Elliot Kim
A nasogastric (NG) tube is a thin, flexible plastic tube inserted through the nose into the stomach or upper portion of the small intestine. It is used for feeding patients who have difficulty swallowing or require additional nutritional supplements. The tube is also used to remove gastric content, either draining the stomach by gravity or by being connected to a suction pump. The placement of an NG tube is always confirmed with an X-ray prior to use to prevent serious complications. However, there is no mention of whether the presence of an NG tube decreases bowel sounds.
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What You'll Learn
NG tube insertion and removal
A nasogastric (NG) tube is a type of medical catheter inserted through the nose into the stomach. It is used to deliver substances such as food or medication or to extract substances from the stomach. The tube is thin, flexible, and made of plastic, and is used for temporary medical purposes.
Insertion
Before inserting the NG tube, a trained healthcare provider will explain the procedure and obtain signed consent from the patient. The patient will then be placed in an upright sitting position, if possible. The healthcare provider will put on medical gloves and numb the patient's sinus cavity and throat with an anesthetic such as lidocaine. They will then lubricate the first few inches of the tube with a sterile lubricating gel.
To insert the tube, the patient is asked to take sips of water through a straw while the tube is gently inserted into the nose and slid along the floor of the nasal cavity. The patient swallows the tube, facilitating its passage into the esophagus. The tube is advanced during swallows to the predetermined depth using the black marks on the tube as a guide.
Removal
To remove the tube, the tape securing it to the patient's face is loosened. The tube is then gently removed from the nostril while pinching it to prevent the patient from breathing in stomach contents. If the NG tube needs to be replaced, a new one should be inserted. If a new tube is unavailable, the old tube can be washed and reused.
Complications
The insertion of an NG tube is generally considered safe, but it can cause complications, especially if performed improperly. Potential complications include discomfort, sinusitis, epistaxis, trauma to the nares, larynx, esophagus, or stomach during insertion, and erosion of gastric mucosa. More severe complications may include respiratory distress, pleural injury, pneumothorax, tracheobronchial aspiration, pneumonia, and death.
Verification of Placement
It is important to verify the correct placement of the NG tube before use. The most accurate way to do this is with a chest X-ray, but this may not always be practical. An alternative method is to insert a syringe into the end of the tube and gently pull back. If stomach contents are in the syringe, the tube is in the correct position. Another method is to inject 20-30 mL of air and listen with a stethoscope under the left subcostal region. The sound of rushing air confirms the tube is in the stomach. An aspirate pH test can also be performed by suctioning out a small amount of fluid and testing it for acid content, which indicates the presence of stomach acid.
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NG tube safety and placement verification
Nasogastric (NG) tubes are thin, soft tubes made of plastic or rubber that are passed through the nose, down the throat, and into the stomach. They are used to deliver food or medicine to patients who have difficulty eating or swallowing. The placement of an NG tube, called nasogastric intubation, can be uncomfortable but is usually not painful.
Safety
The improper placement of an NG tube can result in life-threatening complications such as aspiration pneumonia. Therefore, it is important to verify the correct placement of the tube before its use.
Placement Verification
There are several methods to verify the placement of an NG tube:
- PH Testing: The pH of the NG tube aspirate can be tested using pH indicator paper. Gastric content has a low pH (1.5-3.5) while respiratory tract secretions have a much higher pH. Therefore, a pH level of 0-5.5 indicates the safe placement of the tube.
- X-ray: An abdominal X-ray is considered the gold standard for NG tube placement confirmation as it can visualize the course of the tube. However, it is not always feasible or cost-effective to perform an X-ray before each use of the NG tube.
- Computer Navigation: This method uses real-time computer navigation to direct and verify the placement of the tube. The tip of the NG tube contains an electromagnetic transmitter that produces a location signal. A receiver placed at the patient's xiphoid process tracks the movement of the tube during insertion, and the location is displayed on a monitor.
- Other Methods: Other methods mentioned in literature include observation for the presence of bubbling, auscultation with insufflation of air, litmus paper test, use of biochemical markers, capnography/colorimetric capnometry, ultrasound, and manometer techniques.
It is important to note that some methods, such as auscultation and listening for a gastric "pop", are not reliable for checking NG tube placement and should not be used as the sole method of confirmation.
Additionally, frequent examinations by healthcare providers to ensure the tube is securely in place and properly positioned can help reduce injuries associated with NG tubes.
