Nasogastric Tube Placement

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  • Prevention and/or treatment of nausea and vomiting
  • Treatment of abdominal distension and pain
  • Gastric decompression to facilitate some intra-abdominal surgical procedures
  • Enteral administration of drugs or radiographic material
  • Evaluation of gastric pH
  • Evaluation of GI bleeding
  • Enteral nutrition
  • Patient refusal
  • Anticoagulation or coagulopathy
  • Basilar skull fracture
  • Nasal or other trauma that might affect insertion
  • Sinus surgery
  • Recent sphenoidal or transsphenoidal surgery
  • Nasopharyngeal tumors
  • Esophageal varices
  • Recent esophageal surgery
  • Esophageal stricture
  • Lubricant
  • NG tube
  • #8.0 ETT, split longitudinally
  • Gloves and protective eyewear
  • Topical mucosal vasoconstrictor or anesthetic (optional under anesthesia)
  • Laryngoscope
  • Magill forceps

The nasopharynx extends from the nares superiorly and laterally to the sinuses, eustachian tubes, and sphenoid sinus and inferiorly to the soft palate. The posterior oropharynx begins below the soft palate and extends inferiorly to the glottis and esophageal opening. Notable elements of the nasopharynx are its mucosa, which can be either enlarged or constricted; the hard palate anteriorly; and the soft palate posteriorly. Notable structures in the oropharynx include the tongue, salivary glands, and the tonsils.

The glottis represents the termination of the oropharynx and is located anterior to the esophagus. The anterior mobile leaf-like epiglottis functions to cover the glottis during swallowing. Inside the glottis lie the false and true vocal cords.

The esophagus is a tubular conduit between the oropharynx and stomach. The esophagus consists of both striatal (proximal) and smooth (distal) muscle that exhibit distal-moving peristalsis. It has a moist mucosal surface. The distal esophagus ends in a smooth muscle sphincter, which normally prevents reflux of gastric fluid into the esophagus.

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  • The NG tube is usually placed on either suction or gravity.
  • Usually gravity drainage is sufficient during surgery unless there are specific needs of the procedure for a completely decompressed stomach.
  • A Salem-sump adapter can be affixed to an empty IV fluid bag to facilitate gravity drainage in a closed system.
  • Common
    • Kinking in the oropharynx
    • Epistaxis
    • Intratracheal placement
    • Hypertension, tachycardia, depending on depth of anesthesia
    • Coughing
  • Infrequent
    • ETT cuff damage
    • Atelectasis from tracheal placement with suction applied
  • Serious, rare complications
    • Submucosal dissection
    • Problematic bleeding
    • Intracranial placement
    • Pulmonary injury
    • Glottic injury
    • Vocal cord paralysis (nasogastric tube syndrome
    • Intrapulmonary administration of drugs and tube feeds
    • Disfiguring scar of the anterior nares due to pressure and erosion from the NG tube
    • Esophageal perforation
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