Nasogastric Intubation

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Nasogastric Intubation

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Gastric intubation via the nasal passage (ie, the nasogastric route) is a common procedure that provides access to the stomach for diagnostic and therapeutic purposes. A nasogastric (NG) tube is used for the procedure. The placement of an NG tube can be uncomfortable for the patient if the patient is not adequately prepared with anesthesia to the nasal passages and specific instructions on how to cooperate with the operator during the procedure.

Diagnostic indications for NG intubation include the following:

Therapeutic indications for NG intubation include the following:

Absolute contraindications for NG intubation include the following:

Relative contraindications for NG intubation include the following:

Virgilio E, Balducci G, Mercantini P, Giarnieri E, Giovagnoli MR, Montagnini M, et al. Utility of Nasogastric Tube for Medical and Surgical Oncology of Gastric Cancer: A Prospective Institutional Study on a New and Precious Application of an Old and Economic Device. Anticancer Res. 2018 Jan. 38 (1):433-439. [Medline].

Cullen L, Taylor D, Taylor S, Chu K. Nebulized lidocaine decreases the discomfort of nasogastric tube insertion: a randomized, double-blind trial. Ann Emerg Med. 2004 Aug. 44(2):131-7. [Medline].

Ducharme J, Matheson K. What is the best topical anesthetic for nasogastric insertion? A comparison of lidocaine gel, lidocaine spray, and atomized cocaine. J Emerg Nurs. 2003 Oct. 29(5):427-30. [Medline].

Middleton RM, Shah A, Kirkpatrick MB. Topical nasal anesthesia for flexible bronchoscopy. A comparison of four methods in normal subjects and in patients undergoing transnasal bronchoscopy. Chest. 1991 May. 99(5):1093-6. [Medline].

West HH. Topical anesthesia for nasogastric tube placement. Ann Emerg Med. 1982 Nov. 11(11):645. [Medline].

Wolfe TR, Fosnocht DE, Linscott MS. Atomized lidocaine as topical anesthesia for nasogastric tube placement: A randomized, double-blind, placebo-controlled trial. Ann Emerg Med. 2000 May. 35(5):421-5. [Medline].

Uri O, Yosefov L, Haim A, Behrbalk E, Halpern P. Lidocaine gel as an anesthetic protocol for nasogastric tube insertion in the ED. Am J Emerg Med. 2011 May. 29(4):386-90. [Medline].

Santos SC, Woith W, Freitas MI, Zeferino EB. Methods to determine the internal length of nasogastric feeding tubes: An integrative review. Int J Nurs Stud. 2016 Jun 15. 61:95-103. [Medline].

Fan L, Liu Q, Gui L. Efficacy of nonswallow nasogastric tube intubation: a randomised controlled trial. J Clin Nurs. 2016 Nov. 25 (21-22):3326-3332. [Medline].

Bennetzen LV, Håkonsen SJ, Svenningsen H, Larsen P. Diagnostic accuracy of methods used to verify nasogastric tube position in mechanically ventilated adult patients: a systematic review. JBI Database System Rev Implement Rep. 2015 Feb 13. 13 (1):188-223. [Medline].

Hsieh SW, Chen HS, Chen YT, Hung KC. To characterize the incidence of airway misplacement of nasogastric tubes in anesthetized intubated patients by using a manometer technique. J Clin Monit Comput. 2017 Apr. 31 (2):443-448. [Medline].

Chun DH, Kim NY, Shin YS, Kim SH. A randomized, clinical trial of frozen versus standard nasogastric tube placement. World J Surg. 2009 Sep. 33(9):1789-92. [Medline].

Moharari RS, Fallah AH, Khajavi MR, Khashayar P, Lakeh MM, Najafi A. The GlideScope facilitates nasogastric tube insertion: a randomized clinical trial. Anesth Analg. 2010 Jan. 110(1):115-8. [Medline].

Li J, Feng YM, Wan D, Deng HS, Guo R. A new strategy for enteral nutrition using a deflection flexible visual gastric tube: A randomized crossover manikin trial. Medicine (Baltimore). 2018 May. 97 (20):e10742. [Medline]. [Full Text].

Lee XL, Yeh LC, Jin YD, Chen CC, Lee MH, Huang PW. Nasogastric tube placement with video-guided laryngoscope: A manikin simulator study. J Chin Med Assoc. 2017 Aug. 80 (8):492-497. [Medline]. [Full Text].

Kavakli AS, Kavrut Ozturk N, Karaveli A, Onuk AA, Ozyurek L, Inanoglu K. [Comparison of different methods of nasogastric tube insertion in anesthetized and intubated patients]. Rev Bras Anestesiol. 2017 Nov – Dec. 67 (6):578-583. [Medline]. [Full Text].

Bourgault AM, Halm MA. Feeding tube placement in adults: safe verification method for blindly inserted tubes. Am J Crit Care. 2009 Jan. 18(1):73-6. [Medline].

Metheny NA, Stewart BJ, Mills AC. Blind insertion of feeding tubes in intensive care units: a national survey. Am J Crit Care. 2012 Sep. 21(5):352-60. [Medline].

Appukutty J, Shroff PP. Nasogastric tube insertion using different techniques in anesthetized patients: a prospective, randomized study. Anesth Analg. 2009 Sep. 109(3):832-5. [Medline].

Taylor N, Bamford T, Haindl C, Cracknell A. Discovering Innovation at the Intersection of Undergraduate Medical Education, Human Factors, and Collaboration: The Development of a Nasogastric Tube Safety Pack. Acad Med. 2016 Apr. 91 (4):512-6. [Medline]. [Full Text].

Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC

Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association

Disclosure: Nothing to disclose.

Nirav R Shah, MD, MPH SVP and COO, Kaiser Permanente Southern California

Nirav R Shah, MD, MPH is a member of the following medical societies: American College of Physicians, New York Academy of Medicine, Society of General Internal Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center

Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Vikram Kate, MBBS, MS, PhD, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS Professor of General and Gastrointestinal Surgery and Senior Consultant Surgeon, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), India

Vikram Kate, MBBS, MS, PhD, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS is a member of the following medical societies: American College of Gastroenterology, American College of Surgeons, American Society of Colon and Rectal Surgeons, Royal College of Physicians and Surgeons of Glasgow, Royal College of Surgeons of Edinburgh, Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Andrew K Chang, MD, MS Vincent P Verdile, MD, Endowed Chair in Emergency Medicine, Professor of Emergency Medicine, Vice Chair of Research and Academic Affairs, Albany Medical College; Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Emergency Medicine, Montefiore Medical Center

Andrew K Chang, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American Academy of Pain Medicine, American College of Emergency Physicians, American Geriatrics Society, American Pain Society, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

The Chief Editor would like to acknowledge the assistance of Dr Mohsina Subair, former Senior Resident, Department of Surgery, and Dr Archana Elangovan, Senior Resident, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India, in updating the review of this article.

Nasogastric Intubation

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Nasogastric Intubation

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