic ileus
##Acute gastric dilatation
#Stomach decompression prior to surgery or peritoneal lavage


== Contraindications ==
==Indications==
#Facial fx involving cribriform plate


== Relative Contraindications ==
[[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]
#Severe Coagulopathy
[[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]]
#Gastric bypass and lap band procedures
[[File:Illu esophagus.jpg|thumb|Esophagus anatomy and nomenclature based on two systems.]]
#Esophageal strictures/hx of alkali ingestion
*Gastric decompression
**Post-[[Special:MyLanguage/intubation|intubation]]
**[[Special:MyLanguage/Bowel obstruction|Bowel obstruction]]/[[Special:MyLanguage/ileus|ileus]]
**[[Special:MyLanguage/acute gastric dilation|Acute gastric distension]]
*Aspiration of gastric contents
**Diagnosis/therapy of [[Special:MyLanguage/GI bleed|GI bleed]])
**Gastric lavage in [[Special:MyLanguage/Toxicology|acute poisonings]] (largely abandoned due to lack of efficacy)




== Equipment Needed  ==
==Contraindications==
#PPE including gown for practitioner and pt
#NG Tube- typically a 16F or 18F Sump
#Syringe/Bulb- 50-60cc
#Tape
#Emesis basin
#Towels
#Cup of water with straw


== Procedure ==
*Severe [[Special:MyLanguage/facial trauma|facial trauma]] (due to possible cribriform plate disruption)
#Inform pt of R/B/A
 
#Position pt upright
 
#Place towel over pt's gown and emesis basin in pt's lap
===Relative Contraindications===
 
*Severe [[Special:MyLanguage/coagulopathy|coagulopathy]]
*[[Special:MyLanguage/gastric bypass surgery|Gastric bypass]] and [[Special:MyLanguage/lap band complications|lap band procedures]]
*[[Special:MyLanguage/Esophageal varices|Esophageal varices]]/strictures
*History of [[Special:MyLanguage/caustic ingestion|alkali ingestion]]
 
 
==Equipment Needed==
 
*PPE
*NG Tube- typically a 16F or 18F Sump
*Syringe/Bulb - 50-60cc
*Tape
*Emesis basin
*Cup of water with straw
 
 
==Procedure==
 
[[File:ETTubeandNGtubeMarked.png|thumb|Nasogastric tube below the diaphragm and in the stomach in correct position as seen on [[Special:MyLanguage/CXR|CXR]] (bottom arrow).]]
#Consent by informing patient of risk, benefits, and alternatives
#Position patient upright
#Place towel over patient's gown and emesis basin in lap
#Estimate length of insertion
#Estimate length of insertion
##Measure from tip of nose to earlobe to xyphoid and then add 15cm.
#*A standard of 56cm is reasonable<ref>Phillips DE, Sherman IW, Asgarali S, and Williams RS. How far to pass a nasogastric tube? Particular reference to the distance from the anterior nares to the upper oesophagus. J R Coll Surg Edinb. 1994; 39(5):295-296.</ref>)
#*Alternatively measure from tip of nose to earlobe to xyphoid and then add 15cm
#Check nares for obstruction and pass through the most widely patent nare
#Check nares for obstruction and pass through the most widely patent nare
#Provide relief from discomfort
#Provide relief from discomfort
##Topical vasoconstrictors to both nares
#*Topical vasoconstrictors to both nares
###Oxymetazoline or phenylephrine
#**[[Special:MyLanguage/Oxymetazoline|Oxymetazoline]] or [[Special:MyLanguage/phenylephrine|phenylephrine]]
##Topical Anesthetics (5 min prior to procedure)
#*Topical Anesthetics (5 min prior to procedure)
###Benzocaine, tetracaine, nebulized lidocaine (4 or 10%), lidocaine jelly
#**[[Special:MyLanguage/Benzocaine|Benzocaine]], [[Special:MyLanguage/tetracaine|tetracaine]], nebulized [[Special:MyLanguage/lidocaine|lidocaine]] (4 or 10%), lidocaine jelly
###Anesthetize OP, as well, to prevent gagging
#**Anesthetize oropharynx, as well, to prevent gagging
##Antiemetics
#*Antiemetics
###Zofran and reglan 15 min prior may reduce gagging and nausea
#**[[Special:MyLanguage/Ondansetron|Ondansetron]] or [[Special:MyLanguage/metoclopramide|metoclopramide]] 15 min prior may reduce gagging and nausea
#Insert tube along floor of nose under inferior turbinate
#Insert tube along floor of nose under inferior turbinate
#Pause when NGT is in OP  
#Pause when NGT is in OP
#Flex the pt's neck to decrease chance of tracheal passage
#Flex neck to decrease chance of tracheal passage
#Advance into esophagus
#Advance into esophagus
##Having the pt sip water may aid in esphageal passage
#*Sipping water may aid in esophageal passage
##Withdraw to OP promptly if excessive coughing, gagging, choking or voice change
#*Withdraw to OP promptly if excessive coughing, gagging, choking or voice change
#Once NGT is in esophagus, rapidly insert rest of tube to premeasured length
#Once NGT is in esophagus, rapidly insert rest of tube to pre-measured length
#Confirm placement
#Confirm placement
##Insufflate air while listening over stomach
#*Insufflate air while listening over stomach
##Obtain radiograph
#**One study shows this discovers only 6% of malplacement<ref>Neumann MJ, Meyer CT, Dutton JL, et al. Hold that x-ray:  aspirate pH and auscultation prove enteral tube placement. J Clin Gastroenterol. 1995; 20(4):293-295.</ref>
##Check pH of aspirate (pH<4 there is a 95% chance the aspirate is gastric)
#**Should not be primary confirmation technique<ref>Christensen M. Bedside methods of determining nasogastric tube placement: a literature review. Nurs Crit Care. 2001; 6(4):192-199.</ref>
#*Obtain abdominal xray
#*Check pH of aspirate
#**pH<5.5 in 99% of cases and has sen of 0.78 and spec of 0.86 at or below this level<ref>Boeykens K, Steeman E, Duysburgh I. Reliability of pH measurement and the auscultatory method to confirm the position of a nasogastric tube. Int J Nurs Stud. 2014; 51(11):1427-1433.</ref>
#Secure to patients nose with tape
#Secure to patients nose with tape
#Attach to desired suction, not to exceed 120 mmHg
#Attach to desired suction, not to exceed 120 mmHg


