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Nasogastric intubation is the placement of a tube into the stomach through the nose. Several types of nasogastric (NG) tubes composed of different materials and of varying diameters are available, depending on the purpose of the tube and the length of time it is expected to stay in place.
Nasogastric tubes may be inserted in order to remove stomach contents. Removal can be done for therapeutic reasons, such as to remove toxins, or for diagnostic reasons, such as sampling the contents of the stomach.
Individuals may be fed (enteral feeding) and receive medication through a tube if their ability to swallow has been compromised. In some situations, the tube is inserted through the mouth rather than the nose (oral gastric intubation). Once in place (whether inserted through the nose or mouth), a NG tube is generally well tolerated. An NG tube may be used on hospitalized individuals or individuals in home care, but generally only for periods of less than a month. This is because of increased use of gastrostomy tubes, which travel directly from the stomach through the skin, and are inserted using a simple procedure. These tubes are shorter and larger in diameter, and are not as prone to obstruction.
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Source: Medical Disability Advisor
| NG tubes may be used for diagnostic purposes, such as to withdraw (aspirate) a sample of gastric contents, assess gastrointestinal (GI) bleeding, measure volume of stomach contents, and measure the acidity of gastric contents.
NG tubes may also be used for several therapeutic reasons. They may be placed during surgery in order to keep the stomach empty (decompressed) until the normal functioning (peristalsis) of the GI tract returns. To decompress the GI tract, the tube remains in place with intermittent or constant suction to aspirate the gastric contents and remove gaseous buildup. An NG tube may also be used during emergency treatment of poisonings, when it is desirable to remove all stomach contents. It is also used with certain GI conditions, including GI hemorrhage, loss of intestinal movement (paralytic ileus) with accumulation of gastric liquids, gastric outlet obstruction, and trauma.
Nasogastric tubes are also commonly used in hospitals and home care situations to administer medications to individuals who are unable to swallow safely. Placement of an NG tube is also performed for relatively short-term administration of liquid feedings (enteral feeding, tube feeding) both in the inpatient and outpatient setting.
This procedure should not be performed on individuals with obstruction of the esophagus or substantial trauma to the face, nose, or jaw. Great care should be taken when inserting an NG tube in those who are having convulsions, are unconscious, are uncontrollable bleeders (i.e., because of blood coagulation abnormalities), or who have large esophageal varices, which may be prone to significant bleeding. For most patients, an x-ray is often taken following tube insertion to confirm appropriate placement in the stomach. |
Source: Medical Disability Advisor
| The procedure is performed with the individual sitting up and bending the head and neck slightly forward. If there is an injury or an orthopedic condition of the spine at the neck, the tube is placed without using flexion. A local anesthetic gel can be placed in the nostril used for tube placement, as well as on the tube itself. The lubricated tube is then inserted through the nostril into the back of the throat. The individual is instructed to swallow while the tube is being advanced. Once in the stomach, proper tube placement is verified by taking an x-ray to confirm its position or removing fluid through it and verifying the acidic nature of the stomach contents. When the tube is properly positioned, the tubing is taped to the nose to prevent pulling and dislodgment. |
Source: Medical Disability Advisor
| The predicted outcome depends on the purpose of tube placement. When an NG tube is placed to provide gastric decompression, the predicted outcome is adequate removal of air and gastric contents and relief from vomiting. Other outcomes of decompression include adequate removal of blood and other gastric contents, return of normal bowel function and motility, relief of paralytic ileus, and removal of an overdose. The outcome of a NG tube placed to administer feedings is adequate nutrition and an increase in or maintenance of body weight. |
Source: Medical Disability Advisor
| In general, NG tubes are inserted and removed without difficulty. However, several complications may occur. A nosebleed (epistaxis) may be induced as the tube is inserted through the nose. The tube may be inadvertently introduced into the trachea, resulting in coughing, choking, and difficulty talking. Inadvertent placement of certain tubes (those with weighted tips or metal stylets) into the trachea may cause injury to the lung. Puncture (perforation) of the esophagus may also occur. Gastric contents may be introduced into the lungs, causing injury and inflammation.
If an NG tube is used for feeding, the liquid feeding solution may go into the lungs and result in aspiration pneumonia. When tubes are left in the same nostril for a prolonged period of time, the skin and tissue of the nostril may break down (ulcerate) due to pressure of the tube. The tissue lining the stomach (gastric mucosa) may erode and perforate if a NG tube is connected to suction to provide decompression. Inflammation of the paranasal sinuses (sinusitis) and the esophagus (esophagitis) may also occur. There may be an imbalance of electrolytes in the blood following the removal of a large volume of gastric fluid. |
Source: Medical Disability Advisor
| No work restrictions or special accommodations are necessary after the NG tube is removed. Individuals receiving outpatient NG feedings are often debilitated, and home care services are generally needed for the underlying condition. Individuals receiving a brief period of NG tube feedings following uncomplicated surgery on the throat are usually able to manage their feedings without needing home care. |
Source: Medical Disability Advisor
| Beers, Mark H., and Robert Berkow, eds. "Nasogastric or Intestinal Intubation." The Merck Manual of Diagnosis and Therapy. 17th ed. Whitehouse Station, NJ: Merck and Company, Inc., 1999. |
Source: Medical Disability Advisor