Overview of Fluoroscopy Nasogastric Feeding Tube Placement
Placing a nasogastric tube involves inserting a tube through the nose and into the stomach. This procedure is often assisted by a technique called fluoroscopy, which allows doctors to see the tube as it moves through the throat and down the food pipe, until it reaches the stomach. This helps ensure that the tube is correctly positioned and reduces the risk of complications.
Nasogastric tubes are handy tools used for several purposes. They can be used to relieve pressure in the stomach, deliver nutrition or medications, or remove stomach contents in cases of poisoning or drug overdose. They can also help with diagnosing issues related to upper stomach bleeding. Fluoroscopy is particularly helpful when the patient’s internal structure is complex, as it allows for a safer and more efficient placement of the tube.
Anatomy and Physiology of Fluoroscopy Nasogastric Feeding Tube Placement
When a nurse or doctor inserts a nasogastric tube (a tube that passes through the nose into the stomach to administer food or medicines), they need to navigate several parts of the body. The journey begins at the nostrils, or the “nares,” the outermost part of the nose. From there, the tube moves into a larger area inside the nose called the anterior nasal vestibule. A structure made of cartilage, known as the nasal septum, separates the two halves of the nose.
The tube then moves into an area called the concha. The nasal sinuses, which are air-filled spaces inside the face, are on either side of the concha. About 5 to 7 cm behind your nostrils, the tube connects to an area called the nasopharynx.
The nasopharynx connects to the oropharynx, which extends from the uvula (the little dangly thing at the back of your mouth) to the middle of the epiglottis (a flap of tissue that keeps food and drink from going into your windpipe). Below that is the laryngopharynx, which goes from the mid-epiglottis to the cricoid process (the ring-shaped cartilage near the windpipe).
These three regions— nasopharynx, oropharynx, and laryngopharynx— make up the pharynx. From the base of the skull to the start of the esophagus (a tube that connects your throat to your stomach), the pharynx runs about 12 to 14 cm in length. The esophagus itself is about 25 cm long.
At the end of the esophagus, there’s a muscle called the gastroesophageal sphincter. It’s like a door that opens to let the tube into the stomach. Once the tube moves through this muscle, it enters the stomach. The first part of the stomach it encounters is called the cardia. The top and leftmost part of the stomach, situated under the diaphragm, is known as the fundus.
The last part of the stomach that the tube meets is called the pylorus; it connects the stomach to the duodenum, the first part of the small intestine where digested food leaves the stomach. The opening and closing of the gastric outlet are controlled by the muscle called the pyloric sphincter.
Why do People Need Fluoroscopy Nasogastric Feeding Tube Placement
A nasogastric tube, which is a thin plastic tube inserted through the nose, down the throat, and into the stomach, could be required under various circumstances. For example, it may be needed when the stomach needs to be relieved of pressure or contents, due to blockages anywhere from the stomach exit and beyond. These blockages could be caused by a variety of conditions, such as hernias, growths, abdominal swelling (known as ileus), or internal twisting of the stomach or bowel (known as volvulus), amongst others.
Another reason for placing a nasogastric tube is to remove poisons or to assist victims of drug overdose. Side effects like severe nausea might increase the risk of patients inhaling stomach contents into the lungs, and the tube can help prevent this from happening.
Besides these, a nasogastric tube can also be used for delivering food or medications. This is usually considered on a patient-by-patient basis, where the treating team has to ensure that the patient cannot consume food or liquids without complications. Situations where this might apply include patients with decreased awareness or mental capacity, potentially due to a stroke or head injury, conditions affecting movement like cerebral palsy, mental conditions like dementia, and in premature infants. In some cases, a nasogastric tube can also assist in diagnosing the cause of blood in the stool (known as hematochezia), especially if it originates from an upper gastrointestinal bleed.
If the patient’s anatomy makes the procedure more complicated, doctors can use a method called fluoroscopy to guide the placement of the tube. This is clearly beneficial for patients with progressed head and neck cancers, those who have suffered burns, or those who have recently undergone operations to reconstruct their esophagus. Inserting a nasogastric tube after certain esophagus surgeries can help protect the surgical site and can be very beneficial to the patients. In fact, it is the preferred method when dealing with blockages or leaks at the surgical join following the operation.
