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Nasogastric or Intestinal Intubation

By Walter W. Chan, MD, MPH, Assistant Professor of Medicine;Director, Center for Gastrointestinal Motility, Division of Gastroenterology, Hepatology, and Endoscopy, Harvard Medical School;Brigham and Women's Hospital

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Nasogastric or intestinal intubation is used to decompress the stomach. It is used to treat gastric atony, ileus, or obstruction; remove ingested toxins, give antidotes (eg, activated charcoal), or both; obtain a sample of gastric contents for analysis (volume, acid content, blood); and supply nutrients.

Contraindications to nasogastric intubation include

  • Nasopharyngeal or esophageal obstruction

  • Severe maxillofacial trauma

  • Uncorrected coagulation abnormalities

Esophageal varices previously have been considered a contraindication, but evidence of adverse effects is lacking.

Several types of tubes are available. A Levin or Salem sump tube is used for gastric decompression or analysis and rarely for short-term feeding. A variety of long, thin, intestinal tubes are used for long-term enteral feeding.

For intubation, the patient sits upright or, if unable, lies in the left lateral decubitus position. A topical anesthetic sprayed in the nose and pharynx helps reduce discomfort. With the patient’s head partially flexed, the lubricated tube is inserted through the nares and aimed back and then down to conform to the nasopharynx. As the tip reaches the posterior pharyngeal wall, the patient should sip water through a straw. Violent coughing with flow of air through the tube during respiration indicates that the tube is misplaced in the trachea. Aspiration of gastric juice verifies entry into the stomach. The position of larger tubes can be confirmed by instilling 20 to 30 mL of air and listening with the stethoscope under the left subcostal region for a rush of air.

Some smaller, more flexible intestinal feeding tubes require the use of stiffening wires or stylets. These tubes usually require fluoroscopic or endoscopic assistance for passage through the pylorus.

Complications are rare and include nasopharyngeal trauma with or without hemorrhage, pulmonary aspiration, traumatic esophageal or gastric hemorrhage or perforation, and (very rarely) intracranial or mediastinal penetration.

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