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NG tube uses and benefits
A nasogastric (NG) tube is a thin, flexible tube made of plastic or rubber that is inserted through the nose, down the throat, and into the stomach. It is used for tube feeding and stomach suctioning. It delivers food, medication, or liquid nutrition to patients who have difficulty eating, swallowing, or digesting. It can also be used to remove liquids, air, or stomach contents to relieve pressure or remove poisons in cases of overdose or toxin ingestion.
Uses and Benefits
Nasogastric tubes are used to deliver substances to the stomach and draw them out. They are often used for short-term tube feeding and to deliver oral medications to hospitalized patients. They can also be used to suction out stomach contents to relieve pressure or remove poisons in cases of overdose or toxin ingestion.
NG tubes are beneficial for patients who cannot tolerate oral intake due to swallowing difficulties, digestive issues, inflammation, or other medical conditions. They are commonly used after abdominal surgery and are useful in treating intestinal obstruction. They can also provide nutritional support for patients with conditions such as head and neck cancers, altered mental status, malnutrition, or inflammatory bowel disease.
The single-lumen NG tube has a narrow channel for delivering medications and nutrition into the stomach. The double-lumen NG tube is designed for suctioning with a wider channel and a narrower air vent to relieve vacuum pressure.
NG tubes have been essential tools in multiple medical specialties for over 100 years, providing acute and chronic care. They are widely used in surgery, gastroenterology, pediatrics, and palliative care.
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NG tube complications
A nasogastric (NG) tube is a thin, flexible tube made of plastic or rubber that is passed through the nose, down through the throat, and into the stomach. It is used to deliver food or medicine to the stomach for people who have difficulty eating or swallowing. It can also be used to remove liquids or air from the stomach.
The placement of an NG tube is generally safe and can be done quickly, without surgery. However, there are some complications and side effects associated with the procedure. These are relatively minor and typically resolve once the tube is removed. Here are some potential complications:
- Sinus infection
- Nosebleeds
- Sore throat
- Pressure ulcers
- Irritation to the stomach lining
- The tube becoming entangled or dislodged
- Electrolyte imbalances, such as low potassium
- Gastrointestinal bleeding from prolonged use
- Wounding of the oesophagus or stomach lining
- Respiratory complications
- Esophageal or pharyngeal complications
- Tube obstruction
- Intestinal perforation
- Intracranial perforation
- Unplanned tube withdrawal
- Pressure injuries related to fixation and misconnection
- Pneumothorax
- Chemical pneumonitis
- Respiratory distress syndrome
To prevent complications, it is crucial to verify the correct placement of the NG tube. This can be done through a chest X-ray or an aspirate pH test. Additionally, frequent examinations by healthcare providers are important to ensure the tube is securely in place and properly positioned.
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NG tube alternatives
The use of nasogastric (NG) tubes is a traditional approach that may be unnecessary in many cases and can cause discomfort. Alternatives to NG tubes include:
Orogastric (OG) Tube
OG tubes are similar to NG tubes but are inserted into the mouth instead of the nose. OG tube insertion is typically performed under anesthesia. Once the patient is sedated, a gastric tube guide is inserted into the mouth and down the throat, and the feeding tube is threaded through until it reaches the stomach.
Percutaneous Endoscopic Gastrostomy (PEG) Tube
PEG tubes are placed through an incision in the abdomen and are well-tolerated alternatives for patients who cannot tolerate NG tubes or have contraindications for upper endoscopy. PEG tubes may be preferred over NG tubes in certain conditions, such as head and neck cancer, to provide enteral nutrition during treatment.
Jejunostomy (J) Tube
J tubes are placed through an incision in the abdomen, similar to G tubes, but are positioned lower so that they end in the middle third of the small intestine (jejunum). J tubes are smaller than G tubes and are typically used for administering thin liquids and powdered drugs.
Nasojejunal (NJ) and Nasoduodenal (ND) Tubes
NJ and ND tubes are similar to NG tubes but extend past the stomach into the small intestine (either the jejunum or duodenum). These tubes may be considered as alternatives to NG tubes in specific clinical situations.
Medication and Alternative Medicine
In some cases, medication and complementary alternative medicine may be used as short-term alternatives to NG tubes, especially in the treatment of conditions like amyotrophic lateral sclerosis (ALS).
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