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Nasogastric Tube

Indications:

  • Gastric decompression in cases of ileus, post-operative, unconscious patients, acute pancreatitis.
  • Enteral nutrition.
  • Irrigation and monitoring for gastrointestinal bleeding.
  • Tuberculosis (TB) diagnostics.

Complications:

  • Triggering vomiting, bleeding, tissue injury, vagal reactions, bradycardia.
  • Misplacement (tracheal insertion).
  • Kinking, clogging, or displacement of the tube.

Materials:

  • Plastic or silicone tube (10 – 14 Ch), lubricant with local anesthetic (e.g., Lidocaine gel, Lidocaine spray), adhesive strips (5 – 6 cm), kidney dish, gauze, gloves, bladder syringe, stethoscope, glass of water.

Procedure for Conscious Patients:

  1. Patient Preparation: Inform the patient and remove dentures if necessary.
  2. Positioning: The patient should be sitting up, with the head slightly inclined forward.
  3. Local Anesthesia: Apply Lidocaine spray to the throat and nasal area, then lubricate the tube and nostril with Lidocaine gel.
  4. Insertion: Insert the tube through the nose and gently advance it. The patient should swallow multiple times (encourage drinking water). The tube should reach the stomach after approximately 40 – 45 cm.
  5. Caution: If the patient experiences coughing or difficulty breathing (indicating possible tracheal intubation), immediately withdraw the tube.
  6. Position Check: Inject air with a bladder syringe. Auscultate the epigastrium and listen for a distinct “gurgling” sound.
  7. Fixation: Secure the tube to the nose with adhesive strips.

Note: For longer-term gastric tubes, monitor and replace lost electrolytes. If used for nutrition, no significant loss is expected.

Procedure for Unconscious, Intubated Patients:

  1. Positioning: Place the patient in a supine position.
  2. Lubrication: Lubricate the tube with gel and gently insert it through the nose.
  3. Handling Resistance: If resistance is felt in the mouth, withdraw the tube, rotate it slightly, and reinsert. If necessary, direct the tube towards the esophagus using a gloved finger at the back of the throat.
  4. Laryngoscopic Assistance: If resistance persists, consider inserting the tube under laryngoscopic guidance with a Magill forceps.
  5. Position Check and Fixation: Confirm the correct placement and secure the tube in place.