== Complications  ==
#Pulmonary placement
#Intracranial placement
#Increased cervical and cranial pressures with gagging/vomiting
#Epistaxis
#Invagination of stomach lumen into eyes of ngt


== Source  ==
==Complications==
#Roberts: Clinical Procedures in EM, 5th ed
 
*Pulmonary placement
*Intracranial placement
*Increased cervical and cranial pressures with gagging/vomiting
*[[Special:MyLanguage/Epistaxis|Epistaxis]]
*Invagination of stomach lumen into eyes of NGT
 
 
==See Also==
 
*[[Special:MyLanguage/Upper gastrointestinal bleeding|Upper gastrointestinal bleeding]]
*[[Special:MyLanguage/Small bowel obstruction|Small bowel obstruction]]
*[[EBQ:Nasogastric aspiration and lavage in emergency department patients with hematochezia or melena without hematemesis|EBQ:Nasogastric aspiration and lavage in emergency department patients with hematochezia or melena without hematemesis]]
 
 
==External Links==
 
*[https://litfl.com/nasogastric-and-orogastric-tubes/ LITFL: Nasogastric and Orogastric Tubes]
*[https://www.merckmanuals.com/professional/gastrointestinal-disorders/how-to-do-gastrointestinal-procedures/how-to-insert-a-nasogastric-tube?query=nasogastric%20tube Merk Manual - How To Insert a Nasogastric Tube]
 
 
===Videos===
 
*Insertion
**Tulane (2:55) https://www.youtube.com/watch?v=1OakmxZDa5c
*Unclogging NG Tube:
**Providence Health (3:53) https://www.youtube.com/results?search_query=unclogging+g+tube+emergency+medicine
 
 
==References==
 
<references/>


[[Category:Procedures]] [[Category:GI]]
[[Category:Procedures]]
[[Category:GI]]
</translate>

Revisión actual - 23:47 4 ene 2026


Indications

Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.
Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.
Esophagus anatomy and nomenclature based on two systems.


Contraindications

  • Severe facial trauma (due to possible cribriform plate disruption)


Relative Contraindications


Equipment Needed

  • PPE
  • NG Tube- typically a 16F or 18F Sump
  • Syringe/Bulb - 50-60cc
  • Tape
  • Emesis basin
  • Cup of water with straw


Procedure

Nasogastric tube below the diaphragm and in the stomach in correct position as seen on CXR (bottom arrow).
  1. Consent by informing patient of risk, benefits, and alternatives
  2. Position patient upright
  3. Place towel over patient's gown and emesis basin in lap
  4. Estimate length of insertion
    • A standard of 56cm is reasonable[1])
    • Alternatively measure from tip of nose to earlobe to xyphoid and then add 15cm
  5. Check nares for obstruction and pass through the most widely patent nare
  6. Provide relief from discomfort
  7. Insert tube along floor of nose under inferior turbinate
  8. Pause when NGT is in OP
  9. Flex neck to decrease chance of tracheal passage
  10. Advance into esophagus
    • Sipping water may aid in esophageal passage
    • Withdraw to OP promptly if excessive coughing, gagging, choking or voice change
  11. Once NGT is in esophagus, rapidly insert rest of tube to pre-measured length
  12. Confirm placement
    • Insufflate air while listening over stomach
      • One study shows this discovers only 6% of malplacement[2]
      • Should not be primary confirmation technique[3]
    • Obtain abdominal xray
    • Check pH of aspirate
      • pH<5.5 in 99% of cases and has sen of 0.78 and spec of 0.86 at or below this level[4]
  13. Secure to patients nose with tape
  14. Attach to desired suction, not to exceed 120 mmHg


Complications

  • Pulmonary placement
  • Intracranial placement
  • Increased cervical and cranial pressures with gagging/vomiting
  • Epistaxis
  • Invagination of stomach lumen into eyes of NGT


See Also


External Links


Videos


References

  1. ↑ Phillips DE, Sherman IW, Asgarali S, and Williams RS. How far to pass a nasogastric tube? Particular reference to the distance from the anterior nares to the upper oesophagus. J R Coll Surg Edinb. 1994; 39(5):295-296.
  2. ↑ Neumann MJ, Meyer CT, Dutton JL, et al. Hold that x-ray: aspirate pH and auscultation prove enteral tube placement. J Clin Gastroenterol. 1995; 20(4):293-295.
  3. ↑ Christensen M. Bedside methods of determining nasogastric tube placement: a literature review. Nurs Crit Care. 2001; 6(4):192-199.
  4. ↑ Boeykens K, Steeman E, Duysburgh I. Reliability of pH measurement and the auscultatory method to confirm the position of a nasogastric tube. Int J Nurs Stud. 2014; 51(11):1427-1433.
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