Overview of Nasogastric Tube
Nasogastric tubes, as you may guess from the name, are tubes that are put in through the nose. They go through the back of the throat, down the food pipe, and into the stomach. The first use of these tubes was described by Dr. Abraham Levin in 1921 (refer to the Nasogastric Tube Image).
These tubes are usually used to relieve pressure from the stomach during a blockage or slow movement in the intestines. They can also be used to give food or medicine to patients who cannot eat or drink normally. There are different types of these tubes, each designed according to its specific purpose.
Anatomy and Physiology of Nasogastric Tube
The nostrils, or “nares,” are the front openings of your nasal passages that connect to a part of your throat called the nasopharynx. About 5 to 7 centimeters behind your nostrils, the nasopharynx becomes the oropharynx, which is another part of your throat. The total distance from the base of your skull to the start of your esophagus (the tube that connects your throat to your stomach) is about 12 to 14 centimeters.
The esophagus begins at a point called the upper esophageal sphincter (the doorway to your stomach) and goes down through a muscle in your chest called the diaphragm before reaching the stomach. This tube is roughly 25 centimeters long. The length of the stomach can change because it can stretch, but when it’s empty, it’s usually about 25 centimeters long.
So, if a doctor needs to insert a tube through your nostrils and into the middle of your stomach – for example, to feed you if you can’t eat by mouth – they would need to insert about 55 centimeters of the tube.
To work out how much of the tube to insert, doctors might loop the tube over your ear, place the tip at a point on your sternum called the xiphoid process, and estimate the length. However, no method is entirely accurate, and there is always a small margin of error.
Why do People Need Nasogastric Tube
A nasogastric tube, which is a thin tube that goes through your nose and down into your stomach, is often used by doctors if something is blocking the normal flow in your digestive system. This blockage could be caused by various things like scar tissue, a twist in your intestines, a tumor, or other conditions. When this happens, bodily fluids can’t pass normally and accumulate in your stomach. This build-up can lead to a swollen abdomen, pain, and feeling sick. If the fluids build up too much, you might start to vomit, which can be dangerous if you accidentally breathe it in. This is called aspiration, and it can be very serious, with a high risk of death. Sometimes, a nasogastric tube is used if you feel sick or are vomiting a lot, even if it’s because of medication or intoxication, to stop you from breathing in the vomit. If you’ve had stomach surgery, a nasogastric tube isn’t recommended unless you become too sick afterwards, and even then, it’s better if you can avoid it.
Sometimes, a nasogastric tube is used to give medication or food to people who can eat normally but can’t swallow properly. This could be the case if you’ve had a stroke or a similar condition. If you don’t recover your swallowing ability and need this support for a long time, a different sort of tube might be used that goes directly into your stomach or small intestine.
In the past, a nasogastric tube was sometimes used to control bleeding in the stomach or intestines by washing out the bleeding area. Recent studies show this isn’t very helpful, but in some cases, the tube can still be used to help figure out where the bleeding is coming from. For example, if you’re passing a lot of blood in your stool, the tube can collect some fluid from your stomach to see if there’s blood there. If the fluid has bile in it, which is a dark greenish-brown fluid your liver makes, then the bleeding is probably not from your stomach. If there’s no bile, it’s possible an ulcer in your small intestine is bleeding and also blocking the bile. However, putting in a nasogastric tube doesn’t generally help improve your outcomes if you’re bleeding in this part of your digestive system.
When a Person Should Avoid Nasogastric Tube
Placing a nasogastric tube, a tube that goes through the nose and into the stomach, isn’t always safe for everyone. Some reasons why a person might not be able to have a nasogastric tube placed include:
If a person has serious injuries to the face or base of the skull, a nasogastric tube might make these injuries worse. In fact, the tube has been accidentally placed inside the skull in rare cases of a fracture at the base of the skull.
If a person has injuries to the esophagus, the tube that connects your throat to your stomach, this could also be a problem. This is especially true if the injuries were caused by swallowing something that burns, as the tube could make holes or tears worse.
If there’s a blockage in the esophagus from a tumor or foreign object, it’s usually not safe to place a nasogastric tube.
People who are taking blood thinning medications may be at a higher risk of bleeding from the placement of the tube, so this is another thing that doctors have to consider.
For patients who have had certain types of stomach or hernia surgeries, or whose digestive system is not formed in the usual way, a nasogastric tube should only be placed with the help of a procedure called an endoscopy. This is where a doctor uses a special tool to look inside the body while they’re placing the tube.
Equipment used for Nasogastric Tube
There are different types of nasogastric tubes, which are tubes that doctors insert into your nose and down into your stomach. Choosing the right one is very important. The most common tube used for relieving pressure in the stomach has two pipes or lumens. One large lumen is used for suction, and a smaller one helps avoid the tube getting blocked by letting air in when your stomach is fully empty. This smaller lumen is called a sump.
If the tube is being used to give you food or medicine, a thinner single-lumen tube, like a Dobhoff or Levin tube, might be used. A Levin tube is just a simple thin tube, while a Dobhoff has a weight at the end. This weight helps the tube to move further into your stomach with the help of gravity and the natural movement of your stomach, known as peristalsis. This positions the tube past a part of the stomach called the pylorus, giving extra protection against the risk of food or medicine going the wrong way and causing you to choke.
