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Novel technique to secure nasogastric tube in patients with cancer of the head and neck
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British Journal of Oral and Maxillofacial Surgery 53 (2015) 303–304
Technical note
Novel technique to secure nasogastric tube in patients with cancer of the head and neck D. Patel a , L.-V. Vassiliou a,∗ , K. Andi b a b
Oral & Maxillofacial Surgery Department, St George’s Hospital, London, United Kingdom St George’s Hospital, London, United Kingdom
Accepted 10 December 2014 Available online 13 January 2015
Keywords: Nasogastric tube; Nasopharyngeal; Head neck; Fixation
Nasogastric tubes are used for feeding in many patients after operations for cancer of the head and neck, and they are also used to administer medication for alcohol detoxification. Occasionally patients do not cooperate during placement, and retention of the tube may be difficult because of confusion caused by sepsis, or delirium caused by alcohol withdrawal. We describe an effective way to secure a nasogastric tube that we used after a patient had pulled out several, despite the fact that they had previously been secured using the bridle technique, with sutures, and in other ways.1–3 The patient had inserted his index finger into the nostril, hooked it around the tube above the fixation point (stitch or bridle) and pulled the proximal (oesophageal) part out through the nostril. Both ends of the tube were left hanging in a “U bend” fashion, still suspended by the stitch or bridle. Our method ensures that the tube cannot be removed by an uncooperative or agitated patient. First, it is passed through an appropriately sized nasopharyngeal airway before being inserted into the patient until the airway is sitting at the outer end of the tube. The tube is then inserted into the stomach in the conventional way. Its position should be confirmed according to the policy of the hospital. Once in the correct position, the nasopharyngeal airway should be advanced until its distal end is at the level of the nostril. An appropriately sized airway tube effectively fills the space in the nostril and prevents a finger being used to pull out the nasogastric tube. ∗
Corresponding author. Tel.: +44 07595308387. E-mail addresses: [email protected] (D. Patel), [email protected] (L.-V. Vassiliou), [email protected] (K. Andi).
Fig. 1. Nasogastric-nasopharyngeal tubes.
The nasogastric-nasopharyngeal tube system (Fig. 1) should then be sutured to the septum under local anaesthesia. The distal end of the airway is secured to the columella with a loop suture using a size 2-0 silk. The nasogastric tube is then secured in a similar fashion. Finally, it is necessary to tie the nasogastric tube to the nasopharyngeal airway to prevent the tube being pulled out (Fig. 1).
Conflict of interest We have no conflicts of interest.
http://dx.doi.org/10.1016/j.bjoms.2014.12.006 0266-4356/© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
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D. Patel et al. / British Journal of Oral and Maxillofacial Surgery 53 (2015) 303–304
References 1. Brugnolli A, Ambrosi E, Canzan F, et al., Naso-gastric Tube Group. Securing of naso-gastric tubes in adult patients: a review. Int J Nurs Stud 2014;51:943–50.
2. della Faille D, Hartoko T, Vandenbroucke M, et al. Fixation of nasogastric tubes in agitated and uncooperative patients. Rev Laryngol Otol Rhinol (Bord) 1998;119:59–61 [in French]. 3. Carey M, Al-Hussaini A, Sanu A, et al. Head and neck surgical patients; is it time for a bridle era? Eur Arch Otorhinolaryngol 2014;271:1321–5.
British Journal of Oral and Maxillofacial Surgery 53 (2015) 303–304
Technical note
Novel technique to secure nasogastric tube in patients with cancer of the head and neck D. Patel a , L.-V. Vassiliou a,∗ , K. Andi b a b
Oral & Maxillofacial Surgery Department, St George’s Hospital, London, United Kingdom St George’s Hospital, London, United Kingdom
Accepted 10 December 2014 Available online 13 January 2015
Keywords: Nasogastric tube; Nasopharyngeal; Head neck; Fixation
Nasogastric tubes are used for feeding in many patients after operations for cancer of the head and neck, and they are also used to administer medication for alcohol detoxification. Occasionally patients do not cooperate during placement, and retention of the tube may be difficult because of confusion caused by sepsis, or delirium caused by alcohol withdrawal. We describe an effective way to secure a nasogastric tube that we used after a patient had pulled out several, despite the fact that they had previously been secured using the bridle technique, with sutures, and in other ways.1–3 The patient had inserted his index finger into the nostril, hooked it around the tube above the fixation point (stitch or bridle) and pulled the proximal (oesophageal) part out through the nostril. Both ends of the tube were left hanging in a “U bend” fashion, still suspended by the stitch or bridle. Our method ensures that the tube cannot be removed by an uncooperative or agitated patient. First, it is passed through an appropriately sized nasopharyngeal airway before being inserted into the patient until the airway is sitting at the outer end of the tube. The tube is then inserted into the stomach in the conventional way. Its position should be confirmed according to the policy of the hospital. Once in the correct position, the nasopharyngeal airway should be advanced until its distal end is at the level of the nostril. An appropriately sized airway tube effectively fills the space in the nostril and prevents a finger being used to pull out the nasogastric tube. ∗
Corresponding author. Tel.: +44 07595308387. E-mail addresses: [email protected] (D. Patel), [email protected] (L.-V. Vassiliou), [email protected] (K. Andi).
Fig. 1. Nasogastric-nasopharyngeal tubes.
The nasogastric-nasopharyngeal tube system (Fig. 1) should then be sutured to the septum under local anaesthesia. The distal end of the airway is secured to the columella with a loop suture using a size 2-0 silk. The nasogastric tube is then secured in a similar fashion. Finally, it is necessary to tie the nasogastric tube to the nasopharyngeal airway to prevent the tube being pulled out (Fig. 1).
Conflict of interest We have no conflicts of interest.
http://dx.doi.org/10.1016/j.bjoms.2014.12.006 0266-4356/© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
304
D. Patel et al. / British Journal of Oral and Maxillofacial Surgery 53 (2015) 303–304
References 1. Brugnolli A, Ambrosi E, Canzan F, et al., Naso-gastric Tube Group. Securing of naso-gastric tubes in adult patients: a review. Int J Nurs Stud 2014;51:943–50.
2. della Faille D, Hartoko T, Vandenbroucke M, et al. Fixation of nasogastric tubes in agitated and uncooperative patients. Rev Laryngol Otol Rhinol (Bord) 1998;119:59–61 [in French]. 3. Carey M, Al-Hussaini A, Sanu A, et al. Head and neck surgical patients; is it time for a bridle era? Eur Arch Otorhinolaryngol 2014;271:1321–5.