Objectives:

Intestinal Tube Insertion

• 1. List the indication for gastrointestinal
intubation.
• 2. Identify common gastrointestinal
tubes and their uses.
• 3. Discuss proper insertion,
maintenance and removal of
nasogastric and intestinal tubes.
• 4. Describe what to do in difficult
nasogastric tube placement
Reasons for Intestinal Tubes

• Decompression
 removing gaseous and liquid substances
due to bowel obstruction
• Lavage - washing out the stomach.
• Gavage - feeding patients fluids and/or
nutrients.
• Compression - pressure to specific GI
sites to control bleeding.
• Diagnosis - analysis of GI contents.
 Contraindications to blind
placement

• Facial fractures
• Recent head or facial trauma
• Recent head and neck, nasal,
esophageal, or gastric surgery
• Recent alkali ingestion
Types of Intestinal Tubes

• Levin
• Sump
• Long tubes:
 Miller-Abbott
 Cantor
• Dobhoff - gavage
• Sengstaken-Blakemore - compression
Equipment Needed
• GI tube • Rubber band and
• Water-soluble safety pin
lubricant • Tongue blade and
• Emesis basin flashlight
• Toomey syringe • Suction equipment
• Adhesive tape • Tincture of benzoin
• Small glass with • Normal saline or
water water
• Stethoscope
The best friend…
Toomey Syringe
• ***** Take
great care in patients
with an impaired gag reflex or
decreased level of
consciousness (Tracheal
intubation can be the
result!)****
Preparation:
• Measure the distance
from the tip of the nose,
behind the ears and
down to the xiphoid
process (about 35cm)
• Close the side access
port and attach the
stylet to the tube
Preparation:

• Instruct patient to sit at 45% angle or

higher. Not leaning forward
• Towel on patient’s chest, tissues
nearby (pt. may have tears), wear
gloves
• Have patient blow out of each nostril-
use the more patent one
The Procedure: Insertion …

• Insert the tube into the nostril,

aiming back and down towards
the ear
• Flex the patient’s head down
towards their chest (closes off
the trachea)
• Ask the patient to drink a cup of
water, advance each time they
swallow
The Procedure: Insertion …

• STOP if they gag, cough or choke

• Insufflate 10mls of air and listen over
the abdominal left upper quadrant
• Flush with 10mls of water
• Obtain x-ray, then remove the stylet
(never reinsert the stylet!)
Position tube in stomach
• Insert to predetermined
distance.
• Auscultation over stomach
during injection of 50 ml air
into tube confirms
intragastric location of tube
by characteristic bubbling
sound.
• Aspiration of gastric
contents further confirms
position.
ALTERNATIVE PROCEDURES
• Stiffen soft tube
To avoid curling in pharynx, stiffer tube
by cooling with ice.
• Pass tube with carrier tube
*With very a flexible tube, wedge tube
into gelatin capsule along with stiffer
tube to facilitate passage into stomach.
*Remove carrier tube after gelatin
capsule dissolves
Taping the tube

Tape

Nose
Nasogastric Tube Position
NG Tube
NG Tube
Dobhoff tube
Dobhoff tube
Feeding tube placement
What’s wrong with this picture?
Sengstaken-Blakemore tube
Long tubes
• Uses:
 intestinal tube feedings
 intestinal decompression due to an
obstruction
• Characteristics:
 longer than gastric tubes
 softer
 weighted with mercury
Miller-Abbott tube
Potential Complications
• Arrhythmia/MI
• Pulmonary Intubation (Empyema,
Pneumothorax, tube feeding into
pulmonary tree)
• Pyriform Sinus perforation, Epistaxis
• Gastric Perforation, GI bleeding
• Otitis Media, Sinusitis
Complications
• Nasal septal injury
• Respiratory distress
 tube malposition
• Curling
• Nasal ala necrosis
Tube Removal
• Take the tube off suction
• Release tape
• Pull quickly during Valsalva (exhalation)