Nasogastric Intubation and Feeding Health Article

Definition

Nasogastric intubation refers to the process of placing a soft plastic nasogastric (NG) tube through a patient's nostril, past the pharynx and down the esophagus into a patient's stomach.

Purpose

Nasogastric tubes are inserted to deliver substances directly into the stomach, remove substances from the stomach or as a means of testing stomach function or contents.

The most common purpose for inserting a nasogastric tube is to deliver tube feedings to a patient when they are unable to eat. Patients who may need a NG tube for feedings include: premature babies, patients in a coma, patients who have had neck or facial surgery or patients on mechanical ventilation. Other substances that are delivered through a NG tube may include ice water to stop bleeding in the stomach or medications to neutralize swallowed poisons.

Another purpose for inserting a nasogastric tube is to remove substances from the stomach. A NG tube is used to empty the stomach when accidental poisoning or drug overdose has occurred. A NG tube is used to remove air that accumulates in the stomach during cardiopulmonary resuscitation (CPR). It is used to remove stomach contents after major trauma or surgery to prevent aspiration of the stomach contents. Placing a NG helps prevent nausea and vomiting by removing stomach contents and preventing distention of the stomach when a patient has a bleeding ulcer, bowel obstruction or other gastrointestinal diseases.

A NG tube may be inserted to take samples of stomach contents for laboratory studies and to test for pressure or motor activity of the gastrointestinal tract.

Precautions

Do not use force when inserting a NG tube. If resistance occurs, rotate and retract the tube slightly and try again. Forcing the tube can cause traumatic injury to the tissue of the nose, throat or esophagus.

Always check the tube positioning before giving feedings. If the tube is out of place the patient may aspirate the feeding solution into the lungs.

Keep the patient in an upright or semi-upright sitting position when delivering a tube feeding to enhance peristalsis and avoid regurgitation of the feeding.

Check patients who are receiving continuous feedings via a pump or gravity hourly or according to the medical settings policy, to assure that the tube is in position, the formula is flowing at the correct rate and the patient is comfortable with no signs of distention or distress.

Cap or clamp off the NG tube when not in use to prevent backflow of stomach contents or accumulation of air in the stomach.

If a patient has severe sinus conditions, nasal obstruction or has had facial surgery, it may be necessary to place a oral-gastric tube to avoid further nasal trauma.

If the amount of gastric aspirate is large prior to a bolus or intermittent feeding, notify the physician and follow the protocol of the medical setting for re-instilling the gastric aspirate. The feeding size may need to be decreased if the patient is not digesting it.

NG tube placement is meant to be a short-term solution for feeding problems. Patients that require long term tube feeding should have surgical placement of a gastrostomy tube or gastrostomy button. Long-term NG tube usage can cause nasal erosion, sinusitis, esophagitis, gastric ulceration, esophageal-tracheal fistula formation, oral infections and respiratory infections.