Nasogastric Intubation

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Nasogastric Intubation

• Morning Report

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Learning Objectives

• Different types of tubes
• Indications for NG placement
• Learn the proper technique for placing an NG tube
• Potential complications
• A bit on end-of-life issues and feeding tubes

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Types of Tubes

• Dobhoff
• Salem
• Sengstaken-Blakemore
• lavage

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Dobhoff

• (liquid) Food
• Water
• (some) Meds

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Salem
Main suction port

• GI bleed
• Obstruction
• Ileus
• Removal of gastric contents

Air vent
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Sengstaken-Blakemore

• Insert
• Inflate 1
• Pull back
• Inflate 2
• Pray

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NG Lavage

• A medical-grade garden hose to siphon a toxic
  ingestion

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Questions on types of tubes???
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Complications

• Acute
• Local trauma/bleeding
• Aspiration
• Perforation
• Misplacement
• Lung
• Brain!!!

• Chronic
• Ulceration
• Sinusitis
• Perforation

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NEJM Procedure Video
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Confirming placement

• Gastric insufflation aspiration
• Ask pt to speak
• KUB

Never re-insert wire after it has been
pulled
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(No Transcript)
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On Xray

• Remember, you are not a radiologist
• Check for tip below diaphragm
• Does tube cross midline?
• When does it deviate from the midline?

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Not just a simple procedure
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In Summary

• Indications
• GI bleed
• SBO/ileus
• Food/water
• Meds
• Lavage

• Contraindications
• Maxillofacial trauma
• Caustic ingestion
• Known altered anatomy
• Aspiration risk

Note GI bleed and varices are not on this list!!!
16
yes
/-
yes
no
yes
yes
17
End of Life
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Feeding tube discussions

• Concerns about feeding tubes often driven from
  emotion rather than looking at burdens and
  benefits
• Outcomes are rarely discussed and evidence is not
  reviewed
• Discussions about tube placement and feeding
  often use paradigm of previous patients rather
  than considering the actual condition of the
  person for whom tube placement is considered

-Myles Sheehan, MD, SJ
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• Articles on feeding tubes and end-of-life
• Rabeneck L, Wray NP, Petersen NJ. JGIM 1996.
  11287-293
• Grant MD, Rudberg MA, Brody JA. JAMA 1998.
  2791973-1976
• Finucane TE, Christmas C, Travis K. JAMA 1999.
  2821365-1370
• Murphy LM, Lipman TO. Arch Int Med 2003.
  1631351-3

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Other Resources

• Residency homepage
• http//icvts.ctsnetjournals.org/cgi/reprint/4/5/42
  9.pdf