Nasogastric intubation
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2008-07-06T13:24:28Z
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'''Nasogastric intubation''' is a medical process involving the insertion of a plastic tube ('''nasogastric tube,''' ''' NG tube''') through the [[nose]], past the [[throat]], and down into the [[stomach]].
==Technique==
Before an NG tube is inserted, the Health Care Provider - most often the nurse, must measure with the tube from the tip of the patient's nose, to their ear and down to the [[xyphoid process]]. Then the tube is marked at this level to ensure that the tube has been inserted far enough into the patient's stomach. The end of a plastic tube is lubricated and inserted into one of the patient's anterior nares. It is then moved through the nasal cavity and down into the throat. Once the tube is past the [[pharynx]], it is rapidly inserted down into the stomach.
During the tube's insertion, the patient may gag; in this situation the patient is given water to drink, and the tube continues to be inserted as the patient swallows. Great care must be taken to ensure that it has not passed through the [[windpipe]] and down into the lungs. To ensure proper placement it is recommended (though not unequivocally confirmed) that injection of air into the tube be performed,<ref name=”NEnglJMed2006-Thomsen”>{{cite journal | author=Thomsen TW, Shaffer RW, Setnik GS. | title=Videos in clinical medicine. Nasogastric intubation | journal=N Engl J Med | year=2006 | pages=e16 | volume=354 | issue=17 | pmid=16641390 | doi=10.1056/NEJMvcm050183}}</ref> if the air is heard in the stomach with a stethoscope, then the tube is in the correct position. Another method is to aspirate fluid from the tube with a [[syringe]]. This fluid is then tested with [[PH indicator|pH paper]] (note not [[Litmus test (chemistry)|litmus paper]]) to determine the acidity of the fluid. If the pH is 5.5 or below then the tube is in the correct position. If this is not possible then correct verification of tube position is obtained with an [[X-ray]] of the chest/abdomen.This is the most reliable means of insuring proper placement of a NG tube.<ref name=”NEnglJMed1996-Thomas”>{{cite journal | author=Thomas B, Cummin D, Falcone RE. | title=Accidental pneumothorax from a nasogastric tube | journal=N Engl J Med | year=1996 | pages=1325 | volume=335 | issue=17 | pmid=8992337 | doi=10.1056/NEJM199610243351717}}</ref> If the tube is to remain in place then a tube position check is recommended before each feed and at least once per day.
==Uses==
The main use of a nasogastric tube is for feeding and for administering drugs and other oral agents (such as [[activated charcoal]] and radiographic contrast material). For drugs and for minimal quantities of liquid, a syringe is used for injection into the tube. For continuous feeding, a [[gravity]] based system is employed, with the solution placed higher than the patient's stomach. If accrued supervision is required for the feeding, the tube is often connected to an electronic pump which can control and measure the patient's intake and signal any interruption in the feeding.
Treatment for [[Superior Mesenteric Artery Syndrome]] or severe [[anorexia nervosa|anorexia]] can include nasogastric feeding to stabilize body weight.
Nasogastric aspiration (suction) is the process of draining the stomach's contents via the tube. Nasogastric aspiration is mainly used to remove gastric secretions and swallowed air in patients with gastrointestinal obstructions. Nasogastric aspiration can also be used in [[poisoning]] situations when a potentially toxic liquid has been ingested, for preparation before [[surgery]] under [[anesthesia]], and to extract samples of gastric liquid for analysis.
If the tube is to be used for continuous drainage, it is usually appended to a collector bag placed below the level of the patient's stomach; gravity empties the stomach's contents. It can also be appended to a suction system, however this method is often restricted to emergency situations, as the constant suction can easily damage the stomach's lining.
==Contraindications==
Nasogastric intubation is contraindicated (inadvisable) in patients with base of skull fractures, severe facial fractures especially to the nose and obstructed esophagus and/or obstructed airway.
==Complications==
Minor complications include [[nose bleed]]s, [[sinusitis]], and a sore throat. Sometimes more significant complications occur including erosion of the nose where the tube is anchored, [[esophageal perforation]], [[pulmonary aspiration]], a [[collapsed lung]], or intracranial placement of the tube.
==References==
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==See also==
*[[Force feeding]]
[[Category:Medical equipment]]
[[Category:Enteral feeding]]
[[Category:Medical treatments]]
[[es:Sonda nasogástrica]]