Nasogastric tubes in patients with dysphagia

Abstract

Up to 50% of all strokes cause dysphagic difficulties, and nutritional and fluid management is of crucial importance in these patients. Rainer Dziewas and colleagues (Sept 1, p 725)1Dziewas R Lüdemann P Konrad C Stögbauer F Simple method for placing nasogastric tubes in patients with dysphagia.Lancet. 2001; 358: 725-726Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar describe a novel technique to facilitate the placement of nasogastric tubes in dysphagic stroke sufferers.Despite their positive results, however, we no longer want to use nasogastric tubes in stroke patients. A well recognised difficulty with nasogastric feeding is the inadvertent removal of the tube, which has a subsequent risk of aspiration, especially if the tube is removed incompletely and the tip is placed in the pharynx. Furthermore, the retraining of swallowing muscles is less effective in the presence of a nasogastric tube, and the image of a patient with a tube hanging out of his or her nose may interfere with self-esteem and motivation.Workers have shown clearly in randomised studies that early percutaneous endoscopic gastrotomic feeding is much better than the nasogastric approach2Norton B Homer-Ward M Donnelly MT Long RG Holmes GKT A randomised prospective comparison of percutaneous endoscopic gastrotomy and nasogastric tube feeding after acute dysphagic stroke.BMJ. 1996; 312: 13-16Crossref PubMed Scopus (371) Google Scholar and percutaneous endo-scopic gastrotomy tubes can be inserted and removed safely and with minimum discomfort for the patient.Nasogastric tubes, in our opinion, should certainly no longer have a place in stroke care. Up to 50% of all strokes cause dysphagic difficulties, and nutritional and fluid management is of crucial importance in these patients. Rainer Dziewas and colleagues (Sept 1, p 725)1Dziewas R Lüdemann P Konrad C Stögbauer F Simple method for placing nasogastric tubes in patients with dysphagia.Lancet. 2001; 358: 725-726Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar describe a novel technique to facilitate the placement of nasogastric tubes in dysphagic stroke sufferers. Despite their positive results, however, we no longer want to use nasogastric tubes in stroke patients. A well recognised difficulty with nasogastric feeding is the inadvertent removal of the tube, which has a subsequent risk of aspiration, especially if the tube is removed incompletely and the tip is placed in the pharynx. Furthermore, the retraining of swallowing muscles is less effective in the presence of a nasogastric tube, and the image of a patient with a tube hanging out of his or her nose may interfere with self-esteem and motivation. Workers have shown clearly in randomised studies that early percutaneous endoscopic gastrotomic feeding is much better than the nasogastric approach2Norton B Homer-Ward M Donnelly MT Long RG Holmes GKT A randomised prospective comparison of percutaneous endoscopic gastrotomy and nasogastric tube feeding after acute dysphagic stroke.BMJ. 1996; 312: 13-16Crossref PubMed Scopus (371) Google Scholar and percutaneous endo-scopic gastrotomy tubes can be inserted and removed safely and with minimum discomfort for the patient. Nasogastric tubes, in our opinion, should certainly no longer have a place in stroke care.