The difficult intraoperative nasogastric tube intubation: A review of the literature and a novel approach

Ching, Yiu‐Hei; Socias, Stephanie M.; Ciesla, David J.; Karlnoski, Rachel; Camporesi, Enrico M.; Mangar, Devanand

doi:10.1177/2050312114524390

Cited by 12 publications

(18 citation statements)

References 49 publications

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“…Unconscious patients either in intensive care unit or under general anesthesia may pose a special problem with failed insertion in first attempt reaching up to 50% of cases. [ 1 2 ] With repeated insertion attempts, complications such as bleeding, pharyngeal wall injury, coiling, and hypertension also increase. [ 2 ]…”

Section: Introductionmentioning

confidence: 99%

“…[ 1 2 ] With repeated insertion attempts, complications such as bleeding, pharyngeal wall injury, coiling, and hypertension also increase. [ 2 ]…”

Section: Introductionmentioning

confidence: 99%

“…Starting with simply stiffening of NGT by cooling with iced saline, to using a guitar wire, ureteral catheter, or angiography catheter as a stylet. [ 2 3 ] Furthermore, anterior displacement of the larynx or deflation of the endotracheal tube cuff has been tried to facilitate passage into the esophagus. [ 2 4 ] Even more complex methods such as GlideScope or fiber-optic nasoendoscope have been used.…”

Section: Introductionmentioning

confidence: 99%

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Digital assistance of nasogastric tube insertion in intubated patients under general anesthesia: A single-blinded prospective randomized study

2017

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Background:Nasogastric tube (NGT) insertion may pose a special problem in patients under general anesthesia with first attempt failure rates up to 50%. To increase insertion success rate and decreases related complications, several techniques have been developed. In this study, digital assistance technique is compared to the classic insertion technique in neck flexion.Materials and Methods:In this prospective randomized study, 160 patients were randomly allocated into two groups; control group (Group C, n = 80) where NGT tube will be inserted with the neck in flexion position and digital facilitation group (Group D, n = 80).Results:Overall success rate and first attempt success were statistically higher in Group D compared to Group C (94% vs. 81%, P = 0.02, 80% vs. 62%, P = 0.01 respectively) with significantly lower insertion time in Group D (13 ± 5 s. vs. 10 ± 3 s., P = 0.00).Conclusions:Digital assistance of NGT insertion in the anesthetized or unconscious patient is an effective, fast, and safe method that can be either used as a routine technique or as a rescue in case of failed other methods.

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Section: Introductionmentioning

confidence: 99%

“…[ 1 2 ] With repeated insertion attempts, complications such as bleeding, pharyngeal wall injury, coiling, and hypertension also increase. [ 2 ]…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Digital assistance of nasogastric tube insertion in intubated patients under general anesthesia: A single-blinded prospective randomized study

2017

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“…Resistance encountered should therefore prompt the practitioner to abort any more attempts and instead use alternate methods of insertion especially with a patient specific condition that would predispose them to injurious sequelae. Ching et al describe a case in which after meeting resistance avoided further re-insertions to prevent an injury in a post-esophagogastrectomy patient [ 24 ]. This allowed surgical involvement in the placement of the GT which likely avoided a mucosal injury in a susceptible patient.…”

Section: Resultsmentioning

confidence: 99%

Intraoperative Gastric Tube Intubation: A Summary of Case Studies and Review of the Literature

