What is nasogastric intubation procedure?
Nasogastric intubation, or inserting a tube through the nose and into the stomach, may be done to place a feeding tube or for diagnostic purposes (esophagoscopy or upper endoscopy).
Nasogastric intubation is the insertion of a flexible tube into the nasal passage, through the throat and esophagus into the stomach. It is a minor procedure that provides access to the esophageal passage and the stomach.
For what is nasogastric intubation used?
Nasogastric intubation may be used for diagnostic or therapeutic purposes.
Diagnostic purposes
- Evaluation of upper gastrointestinal (GI) tract bleeding
- Extraction of gastric fluid content for testing
- Identification of the esophagus and stomach on a chest radiograph
- Administering radiographic contrast dye in the upper GI tract
- Identification of cancer cells in patients with gastric cancer
Therapeutic purposes
- Gastric decompression to decrease abdominal pressure and prevent esophageal regurgitation during or after a surgery with general anesthesia
- Relief of symptoms, and bowel rest in case of small bowel obstruction or pancreatitis
- Stomach pumping (gastric lavage) after recent ingestion of toxic substances
- Bowel irrigation to prevent the absorption of ingested toxic matter
- Administration of medication
- For feeding before or after certain surgeries
- To enable the development of an open tract in the esophagus after ingestion of corrosive material
- Nasogastric intubation cannot be performed in patients with
- Severe injury in the middle of the face
- Recent nasal surgery
- Nasogastric intubation may be performed with due precautions in patients with
- Coagulation disorder
- Enlarged veins in the esophagus (esophageal varices)
- Recent banding for esophageal varices
- Anastomosis in the esophagus or stomach (creation of a connection between unconnected parts of GI tract)
- Ingestion of alkaline substance
How is nasogastric intubation performed?
The nasogastric intubation is mostly performed with topical anesthesia, while the patient is awake. The patient needs to follow instructions as the doctor performs the procedure. The procedure may also be performed when a patient is under general anesthesia or unconscious from an ingested substance or trauma.
- There usually is no requirement of any preparation by the patient before the procedure.
- The patient is seated in an upright position, if conscious.
- The doctor first examines the patient’s nose for presence of septal deviation before deciding which nostril to insert the tube in.
- The patient sniffs and swallows a local anesthetic which numbs the nasal passage and the throat.
- The doctor may also spray the anesthetic inside the nasal passage and the throat.
- The doctor inserts the lubricated tube through the nostril gently.
- As the tube is slowly advanced through the nasal passage and the throat, the patient follows instructions from the doctor.
- Typically, the patient has to flex the neck and swallow sips of water through a straw.
- The doctor continues to advance the tube into the esophagus until it reaches into the stomach.
- In sedated or unconscious patients the doctor uses direct or video-assisted laryngoscope (a device to view the throat and voice box [larynx]) for guidance.
- The doctor verifies the correct placement of the nasogastric tube with a chest X-ray.
- If the nasogastric intubation is done for diagnostic purposes, the patient will be able to leave shortly after completion of the procedure.
- In therapeutic situations, the removal of the tube and recovery of the patient will depend on the reason for the nasogastric intubation, and the condition of the patient.
Is nasogastric intubation painful?
Nasogastric intubation is not painful for most people though it does cause a certain amount of discomfort. Pain is usually prevented with local anesthesia and gel lubrication of the nasogastric tube. In some people, the insertion may cause
- Irritation of nose and throat
- Gagging sensation
- Watery eyes
What are the complications of nasogastric intubation?
Nasogastric intubation is a commonly performed procedure and complications are rare. There are a few mild side effects such as
- Sore throat
- Stuffy nose
- Minor nosebleed
These side effects usually resolve in a short while, and throat lozenges and salt water gargle help with throat irritation.
There may be a few rare complications such as
- Bleeding in the nasal cavity (epistaxis)
- Irregular heartbeat (arrhythmia)
- Drop in heart rate and blood pressure (vasovagal episode)
- Bronchial spasm
- Inhaling gastric contents into the airway (aspiration)
- Perforation of the esophagus
- Insertion of tube into the larynx and the airway