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Nasogastric Intubation

Assess indications and explain procedure to patient/family. A specific surgical consent is not generally obtained.

Indications:

1.        Removing stomach contents

A. Diagnostic

GI bleeding

Penetrating or blunt trauma

B. Therapeutic

Paralytic ileus

Gastric dilatation

Intestinal obstruction Persistent vomiting

Removal of toxins and pill fragments

Heating or cooling for temperature abnormalities

C. Prophylactic

Decompression prior to abdominal surgery or peritoneal lavage

Prevention of aspiration in multiple trauma

2. Instillation of materials

Medications, feedings, contrast, charcoal

Contraindications:

(Note: varices are not a contraindication)

Equipment:

1.        Salem sump tube of appropriate size

2.        Suction apparatus

3.        Cup of water with straw (for cooperative patients)

4.        2% Lidocaine gel, small syringe

5.        Lubricant

6. Tape, benzoin

7. Nasal decongestant (optional)

Procedure:

1. Position patient: fully sitting if awake; supine wlneck flexion if comatose

2. Inspect nares for obstruction; apply nasal decongestant and anesthetic to nasal mucosa, pharynx

3.  Estimate tube insertion length: ear-nose-xiphoid, mark wltape (Fig. 1)

4.  Pass lubricated tube along floor of nose (Fig. 2)

5. Ask patient to sip water, advance tube quickly with swallowing

6. Confirm placement by auscultation over stomach, aspiration of gastric contents,

or by x-ray in comatose patients.

 

 

7. Secure with tape (Fig. 3)

 

 

 

 

Complications: Prevention and Management

 

Complication:

Prevention:

Management:

Inability to insert tube into the naris due to resistance:

Topical vasoconstriction

Try other naris; a smaller caliber tube; or consider oral gastric intubation.

Nasal bleeding:

Topical vasoconstrictor.

Rule out coagulopathy.

Local pressure.

Consider oral gastric intubation.

Excessive gagging:

Topical anesthetic.

 

Coiling of the tube in the oral cavity:

Mild neck flexion; stiffening of the tube tip by cooling in ice.

Partially withdraw, and again encourage patient to swallow.

Tracheal intubation:

 

Withdraw and re-advance with slight neck flexion.

Reflux of gastric contents into the vent lumen:

Do not clamp vent lumen.

Flush vent lumen with a syringe filled with air.

Bronchial placement:

Radiologic exam is mandatory in comatose patients.

Remove and replace.

Obstruction of tubes used for instillation:

Only liquids should be administered, followed by 30 -50cc water flush.

Attempt to flush with 50cc water.

 

Documentation:

A note should be placed in the medical record as to the indications for NG tube

placement as well as a lack of contraindications. The note should indicate whether complications occurred and how they were managed.

 

General Items for Evaluation:

         Understands indications/contraindications

         Educates/prepares patient

         Identifies proper landmarks

         Uses sterile techniques

         Performs procedure correctly

         Understands potential complications and their management

         Adequate documentation performed

 


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