Other necessary tools include a sterile lubricating gel to make inserting the tube easier and gloves to safeguard both you and the person placing the tube. The gloves don’t have to be sterile, as the insertion isn’t a sterile procedure.
Optional but useful items include a water cup with a straw for you to drink during the procedure if you can manage it. Drinking can help move the tube and also soothes any throat irritation the tube might cause. Using anesthetic like lidocaine on the area doesn’t usually help, although there is some evidence that inhaling lidocaine mist can ease discomfort and make placing the tube easier. Having a basin close by is also a good idea in case you need to vomit during the procedure.
Who is needed to perform Nasogastric Tube?
If you are having a tube placed by a doctor with a lot of experience, they can usually do it by themselves. However, it’s often helpful to have another person there to help in case they need something, like a bowl, during the process. In particular, having an extra person can be especially important if the patient starts to vomit, also known as emesis, during the procedure.
Preparing for Nasogastric Tube
Before a medical procedure, doctors will explain why it’s needed, potential risks, and other treatment options. They will then ask the patient to sign a form to show that they understand and agree to the treatment. If possible, the patient will be asked to sit up. A sheet will be put on the patient’s chest to protect them in case they vomit during the procedure.
A thin tube, called a nasogastric tube, is then connected to a suction tube which is attached to a suction bucket. This tube goes into the patient’s nose and down to the stomach. The suction bucket is there to catch anything that might spill out from the stomach. This helps to reduce the risk of anything, such as stomach contents, accidentally spilling out.
Throughout the process, all necessary supplies are kept close by. This means that there’s no need for any extra movement during the procedure, making it as smooth and comfortable as possible for the patient.
How is Nasogastric Tube performed
When a healthcare professional is preparing to insert a tube into a patient’s nose and stomach (also known as a nasogastric or NG tube), they first need to put on non-sterile gloves and make sure the tip of the tube is lubricated. It’s important the tube isn’t accidentally directed upwards, as this could cause discomfort by pushing against the top of the sinus cavity. Instead, the tube should be directed straight back, parallel to the floor, and towards the back of the patient’s throat.
To make the insertion smoother, the patient may be given some water to sip through a straw. This can help the tube slide down more easily. If it’s initially difficult to put the tube in, the healthcare professional can try removing the tube, then re-inserting it after a short break or through the other nostril. This is because the tube could have gotten coiled inside the throat or nasal sinus.
Once it seems the tube is in the right place (usually around 55 cm in), it should be secured to the nose with medical tape. At this point, the healthcare professional may try to draw out fluid from the stomach with a syringe to confirm the tube is in the right spot. Some professionals also use a method where they push air through the tube while listening with a stethoscope, but this isn’t always reliable.
The best way to confirm the location of the tube is by taking an abdominal X-ray. This is especially important if the tube will be used for feeding, as feeding into the lungs by mistake can cause serious complications. Ideally, for suction, the tube is placed within the stomach, while for feeding, the tube is placed past the pylorus in the stomach to decrease the risk of aspiration of food into the lungs.
Removing the NG tube is usually a straightforward procedure, but care is needed to ensure it doesn’t get knotted up during removal.
Possible Complications of Nasogastric Tube
The placement of a nasogastric tube, a tube inserted through the nose and into the stomach, can sometimes lead to complications. Most commonly, people may experience discomfort, sinus inflammation, or nosebleeds. Usually, these problems go away on their own once the tube is removed. If you have a previous injury in your esophagus, the tube can sometimes make it worse – that’s why doctors have to be very careful when they insert the tube, especially if you’ve swallowed something that has caused burns in your esophagus. If you’ve had an injury to the bone at the base of your skull, there might be a risk that the tube could accidentally be placed inside the brain.
Before anyone uses the tube to give you medicine or food, it’s essential to make sure it’s correctly placed in your stomach. If the tube is in your lungs, taking medicine or food through it can be very dangerous and could even lead to death. The tube can sometimes accidentally go into the windpipe even in people who are already on a breathing machine.
If you have a specific kind of nasogastric tube that has two tubes (double-lumen), you should know about another possible problem. While this type of tube is in place, it can hold the upper and lower part of your esophagus open. If the tube gets blocked and can’t let air out of your stomach, this can increase the chance of inhaling food or liquid into your lungs.
Prolonged use of these tubes can lead to irritation of the stomach lining, which could cause bleeding in your digestive system. Washing out the stomach with a lot of liquid through the tube can sometimes cause an imbalance of important minerals, like potassium, in your body. If the tube puts pressure on the same spot in your nose for too long, it can cause a pressure sore or even tissue death. Therefore, it’s crucial to adjust the tube’s position and tape it again from time to time to avoid this complication.
What Else Should I Know About Nasogastric Tube?
Nasogastric tubes, or small tubes inserted through your nose and down into your stomach, are a standard part of medical care for several common health issues. They can help with a range of situations, like relieving a bloated stomach, giving food or medicine to someone who can’t swallow properly, or identifying the source of internal bleeding.
Doctors should not hesitate to use nasogastric tubes when necessary and should know how to handle them correctly. However, incorrect placement of these tubes can lead to substantial complications, especially if medicine or nutrients meant for the stomach enter the lungs instead. Because of this, it’s crucial that everyone in a healthcare team is aware of when to use nasogastric tubes, when not to use them, what potential risks are involved, and how to check that the tube is placed correctly.