When a Person Should Avoid Fluoroscopy Nasogastric Feeding Tube Placement
One of the main reasons why a person might not be able to get a nasogastric tube placed using a tool called a fluoroscope is if they don’t agree to the procedure. People have the right to decide for themselves if they want the treatment, no matter how much it might help them. This idea of making your own healthcare decisions is called autonomy, and it’s one of the basic principles of medical ethics. If a person says no to the procedure, doctors can’t carry it out, no matter the situation.
Another important reason someone couldn’t have a nasogastric tube placed is if they’ve had serious injuries to their face or skull. This could accidently make the tube go into their skull instead of their stomach, which could have devastating effects.
Other reasons someone might not be able to get the procedure include problems with blood flow, issues with their blood clotting, swollen veins in their esophagus, having had certain procedures on their esophagus recently, having a condition that makes their stomach empty too slowly, or if they’ve had certain types of surgeries on their stomach.
Equipment used for Fluoroscopy Nasogastric Feeding Tube Placement
There are two main types of equipment used in a medical process called fluoroscopy – fixed and mobile. The mobile equipment is made up of a movable unit shaped like a C, with an x-ray device on one end and a screen that displays the images on the other. This equipment is more flexible and can be moved to the location most convenient for the medical professional. It’s often used for bone-related procedures. The fixed system involves a special exam table that allows x-rays to pass through it, with an x-ray device underneath and an imaging detector above the table. This is primarily used for inserting tubes (tubing) when fluoroscopy is chosen as the method. A liquid that can be easily seen on x-ray (water-soluble contrast media) is used to show the outline of the digestive tract as the tube is inserted. If the patient’s body is challenging to navigate, a thin, flexible guide (guidewire) may be used to help insert the tube in the desired direction.
There are several types of nasogastric tubes (tubes inserted through the nose, down the throat, and into the stomach) that can be chosen based on the purpose of the procedure. The Levin is a single-tube type with a port for draining near the stomach end. It’s designed to be easily seen on x-rays (radiopaque) providing a clear view. It’s typically used for removing stomach contents, rinsing the stomach, or delivering food and medicine.
A Dobhoff tube can also be used. This tube has a weighted end, which helps it move through a particular stomach valve, the pyloric sphincter, following the natural movement of digestion instead of needing human hands to push it along. The Salem Sump is a tube with two sections, mainly used for ongoing suction, and includes a second tube that opens to the air to help with suctioning.
The Miller-Abbott tube, another double-section tube, has a balloon on one tip and holes on the other. When it’s moved into the stomach, the balloon is filled up. The balloon then continues through the intestine, and the contents are suctioned out through the tube. This tube is used for issues with blockages in the intestine. Lastly, the Cantor tube is used for relieving pressure in the intestine (intestinal decompression). There’s a balloon at the end which is filled with mercury to help the tube elongate, advancing along the digestive tract.
Who is needed to perform Fluoroscopy Nasogastric Feeding Tube Placement?
When a patient needs a special tube called a nasogastric tube inserted using a method known as fluoroscopy, a group of different healthcare professionals work together to provide the best care. Speech and language therapists are part of this team – they help by assessing the patient’s physical and mental abilities and determining whether this procedure is safe and necessary. They also keep track of how the patient is doing and decide when or if the nasogastric tube isn’t needed anymore. The actual process of inserting this tube with assistance of fluoroscopy is done by someone like a radiologist, a physician assistant or a nurse practitioner.
There are also other members in this healthcare group. These are people like hospital doctors, specialized doctors, pharmacists, nurses, technicians, community health workers, and even providers who give emotional, social, and spiritual support. They all work together to make sure the patient receives the best possible care.
Preparing for Fluoroscopy Nasogastric Feeding Tube Placement
Before starting any medical procedure, it’s crucial to get permission or ‘consent’ from the patient or someone who has the authority to make decisions on their behalf. Once we have this consent, our focus shifts towards preparing the patient medically for the procedure. This means making sure that the patient is physically stable and ready to undergo the process.
