Novel technique to secure nasogastric tube in patients with cancer of the head and neck

Abstract

s T l s asogastric tubes are used for feeding in many patients after perations for cancer of the head and neck, and they are lso used to administer medication for alcohol detoxification. ccasionally patients do not cooperate during placement, and etention of the tube may be difficult because of confusion aused by sepsis, or delirium caused by alcohol withdrawal. We describe an effective way to secure a nasogastric tube hat we used after a patient had pulled out several, despite the act that they had previously been secured using the bridle echnique, with sutures, and in other ways.1–3 The patient ad inserted his index finger into the nostril, hooked it around he tube above the fixation point (stitch or bridle) and pulled he proximal (oesophageal) part out through the nostril. Both nds of the tube were left hanging in a “U bend” fashion, still uspended by the stitch or bridle. Our method ensures that the tube cannot be removed by an ncooperative or agitated patient. First, it is passed through n appropriately sized nasopharyngeal airway before being nserted into the patient until the airway is sitting at the outer nd of the tube. The tube is then inserted into the stomach n the conventional way. Its position should be confirmed ccording to the policy of the hospital. Once in the correct osition, the nasopharyngeal airway should be advanced until ts distal end is at the level of the nostril. An appropriately ized airway tube effectively fills the space in the nostril and revents a finger being used to pull out the nasogastric tube.