Nasogastric and nasoenteric tubes

 Nasogastric and nasoenteric tubes are flexible double or single lumen tubes that are passed proximally from the nose or mouth distally into the stomach or small bowel. In adults, they are used for gastrointestinal decompression in the treatment of small bowel obstruction or prolonged severe ileus, administration of medications or enteral nutrition, and occasionally for gastric lavage. (See 'Introduction' above and 'Indications' above.)

●Nasogastric and nasoenteric tube placement is contraindicated in patients with esophageal stricture, and every effort should be made to avoid their use in patients with esophageal varices or a bleeding diathesis. Nasal intubation is contraindicated in patients with basilar skull fracture or facial fracture; these patients should undergo oral tube placement. (See 'Contraindications' above.)

●Do not usie prophylactic postoperative nasogastric tubes after gastrointestinal or abdominal surgery (Grade 1B). Although nasogastric or orogastric tubes are placed in the operating room for gastrointestinal decompression during surgery, the majority of these tubes should be removed once the patient is alert and recovered from anesthesia. In the past, routine postoperative gastrointestinal decompression was thought to speed the return of gastrointestinal function following thoracic or abdominal surgery. However, the time to return of bowel function was not significantly changed and could even be delayed. (See 'Prophylactic placement' above.)

●Nasogastric and nasoenteric tubes are available in multiple sizes and lengths (table 1). Dual lumen sump tubes are most commonly used for gastrointestinal decompression. Although sump tubes can be used for the administration of medications and for enteral nutrition, these tubes are stiff and irritating. Specifically designed, flexible, small-diameter enteral tubes are preferred for long-term nutrition. (See 'Types of tubes' above.)

●The majority of nasogastric and nasoenteric tubes can be placed at the bedside. For tubes that will be used only for gastrointestinal decompression, initial confirmation of the tube's position by clinical means is usually adequate. However, we always radiographically confirm the position of any tube that will be used to administer tube feeding formula or medications. (See 'Confirmation of placement' above.)

●The proper functioning of nasogastric and nasoenteric tubes should be routinely checked every four to eight hours by irrigating the tube. The drainage from tubes placed for gastrointestinal decompression should also be documented to help judge the progression or resolution of obstruction/ileus and requirements for supplemental intravenous fluid. Tubes are removed when the indication for their use is no longer present. (See 'Management' above.)

●Complications of nasogastric tubes are a consequence of tube placement (eg, perforation, pulmonary abscess), chronic irritation of the gastrointestinal tract (eg, gastritis, ulcer), or altered physiology (eg, reflux) due to the presence of the tube. Proper placement and confirmation of positioning should prevent many of these complications. When gastrointestinal reflux, gastritis, or ulcer is identified, the tube should be removed (ideally) and other treatment measures instituted as indicated. (See 'Complications' above.)