CHAPTER 15. NASOGASTRIC TUBE PLACEMENT
Indications124
Contraindications124
Equipment124
Practical procedure124
Post-procedure investigations127
Complications127
The modern nasogastric (NG) tube is a 1921 modification by John Alfred Ryle (1889–1950). He covered the tip of the NG tube with rubber to prevent injury to the gastric mucosa, unlike Previous tubes which had a metal bulb at their tip. However, the earliest recording of using a tube for enteral nutrition was that of the Seville-born Arab surgeon Ibn Zuhr (also known as Avenzoar, 1091–1161) who fed a patient with an oesophageal stricture via a silver tube. Incidentally Ibn Zuhr is also credited with the first correct description of performing a tracheotomy for suffocating patients.
INTRODUCTION
Nasogastric tube placement is a simple procedure, but can be unpleasant for the conscious patient. This is commonly performed by nursing staff; however, junior doctors would be expected to place them if these initial attempts are unsuccessful. Small-diameter (8–12 Fr) tubes are frequently used for patents who require enteral feeding. Larger tubes (14 Fr or larger) are used to administer medications, provide gastric decompression or allow continuous aspiration of retained gastric contents. These larger tubes are acceptable for feeding over a short period, usually less than 1 week. Small-bore NG tubes cause less trauma to the nasal mucosa both during insertion and while in situ, and are better tolerated. Placement errors lead to potentially major complications, most commonly when mistakenly placed in the respiratory tract. Failure to observe pathological states that constitute a contraindication to NG tube placement can result in passage of the tube into the brain (base of skull fracture) or peritoneum (upper GI perforation).
INDICATIONS
WIDE-BORE NASOGASTRIC TUBES
• Bowel obstruction.
• Gastric outlet obstruction.
FINE-BORE NASOGASTRIC TUBES
• Enteric feeding.
CONTRAINDICATIONS
• Coagulopathy (a relative contraindication).
• Oesophageal varices.
• Maxillofacial and oropharyngeal trauma or surgery.
• Skull fractures.
• Unstable cervical spine injury.
• Laryngectomy.
• Compromised airway.
EQUIPMENT
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