The gastric tube, also known as the nasogastric tube or NGS, is a medical device widely used in gastroenterology. There are two main types of nasal probes: feeding or suction depending on their indication. How is a gastric tube inserted? In what cases is it indicated? The answers of Dr Naoufal Chaib, gastroenterologist and hepatologist.
What is a nasogastric feeding tube (NGT)?
The nasogastric feeding tube (NGS) is a medical device inserted through the nose, which passes through the esophagus to reach the stomach. “It is generally made of more or less flexible silicone, and there are several sizes depending on the size of the patient’s nasal cavity (child or adults). Some have a radio-identifiable metal tip (weighted probe) so that we can ensure that it is located in the stomach and not in the bronchi.” explains Dr Chaid. Nasogastric tubes can be used in the short or medium term, depending on the patient’s needs.
Indications: Why use a gastric tube?
There are two types of gastric tube, depending on whether it is intended to feed the patient or to empty the stomach. Their indications are very specific.
The gastric suction tube or Salem tube
The gastric suction tube or Salem tube is mainly used to suction liquids and gases from the gastrointestinal tract. The main indication for this procedure, known as decompression, is digestive obstruction. “In the presence of a clinical occlusive syndrome, the stomach fills and can no longer evacuate into the digestive tract which is blocked. The major risk is that the patient will vomit and inhale the contents of their stomach into the bronchi, which can lead to death. Aspiration of gastric contents is therefore necessary to avoid this” describes Dr Chaid. Digestive obstruction manifests itself by 4 main symptoms: abdominal pain, cessation of transit, vomiting and abdominal distension.
“The suction probe is also indicated in esophageal or stomach surgery to prevent gastric fluids from irritating the seam postoperatively. It is a protection of the anastomosis” sums up the specialist doctor.
The gastric feeding tube
The gastric feeding tube is prescribed in the event of insufficient nutrient intake, when the patient cannot or does not want to eat. Its main objective is to provide it with a minimum nutritional intake. In practice, its main indications are:
- Malnourished patients : This is what we call enteral nutrition, which aims to bring nutrients directly into the stomach or the jejunum which corresponds to the beginning of the small intestine. “It must then be discussed with a dietitian, who will identify its precise intake and nutritional needs.” says Dr. Chaib;
- It is particularly useful when the mouth and/or esophagus must be put to rest, for example after radiotherapy to the ENT sphere, or in the event of swallowing disorders or an obstruction in the gastrointestinal tract;
- The gastric feeding tube can also be used to administer medications. – It is usually inserted through the nose and pushed into the stomach or jejunum, a part of the (small intestine);
- In certain anorexic patients: but the patient must adhere to the treatment;
- Lpatients who are unable to feed themselves due to an altered consciousness or in the event of false food routes;
- THE premature babiesin whom the sucking reflex is not yet acquired, or the digestive system is not yet mature;
- In prevention of malnutrition before heavy treatment (such as chemotherapy) or major surgery.
How is a gastric tube placed in the stomach in the hospital or at home?
Inserting a gastric tube is a medical procedure carried out by a healthcare professional, usually a nurse. It can be done in hospital or at home, on medical prescription.
“This is a procedure that can be a little stressful for the patient, so it is essential that they are comfortably seated and that their environment is calm” underlines the gastroenterologist. The nurse or doctor responsible for insertion must then take measurements to estimate the length of the probe to be inserted: he first measures the nose-ear distance and places a first mark, then the ear-umbilicus distance (2nd mark). A lubricating spray is used on the end of the probe to allow it to slide more easily within the nasal cavity. The patient is asked to position themselves in a semi-sitting position, and the practitioner slides the probe horizontally into the nostril.”The patient must swallow a sip of water the moment he feels the probe reaching his throat: there is real coordination between the patient and the caregiver” indicates Dr. Chaib. Sometimes the patient has a gag reflex, which may require repeating the operation.
After placement, the correct positioning of the tube in the stomach is checked, usually by aspiration of gastric fluid or by injection of air while listening to the epigastric trough with a stethoscope. Once the position of the probe is confirmed, it is fixed on the side of the nose using an adhesive bandage.
“The procedure is normally quick, around ten minutes in total, and should not be painful, although it can be relatively unpleasant.” specifies the doctor.
What are the systematic measures associated with gastric tube placement?
The placement of a gastric tube is systematically associated with two complementary procedures:
- A chest x-ray centered on the stomach : in order to check the correct location of the probe. “This is particularly essential for the feeding tube, which must absolutely not be found in the bronchi.” specifies Dr Chaib;
- La prescription d’IPP (proton pump inhibitors): “PPIs must be systematically prescribed to limit ulceration of the digestive wall in contact with the probe.“insists the specialist.
Can you eat with a nasogastric tube?
The possibility of eating with a nasogastric tube depends on the medical situation of each patient. In some cases, oral feeding can be maintained, particularly when the tube is used to supplement nutrient intake. However, all ingested foods must be thoroughly blended to obtain a smooth and homogeneous consistency, thus facilitating their passage through the tube.
It is also possible to give food by mouth to a patient who has a nasogastric tube, if the patient insists on eating and the nurse deems it appropriate. However, this decision should always be made based on the patient’s overall health and the reason the catheter was placed.”On the other hand, it is formally contraindicated to eat with a suction tube, since its aim is precisely to empty the contents of the patient’s stomach.” recalls Dr. Chaib.
When to remove a nasogastric tube?
Removing a nasogastric tube, also called catheterization, is a procedure that is generally done when the patient has completed their treatment or when their condition has improved. Several factors can determine the appropriate time for removal, such as the length of time the catheter has been in use, the type of catheter used, and the patient’s current health status.
For example, a suction tube may be removed once the stomach has been sufficiently emptied or a gastrointestinal obstruction has resolved. As for a feeding tube, it can be removed when the patient is able to feed orally without risk of aspiration or aspiration.
In all cases, the decision to remove the probe should always be made by a healthcare professional, taking into account the specific needs of the patient. A poorly performed removal procedure can cause complications, hence the importance of medical monitoring.
What is a nasopharyngeal tube?
The nasopharyngeal tube is another type of tube, less common than the gastric tube. It is introduced through the nose and ends in the pharynx, which is the part of the throat that connects the mouth and nose to the esophagus and trachea. This probe mainly has a monitoring and diagnostic function. It makes it possible, for example, to measure the pressure in the pharynx, to take samples for microbiological examinations or to monitor the patient’s oxygenation in the event of respiratory problems.
What are the risks of inserting a nasogastric tube?
Like any medical procedure, the placement of a nasogastric tube, although generally without risk, can cause some complications.
- Nasal irritation and bleeding : Insertion of the probe may irritate the nasal mucosa, causing bleeding;
- Tissue damage : Incorrect placement of the probe can cause damage to internal tissues;
- Stomach perforation : In more serious cases, incorrect insertion of the tube can lead to perforation of the stomach;
- Suture release : After digestive surgery, the use of a tube can lead to fluid stasis in the stomach and dilation of the hollow organs. This can put tension on the sutures, potentially causing them to loosen.
Each patient is unique and these risks may vary depending on the patient’s health status, the insertion technique used and the care taken when handling the probe.
What are the contraindications to inserting a gastric tube?
Although gastric tube placement is generally safe and beneficial for the patient, it may be contraindicated in certain specific situations. We can…