Nasogastric Feeding Tube Placement Research Articles

Advice for prevention of inadvertent respiratory placement of nasogastric feeding tube

Misplacement of nasogastric feeding tubes into the respiratory tract often results in tremendous complications such as pneumonia, empyema and pleural effusion. The National Health Service issued advice to prevent these errors in 2005, describing that verification of pH 5.5 or lower of the aspirate fluid or X-ray confirmation is a prerequisite condition for feeding. However, the usefulness and feasibility of this advice has not been well evaluated. Our experience to implement this advice revealed the problem that in about 30% of the instances before feeding, such verification is infeasible. Therefore, we suggest the following recommendations by reviewing the literature and caregivers' opinions. 1. Placement of newly inserted tubes should always be confirmed by X-ray before use for feeding or medication. 2. At re-insertion of the tube, verification of pH 5.5 or lower of the aspirate fluid or X-ray confirmation should essentially be performed before medication or feeding. 3. Before every feeding, checking the external length of the tube from the nostril and observing the inside of the mouth should be done to determine if the tube is partially removed or not. If there is no suspicion of tube removal, feeding can be started.

Nasogastric feeding tube placement in patients with esophageal cancer: application of ultrathin transnasal endoscopy

Patients with esophageal cancer often present with dysphagia and malnutrition. Obstructive symptoms may improve after radiotherapy and chemotherapy. Nutrition support via a nasogastric tube (NG) or gastrostomy is very important during treatment. The newly developed ultrathin endoscope (Olympus, GIF-N230, outer diameter: 6 mm) has a smaller diameter than the standard endoscope and can be introduced into the esophagus via the nasal cavity. This article reports on the use of an ultrathin endoscope for NG placement for patients with esophageal cancer who presented with dysphagia and failed traditional NG tube placement. A consecutive series of 40 patients with esophageal cancer were referred to our hospital from November 2001 to October 2002 for endoscopic placement of NG tubes due to failure of traditional methods of NG placement. An ultrathin endoscope was used to advance the guidewire into the stomach via the nasal cavity. After withdrawal of the scope, the NG tube was inserted over the guidewire under fluoroscopy. A total of 71 procedures were performed in 40 patients (37 males, 3 females), age 57 +/- 15 years (range, 37-91 y). Seventy procedures (99%) were successful in completing NG tube placement by using an ultrathin transnasal endoscope. Only one procedure failed because the esophageal lumen was completely occluded and the guidewire was not able to be passed through the obstructed site. The average duration that the NG tube was left in place was 49 +/- 35 days (range, 2-144 days). No procedure-related complications, such as bleeding or perforation, occurred. Using ultrathin transnasal endoscopy to place an NG tube for esophageal cancer patients is effective and safe. It simplifies the procedures and increases the success rate.

Complications after CO2 laser surgery of laryngeal cancer in the elderly

Conclusion. Cancer of the larynx in elderly patients should be treated with curative intention, if the extension of the primary tumour allows safe resection. Transoral CO2 laser microsurgery is associated with a low rate of major complications and can be regarded as suitable even for elderly patients. Age itself should never be the sole factor in deciding which therapy should be undertaken. Objectives. In the industrialized nations the age group beyond 75 years will grow steadily, requiring special attention by medical professionals in the future. Nowadays laryngeal cancer is often treated by transoral CO2 laser microsurgery. Because of a variety of comorbidities, the incidence of perioperative complications in the group of elderly patients is of increasing interest. To date, no references in the literature have discussed complications after transoral CO2 laser microsurgery in this age group. Patients and methods. Twenty-four patients over the age of 75 suffering from squamous cell carcinoma of the larynx and treated by transoral CO2 laser microsurgery since 1998 were analysed for intraoperative and postoperative complications. Results. There was no evidence of surgery-related complications at all. Postoperatively, 6 of 24 patients complained about dysphagia. Due to intraoperative placement of nasogastric feeding tubes in these six cases further complications such as pneumonia resulting from aspiration could have been avoided.