A novel placement technique for nasogastric and nasoesophageal tubes

Abstract

Early enteral nutrition in dogs and cats can have significant benefit in the therapeutic management of critical illness. Blind placement of nasogastric or nasoesophageal feeding tubes to accomplish this goal has become standard practice. However, complications from tube misdirection into the tracheobronchial tree can lead to significant patient morbidity and mortality. Safe and consistent alternatives are desirable to minimize these risks. A modified method for placement of nasoenteric tubes is described. The main variation from standard procedure involves a second tube measurement, with the distal tip of the tube positioned at the thoracic inlet and measured to the nostril. The tube is advanced to this level and tested for negative pressure using a 12 mL syringe attached to the end of the feeding tube. This improves confidence in esophageal positioning before complete advancement of the tube to its distal endpoint. This procedural adaptation to feeding tube placement has the potential to reduce bronchopulmonary trauma from intratracheal misdirection by providing an early safety check to identify malpositioning. Prospective validation studies are needed to support its advantages over standard tube placement techniques.