Long

Machan

Tollinche

2017

OJAnes

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Study Objective Establish complications and risk factors that are associated with blind tube insertion, evaluate the validity of correct placement verification methods, establish the rationales supporting its employment by anesthesia providers, and describe various deployment facilitators described in current literature. Measurements An exhaustive literature review of the databases Medline, CINAHL, Cochrane Collaboration, Scopus, and Google Scholar was performed applying the search terms “gastric tube”, “complications”, “decompression”, “blind insertion”, “perioperative”, “intraoperative” in various order sequences. A five-year limit was applied to limit the number and timeliness of articles selected. Main Results Patients are exposed to potentially serious morbidity and mortality from blindly inserted gastric tubes. Risk factors associated with malposition include blind insertion, the presence of endotracheal tubes, altered sensorium, and previous tube misplacements. Pulmonary aspiration risk prevention remains the only indication for anesthesia-related intraoperative use. There are no singularly effective tools that predict or verify the proper placement of blindly inserted gastric tubes. Current placement facilitation techniques are perpetuated through anecdotal experience and technique variability warrants further study. Conclusion In the absence of aspiration risk factors or the need for surgical decompression in ASA classification I & II patients, a moratorium should be instituted on the elective use of gastric tubes.

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“…During selected surgical procedures, the insertion of such tubes is done in the pre-operative ward. There are lot of reported difficulties during insertion in the intraoperative period [1]. The Ryle's tube is inserted in a classical manner but usually adjusted to enable the surgeon to do the gut surgery.…”

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confidence: 99%

A Novel Technique of Ryle’s Tube Fixation (Partha’s Technique) for Convenient Intraoperative Use

Parthasarathy

2020

Asian J Pharm Clin Res

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Dear sir, Nasogastric tube (Ryle’s tube) insertion is one of the commonest ward procedures done for different indications. During selected surgical procedures, the insertion of such tubes is done in the preoperative ward. There are lot of reported difficulties during insertion in the intraoperative period.1 The Ryle’s tube is inserted in the classical manner but usually adjusted to enable the surgeon to do the gut surgery. The tube is usually fixed to the nose by a plaster wound round the tube. This technique is usually difficult to unwound if there is a need to reposition. In surgical and medical wards, the necessity for repositioning is not very significant. But during the intraoperative period, the surgeons always prefer to move the tube here and there to make the operative field better. This in turn causes much discomfort to the attending anaesthesiologist if the plaster is stuck in a traditional way. Hence, we propose a novel technique of fixation wherein we get the advantages of avoiding accidental removal but with the ease of frequent positional adjustment. A sixty-five-year-old male came for upper Gastro-intestinal surgery. The Ryle’s tube was inserted in the ward and fixed as given in fig 1. To adjust the position after removal of the plaster becomes a herculean task. Its more difficult to adjust the plaster with gloved hands. The plaster was removed before induction and fixed as described below. The first plaster (P1 in fig 2) was vertical and fixed the tube to the nose in a vertical fashion. The portion of the plaster which sticks to the tube should be around 50 % of the plaster length. Usually there is a small gap between the attachment of the tube and the nose. The next or the second plaster (P2 in fig 2) was transverse which fixed the vertical plaster to the nose. The transverse plaster never touched the Ryle’s tube. (Fig 2) If we need to adjust the position, the plasters can be easily loosened to adjust and fix again. The portion of the plaster in the gap can be lifted to loosen. There is no need for changing the plasters. Many a time, the surgeons may ask for repeated changes of position during the surgery. Hence this Partha’s technique of fixation suits repeated unfastening and regluing. There are reports of lost Ryle’s tubes2 after fixation in the wards. Lorente3 in his study of intensive care patients, found an incidence of accidental removal of Ryle’s tube as 4.48%. A single plaster use may be a cause of malposition. An extensive search of the literature did not reveal fixation techniques with their pros and cons. We have been using this technique for many years so far with minimal problems. This report is limited to the fact that it is not used much with no comparative studies to know its advantages and disadvantages.

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The difficult intraoperative nasogastric tube intubation: A review of the literature and a novel approach

Cited by 12 publications

References 49 publications

Digital assistance of nasogastric tube insertion in intubated patients under general anesthesia: A single-blinded prospective randomized study

Digital assistance of nasogastric tube insertion in intubated patients under general anesthesia: A single-blinded prospective randomized study

Intraoperative Gastric Tube Intubation: A Summary of Case Studies and Review of the Literature

A Novel Technique of Ryle’s Tube Fixation (Partha’s Technique) for Convenient Intraoperative Use

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