Nasogastric tube is a tube that is passed through the nose and down through the nasopharynx and esophagus

into the stomach, abbreviated as NGT. It is a flexible tube made of rubber or plastic, and it has bidirectional potential. It can be used to remove the contents of the stomach, including air, to decompress the stomach, or to remove small solid objects and fluid, such as poison, from the stomach. An NGT can also be used to put substances into the stomach, and so it may be used to place nutrients directly into the stomach when a patient cannot take food or drink by mouth. Gastric gavage, a feeding tube is a medical device used to provide nutrition to patients who cannot obtain nutrition by swallowing. The state of being fed by a feeding tube is called gavage, enteral feeding or tube feeding. Placement may be temporary for the treatment of acute conditions or lifelong in the case of chronic disabilities. A variety of feeding tubes are used in medical practice. They are usually made of polyurethane or silicone. The diameter of a feeding tube is measured in French units (each French unit equals 0.33 millimeters). They are classified by site of insertion and intended use. Gastric lavage, also commonly called stomach pumping or gastric irrigation, is the process of cleaning out the contents of the stomach. It has been used for over 200 years as a means of eliminating poisons from the stomach. Such devices are normally used on a person who has ingested a poison or overdosed on a drug or consumed too much alcohol. They may also be used before surgery, to clear the contents of the digestive tract before it is opened. Apart from toxicology, gastric lavage (or nasogastric lavage) is sometimes used to confirm levels of bleeding from the upper gastrointestinal tract.[1] It may play a role in the evaluation of hematemesis. It can also be used as a cooling technique for hyperthermic patients. Indication and Purpose By inserting a nasogastric tube, you are gaining access to the stomach and its contents. This enables you to drain gastric contents, decompress the stomach, obtain a specimen of the gastric contents, or introduce a passage into the GI tract. This will allow you to treat gastric immobility, and bowel obstruction. It will also allow for drainage

and/or lavage in drug over dosage or poisoning. In trauma settings, NGTs can be used to aid in the prevention of vomiting and aspiration, as well as for assessment of GI bleeding. NGTs can also be used for enteral feeding initially.

A person may need a stomach tube inserted to:   Empty the stomach after a drug overdose or accidental poisoning

Drain the stomach after major trauma, so the person can't inhale stomach contents into the lungs

Treat malnutrition by giving feedings through the tube. Tube feeding is also used when a person is unable to eat normally, such as after a stroke

Keep the stomach relaxed after major surgery to the abdomen, such as abdominal exploration

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Prevent distension of the stomach when the person has a bowel obstruction

Contraindications Nasogastric tubes are contraindicated or used with extreme caution in people with particular predispositions to injury from tube placement. These may include:  Patients with sustained head trauma, maxillofacial injury, or anterior fossa skull fracture. Inserting a NGT blindly through the nose has potential of passing through the crib form plate, thus causing intracranial penetration of the brain.

Patients with a history of esophageal stricture, esophageal varices, alkali ingestion at risk for esophageal penetration.

Comatose patients have the potential of vomiting during a NG insertion procedure, thus require protection of the airway prior to placing a NGT. Caution should be utilized when passing a NGT in a patient with suspected cervical spine injury.

Excessive manipulation or movement by the patient during placement including coughing or gagging may potentiate cervical injury.

Manual stabilization of the head is required during the procedure.

Management:  Provide good oral hygiene at regular and frequent intervals. Offer water or mouthwash to rinse the mouth every hour. Assist the patient to brush his teeth at least every 4 hours.

 Keep the nostrils free of accumulations of dried secretions.  If permissible, apply lubricant such as Vaseline to the lips and nostrils for the patient's comfort. Patients may wear lipstick.

 Encourage the patient to swallow saliva naturally; the tube is a constant source of annoyance and the patient may have a tendency to expectorate excessively. The physician may allow chewing gum or hard candy to help maintain mouth moisture and to encourage normal swallowing of saliva. Only conscious, responsive, alert patients should be given these items.  Monitor pH of gastric aspirate 6th hourly using pH test stick for patients at risk of developing stress ulcers (eg head injuries, burns, past history gastric/duodenal ulcer, coffee grounds aspirate). Maintain pH >4 if patient not receiving sucralfates.