Nasogastric tubes

Nasogastric tubes are frequently placed in ICU patients for gastric decompression. Some nasogastric tubes have side-ports to facilitate suction, and these should be located below the gastroesophageal junction. Small-bore feeding tubes help to meet the patient's nutritional requirements, with the tip ideally placed beyond the pylorus in the duodenum. However, the weighted tip tends to remain in the fundus in the supine patient. Positioning the patient in the right lateral decubitus position often helps advance the tube tip into the duodenum, if his or her condition will allow. Radiographs should be obtained before use, particularly in the unresponsive patient, to confirm proper positioning.

Sengstaken-Blakemore or Minnesota tubes are placed in patients with bleeding esophageal varices. Radiographs to confirm the proper placement of these tubes are particularly important prior to inflation of the esophageal and gastric balloons because of the potential for injury when these large-capacity balloons are inflated. Complications include pneumomediastinum, subcutaneous emphysema, pleural effusion, pneumothorax, pneumonia, and aspiration ( HenschkeMetMnal.1996).

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