Nasogastric Intubation

Nasogastric intubation is a process that involves insertion of the nasogastric tube into the nose down to the stomach. Nasogastric tubes are long, thin, rubberize or plastic tubes with holes at the ends.

There are several types of nasogastric tubes available depending on the purpose, length, and expected duration of use.

• Levin tube – or also referred to as lumen is made up of plastic where the endings are composed of several holes used for drainage. There are several markings in the lumen to help determine how far the tube goes. This tube is most helpful in suctioning and instilling materials in and out of the stomach.

• Salem-Sump tube – is a two-lumen type of equipment which is composed of a drainage tube and another small tube which is exposed into the atmosphere. This type of tube can be used with continuous suction compared to the other tubes because of the continuous airflow that helps reduce drawing up of stomach contents.

• Miller-Abbott tube – is also a two-lumen type of equipment where at one end has a rubberize balloon and the other tip has holes. The tube has two openings; one used for suctioning and the other used to inflate the balloon. When the tube is inside the stomach, the balloon will be inflated with air to help the tube move along the intestinal tract.

• Cantor tube – it consists of a lumen and a bag on the other end. Mercury is injected into the bag where it helps the tube in moving along the intestinal tract. It is most effective when used as intestinal decompressor.

Uses of Nasogastric Intubation

Nasogastric intubation has many use, they are:

• Used to remove stomach contents especially in cases of food poisoning and pyloric obstruction

• Used for feeding patients who have difficulty in swallowing or for unconscious patients

• Used to administer drugs to patients who are unable to take the drugs successfully

• Used to take fluid samples from the stomach for gastric analysis

• Used as gastrointestinal decompression for SBO drainage, prolong nausea, postop state, ileus

Contraindications of using Nasogastric Intubation

Some certain circumstances inhibit patients from using nasogastric intubation. The following are some of these situations:

• Facial fractures especially those suspected with cribriform plate injuries

• Obstruction in the nasopharyngeal or in the upper esophageal

• Severe skull fractures or maxillofacial trauma

• Severe case of uncontrolled coagulopathy

• Nasal stenosis, astresia, mass

• Comatose patients specifically those with unprotected airways

• Patients known with tracheo- esophageal fistula and esophageal stricture

Complications from Nasogastric Intubation

Nasogastric tubes are easily inserted and removed but there are certain complications associated with nasogastric intubation. Minor complications include sinusitis, nose bleeds, and sore throat.

Other significant complications while inserting or extubating are:

• Nasal trauma

• Gastric trauma

• Nasotracheal intubation

• Mucosal damage

• Entrapment

• Laryngotracheal obstruction

• Intra-cranial penetration

Complications while using nasogastric intubation include:

• Pulmonary aspiration

• Mucosal injury

• Gastroesophageal reflux

• Chronic irritation

• Gastrointestinal bleeding.

Preparation for the Procedure

Before patients undergo nasogastric intubation, they are advised not to eat or drink anything for several hours. While waiting for the patient’s consent it is important to explain the procedure, the process and its route for further understanding. Once the patient agrees with the procedure, he or she will be advised to sit in an upright position or elevate the head of the bed for a lesser risk of aspiration. Next is to check for any nasal obstruction by letting the patients inhale and exhale briskly at each nostril. Then the doctor will test the patient’s gag reflex because patients with difficulties in gagging are at high risk of acquiring pulmonary aspiration.

Procedure for Nasogastric Intubation

The following are the steps done during nasogastric intubation procedure.

1. Estimate the tube and make sure that the tip should have at least 40-50 cm.

2. Soften the tube by wetting its tip in warm water.

3. Lubricate and examine the tube for any rough edges and blocked holes.

4. While tilting the patient’s head down, push the tubes gently through the nose floor.

5. While the tubes are passing through the esophagus, patients are asked to take deep breaths while making swallowing movements or sipping a little water to assist the passage.

6. To confirm if the tube has reached the stomach, an aspiration of gastric content or checking of the pH level is done. In some cases verification through radiology is necessary to confirm placement of tube especially for comatose patients.

7. If the location is correct, the tube will be advanced to at least 60 cm before applying tape tube to the nose and tincture of benzoin.

Risks while having  Nasogastric Intubation

The use of nasogastric intubation has its own risks. A possibility of injury, bleeding, or infection might occur along the tube’s passage way. In some cases the tube might enter a wrong place which may cause more problems; while certain medications might create allergic reactions.

Great care should be taken while performing nasogastric intubation especially for unconscious patients, or those with convulsions or uncontrollable bleeding, and individuals who have large esophageal varices.