Nasoenteric Feeding Tube Insertion

W17 Nasoenteric Feeding Tube Insertion



Deepika Mohan



image Before Procedure



Indications



• Inability to maintain volitional intake in the setting of a functional gastrointestinal tract and:
• Critical illness expected to require more than 2 days’ intensive care unit (ICU) stay

• Poor nutritional status

• Multiple comorbid conditions

• Weight loss and nutrient depletion

• Failure to eat for more than 7 days


Contraindications



• Inability to tolerate enteral nutrition:
• Mechanical bowel obstruction

• Peritonitis

• Hemodynamic compromise (e.g., starting or escalating dose of vasopressors in previously stable patient)

• Short gut (relative)

• Severe cranial or facial fractures

• Esophageal obstruction or recent surgery

• Esophageal or gastric varices

• Coagulopathy (relative)


Equipment



• Tube:
• Nasogastric sump tube (14F-18F)

• Nasoenteric feeding tube with stylet and/or metal weighted tip

• Lubricant

• Gloves

• Gown with long sleeves

• Eye protection

• Emesis basin

• Syringe
• 60-mL Toomey syringe if inserting sump tube

• 10-mL Luer-Lok syringe if inserting nasoenteric feeding tube

• Stethoscope

• Adhesive device
• Tape

• Bridle

• Optional:
• Lidocaine jelly

• Pro-motility agent (e.g. metoclopramide, erythromycin)

• End-tidal CO2 detector


image Anatomy


Successful placement of the feeding tube requires that it pass through the nasal cavity, pharynx, esophagus, and into the stomach. The nasal cavity consists of the nares, septum, lateral nasal wall, and roof. The pharynx consists of a space that extends from the nares down to the inferior border of the cricoid cartilage. At this level, it divides into the esophagus and larynx. The esophagus continues until it terminates in a smooth-muscle sphincter that separates the lower esophagus from the stomach. Typically the lower esophageal sphincter lies 40 cm from the incisors. The pylorus lies approximately 60 to 65 cm from the incisors.

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Jul 7, 2016 | Posted by in CRITICAL CARE | Comments Off on Nasoenteric Feeding Tube Insertion

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