Insertion of difficult nasogastric tubes through a nasoesophageally placed endotracheal tube

Siegel, Ira B.; Kahn, Roberta C.

doi:10.1097/00003246-198709000-00017

Cited by 15 publications

(6 citation statements)

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“…Although common techniques for NGT insertion are lateral neck pressure, head flexion, freezing the NGT before its insertion, anterior larynx displacement, slit ETT as introducer, as well as lateral head positioning, none of them has reported high success rate [17][18][19][20][21] (Table 1). For the first time, Siegel et al showed that a nasopharyngeally placed endotracheal tube could facilitate the insertion of a difficult nasogastric tube [55]. While there have been a few studies showing that ETT assisted gastric tube insertion, the gastric tube used in these studies were orogastric tubes [56,57].…”

Section: Insertion Techniquesmentioning

confidence: 99%

Nasogastric tube insertion in anaesthetized patients: a comprehensive review

Sanaie

Mahmoodpoor

Najafi

2017

Anaesthesiol Intensive Ther

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Nasogastric tubes (NGT) still remain the easiest and the best way for gastrointestinal tract access. There are various indications for the insertion of a nasogastric tube in anaesthetized and critically ill patients. Although many techniques have been introduced to facilitate nasogastric tube insertion using anatomic landmarks and a group of devices, there is no consensus on a standard method. Moreover, there are different methods for the assessment of the correct placement of a nasogastric tube. In addition to these challenges in insertion and assessment methods, there are varieties of major life-threatening and minor complications to be addressed. Thus, selecting the most appropriate approach requires enough knowledge in this area, considering patient condition and clinical factors, as well as the practitioners' sufficient education and experience, along with skill in performance. This is a comprehensive review of the literature evidence on different methods for nasogastric tube insertion, on the assessment of correct placement and the evaluation of complications, in addition to an approach to the effect of education on the quality of routine practice and patients' outcome.

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Section: Insertion Techniquesmentioning

confidence: 99%

Nasogastric tube insertion in anaesthetized patients: a comprehensive review

Sanaie

Mahmoodpoor

Najafi

2017

Anaesthesiol Intensive Ther

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“…During the new method, we used an ETT with an inner diameter of 7.0 mm (outer diameter 9.6 mm). This method was based on a previously presented NGT insertion method in comatose patients 8. For all methods, correct insertion was confirmed by portable chest x-ray.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, we devised a new method using an endotracheal tube (ETT) based on the previously described NGT insertion method8 and compared the success rates and procedure times for these three insertion methods.…”

Section: Introductionmentioning

confidence: 99%

Success rates and procedure times of oesophageal temperature probe insertion for therapeutic hypothermia treatment of cardiac arrest according to insertion methods in the emergency department

et al. 2012

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“…Fibreoptically it has been determined that NGTs usually encounter greatest resistance to insertion at the arytenoid cartilages and the piriform sinuses (1). Over the years, many techniques have been proposed to aid in the process of NGT insertion including forward displacement of the larynx (2), use of split endotracheal tubes placed via the nasoesophageal route (3), use of a nasopharyngeal airway to serve as an obturator (4), immersion of the NGT in ice‐cold water (5), forward neck flexion (6) and insufflation of air in the oropharnyx to open the upper oesophageal sphincter (7).…”

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confidence: 99%

Insertion of a nasogastric tube under direct vision: another atraumatic approach to an age‐old issue

Gombar¹,

Khanna²,

Gombar³

2007

Acta Anaesthesiol Scand

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Sir,The insertion of a nasogastric tube (NGT), in an anaesthetized, paralyzed and intubated patient, as easy as it may seem, can be a tiresome and an challenging exercise for even the most experienced anaesthesiologist.Fibreoptically it has been determined that NGTs usually encounter greatest resistance to insertion at the arytenoid cartilages and the piriform sinuses (1). Over the years, many techniques have been proposed to aid in the process of NGT insertion including forward displacement of the larynx (2), use of split endotracheal tubes placed via the nasoesophageal route (3), use of a nasopharyngeal airway to serve as an obturator (4), immersion of the NGT in ice-cold water (5), forward neck flexion (6) and insufflation of air in the oropharnyx to open the upper oesophageal sphincter (7).A recently described innovative technique proposes to use the flexible fibreoptic bronchoscope to guide the NGT through the nasal cavity under vision and subsequently direct it down the oesophagus using the laryngoscope and Magill's forceps in a standard manner (8). However, the justification of using a flexible fibreoptic bronchoscope as a means to guide a NGT needs questioning especially when there are problems with universal availability and the inherent possibility of damage to the expensive fibreoptic system.We have developed a simple technique of NGT insertion under direct vision involving minimal laryngoscopy and airway instrumentation. This involves the standard passage of a generously lubricated 18/16-G NGT through the appropriate nasal passage. A gentle laryngoscopy is then performed and the NGT is retrieved via the oral cavity by grasping its tip with a Magill's forceps and nearly the entire length is pulled out through the oral cavity leaving only about 3-4 inches outside the nares. Next, the tip of the tube is guided into the oesophagus by grasping it 2-3 inches proximal to its distal end with a Magill's forceps. This step does not need any operation in the depth of the oropharynx thus allowing better manoeuvrability. Once a sufficient length of NGT is introduced inside, the proximal end is pulled out until the desired mark is reached at the level of nares whereupon it is secured with the adhesive tape.Our method has distinct benefits, which include a decreased time period of laryngoscopic stimulation and its consequences therein, a greater range of manoeuvrability by not having to work in the depths of the oropharynx thus avoiding trauma to delicate structures such as uvula and the soft mucosa of the posterior pharyngeal wall. Moreover, the technique is 100% successful even in patients where other methods have failed.The use of laryngoscopy with the Magill's forceps to aid insertion of the GT is not new but our modification of this technique has allowed us a safe, easy and atraumatic means to accomplish the same result.

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Insertion of difficult nasogastric tubes through a nasoesophageally placed endotracheal tube

Cited by 15 publications

References 0 publications

Nasogastric tube insertion in anaesthetized patients: a comprehensive review

Nasogastric tube insertion in anaesthetized patients: a comprehensive review

Success rates and procedure times of oesophageal temperature probe insertion for therapeutic hypothermia treatment of cardiac arrest according to insertion methods in the emergency department

Insertion of a nasogastric tube under direct vision: another atraumatic approach to an age‐old issue

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