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LETTER TO EDITOR
Year : 2017 | Volume
: 11
| Issue : 4 | Page : 518-519
Use the natural curve of the nasogastric tube: A simple technique of insertion
Monish S Raut
Department of Cardiac Anesthesiology, Sir Ganga Ram Hospital, New Delhi, India
Correspondence Address:
Monish S Raut
Department of Cardiac Anesthesiology, Sir Ganga Ram Hospital, New Delhi - 110 060
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/sja.SJA_389_17
| Date of Web Publication | 22-Sep-2017 |
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How to cite this article:
Raut MS. Use the natural curve of the nasogastric tube: A simple technique of insertion. Saudi J Anaesth 2017;11:518-9 |
Sir,
Nasogastric tube (NGT) is commonly used for administration of nutrition or medication in hospital wards and Intensive Care Unit.[1] Insertion of NGT is generally facilitated by the cooperation of the patient by swallowing on instruction. However, in an unconscious intubated patient, NGT insertion may be a difficult procedure due to nonfollowing of swallowing instructions and leading to high first-attempt failure rates (nearly 50%). Complications such as mucosal bleeding and hemodynamic compromise increase with each failed attempt of insertion of NGT.[2] NGT made of polyurethane becomes soft during the insertion procedure due to exposure to patient's body temperature. A curved shape of the NGT as in the packet favors intraoral coiling than a straight tube. Stiffening of NGT using wire or ureteral catheter as a stylet or cooling it with ice saline has been suggested to facilitate the insertion. Coiling of the NGT in the mouth can be manipulated using laryngoscopy and Magill forceps. However, this may need the use of muscle relaxant, and laryngoscopy-induced sympathetic stimulation may be detrimental in some neurological cases. NGT gets commonly impacted at piriform sinuses and arytenoid cartilages areas.[3] Anterior traction of thyroid cartilage, deflating endotracheal balloon cuff, and neck flexion during the insertion process can mitigate this problem sometimes.[3] The use of angiography catheter in the NGT insertion has also been described.[3]
In our method, we used stiff NGT kept in the refrigerator. Packed NGT has U-shaped curves after certain length of straight course. Distance between the nostril and mandibular angle is measured. Well-lubricated NGT with lignocaine jelly is inserted through a patent nostril in a perpendicular direction till the above-measured length [Step 1, [Figure 1]]. At this point, NGT is completely rotated at 180° [Step 2, [Figure 1]] and then it is advanced further [Step 3, [Figure 1]] till the mark of 50 or 55 cm in adult patient. Gastric placement of the tube is confirmed by auscultation method. | Figure 1: Schematic diagram depicting the steps of insertion of nasogastric tube by Raut' method (Step 1 - Nasogastric tube is inserted till the length similar to distance between nostril and mandibular angle. Step 2 - Then, nasogastric tube is rotated by 180°. Step 3 – nasogastric tube now is further advanced)
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Conventionally advancing the NGT without rotation generally causes impingement of the tip of the NGT on the posterior aspect of the tongue. Further progression of the tube can lead to intraoral coiling. Tip of the NGT is always directed anteriorly in this method of insertion, so this can also potentially cause misplacement of the NGT into trachea. In our method of insertion, tip is always posterior and hence the tube always advances with posterior esophageal wall, thereby reducing the chances of above complications. The use of muscle relaxants is avoided, and endotracheal tube cuff is not deflated during the procedure. This also helps in reducing the possibilities of aspiration and ventilator-associated pneumonia. Further research studies are warranted to establish the easiness of this simple technique.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Pillai JB, Vegas A, Brister S. Thoracic complications of nasogastric tube: Review of safe practice. Interact Cardiovasc Thorac Surg 2005;4:429-33.  [ PUBMED] |
| 2. | Chun DH, Kim NY, Shin YS, Kim SH. A randomized, clinical trial of frozen versus standard nasogastric tube placement. World J Surg 2009;33:1789-92. [ PUBMED] |
| 3. | Ghatak T, Samanta S, Baronia AK. A new technique to insert nasogastric tube in an unconscious intubated patient. N Am J Med Sci 2013;5:68-70. [ PUBMED] |
[Figure 1]
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