In case of planned procedures, we recommend that the patient does not eat or drink anything, also referred to as being ‘NPO’, for 12 hours prior to the procedure. This is to lower the risk of the patient feeling nauseous or even throwing up, which in extreme cases, can cause food or drink to be accidentally inhaled into the lungs, a situation known as ‘aspiration’. This preparation helps to ensure the procedure goes smoothly and safely.
How is Fluoroscopy Nasogastric Feeding Tube Placement performed
In this procedure, the patient is usually lying flat on their back, although they can also be in a sitting position. Doctors don’t generally provide sedation, although, in some cases, fentanyl, a strong painkiller, might be given through a vein. The doctor begins by checking both nostrils to see if there’s any misalignment or blockage. If there’s significant pain, the doctor may use 2% lidocaine gel. This is a type of numbing medication which also helps the tube to slide easily through the nasal passageway.
Once this is done, the doctor will then insert a thin tube, known as a nasogastric tube, into the nostril. This can be done with or without the use of a guidewire, depending on the case. The guidewire helps guide the tube to its destination in the stomach. In order to see the tube’s path in real-time, the doctor may use a technique called fluoroscopy. This involves using X-rays to get live images of the inside of your body on a screen while the tube is being inserted.
Possible Complications of Fluoroscopy Nasogastric Feeding Tube Placement
Fluoroscopy is a technique that uses a type of radiation, just like X-rays. One complication of fluoroscopy is radiation burns, but this is very rare because low doses of radiation are used during the process. There are two types of risks tied to fluoroscopy: deterministic and stochastic. Deterministic risks come into play at a certain level of radiation, meaning that this type of effect has a clear cause-and-effect relationship. Stochastic risks, on the other hand, increase depending on the dosage and can lead to cancer due to radiation exposure. To keep patients safe, doctors always aim to keep radiation exposure as low as reasonably possible (known as the ALARA principle).
A benefit of fluoroscopy is that it allows doctors to see what they’re doing in real-time. However, even with this technology, there’s still a chance of incorrect placement due to human error. There can also be various complications such as perforation, which can occur at any point during the insertion process, leading to uncontrollable bleeding or infection.
While less likely with fluoroscopy, there’s a chance that the tube could end up in the respiratory system (the part of your body involving your lungs and breathing). This can cause aspirations pneumonia or pneumothorax (a collapsed lung). If the tube isn’t properly held in place, it can displace, and this can become more of a risk. Other problems from the tube being in the respiratory tract include the formation of a bronchopleural fistula (a passage between the bronchial tubes and the pleural cavity, the space around the lungs), respiratory failure, and in rare cases, death.
After the tube is correctly placed, additional complications can occur. These include pressure necrosis (tissue death from too much pressure) at the tip of the nose, rhinitis (inflammation of the nasal passages), conjunctivitis (pink eye), esophageal varices (enlarged veins in the esophagus), and even rarely vocal cord injury and paralysis. The last issue can occur from the tube putting too much pressure on the tissue or from damage to the recurrent laryngeal nerve (a nerve in your neck). This can lead to swelling above the vocal cords, which is known as nasogastric tube syndrome. Other problems can also include a blocked tube, gastrointestinal diarrhea, and refeeding syndrome (a metabolic disturbance that can occur when feeding is restarted after a period of starvation or fasting).
Feeding through a nasogastric tube shouldn’t be done for more than 4 to 6 weeks, due to these potential complications or if the treatment isn’t being properly followed.
What Else Should I Know About Fluoroscopy Nasogastric Feeding Tube Placement?
A nasogastric tube is a thin tube inserted through your nose and down into your stomach. This is done for several reasons and can be performed in a few different ways. One way to do this procedure is using a technique called fluoroscopy.
Fluoroscopy is a special kind of X-ray that creates real-time images, almost like a movie, helping the doctors to guide the tube accurately into place. It is especially useful when navigating around more complex internal body shapes. By being able to see what’s happening live, doctors can avoid mistakes and reduce the risk of complications during the procedure.
