gastrointestinal disorders
How To Insert a Nasogastric Tube
Warnings and Common Errors for Nasogastric Tube Insertion
Patients who are at increased risk of aspiration, such as those with altered mental status, should have their airway protected with an endotracheal tube with the cuff inflated before placement of the nasogastric tube. A common error is inserting the tube upward where its passage may be blocked by the middle nasal turbinate. This can injure the turbinate and cause bleeding. Maxillofacial trauma can disrupt the cribriform plate. This trauma increases the risk that a poorly placed nasogastric tube may perforate the cribriform plate and cause serious damage to the brain. When placing an intestinal feeding tube, the wire or stylet should never be allowed to protrude beyond the end of the feeding tube because these stiff, small-diameter wires can injure the wall of the esophagus or other parts of the GI tract. A common error is failure to optimally anesthetize the nasopharyngeal passageways. When using suction, use low intermittent suction to prevent continuous suctioning of one area, which can lead to ulceration and bleeding. 