Nasogastric tubes form an integral part of surgical management and have a variety of therapeutic uses (Table 1). They are increasing being left in situ for protracted periods in the intensive care setting when used for enteral feeding in critically ill patients.1,2 Nasogastric tubes are such a common feature in surgical patients that the morbidity associated with their use is frequently underestimated (Table 2).3,4 The following technique of securing a nasogastric tube is recommended to avoid soft palate ulceration and pressure necrosis of the nostril (Fig. 1).

Table

Table 1 Therapeutic uses of nasogastric tubes

Table 1 Therapeutic uses of nasogastric tubes

  • Aspiration of gastric contents

  • Decompression of the small intestine (the ‘drip and suck’ regimen)

  • Protection of proximal gastrointestinal anastomoses

  • Enteral feeding

  • Administration of drugs

Table

Table 2 Morbidity associated with nasogastric tubes

Table 2 Morbidity associated with nasogastric tubes

  • Oesophagitis

  • Sinusitis

  • Chest infections

  • Soft palate and nasal ulceration

  • Nasogastric tube syndrome (acute upper airway obstruction resulting from post cricoid chondritis)

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Figure 1 Ulceration of right nostril shown from below. The nasogastric tube has been re-secured in the recommended way.

A 10-cm strip of Elastoplast or Mefix tape is taped longitudinally to the nose as shown, and the tape is pinched distal to this to form a tape-to-tape ‘mesentery’ or hinge (Fig. 2). The free end of the tape is then firmly attached to the nasogastric tube. A further 5-cm strip of tape is then placed transversely across the bridge of the nose to ensure firm anchorage of the nasogastric tube. The ‘hinge’ thus formed allows the nasogastric tube to move on swallowing, avoiding pressure necrosis. We advise that the tape is replaced every 2–3 days, as the sebum produced by the patient's nose reduces adhesion.

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Figure 2 Recommended method of attachment with tape-to-tape ‘hinge’.

Ulceration of the nares is associated with a nasogastric tube being present for a protracted period, specifically one that has been taped too firmly, failing to allow it to migrate with deglutition. This results in pressure necrosis of the edge of the nostril as shown in Figure 1, and an unsightly notch shaped defect with permanently impaired cosmesis. The same mechanism leads to painful ulceration of the soft palate, with pain on swallowing, and a consequent risk of impaired nutrition. This can easily be avoided by allowing the nasogastric tube to move on swallowing, and this technique combines secure attachment of a nasogastric tube with avoidance of nasal and soft palate ulceration.

1. Hardy JR. Medical management of bowel obstruction. Br J Surg 2000; 87: 12813. Crossref, MedlineGoogle Scholar
2. Cuschieri A. Essential Surgical Practice 2000; 3rd ednOxford: Butterworth-Heinemann Google Scholar
3. Nehru VI, Al Shammari HJ, Jaffer AM. Nasogastric tube syndrome: the unilateral variant. Med Princ Pract 2003; 12: 446. Crossref, MedlineGoogle Scholar
4. Nurse who inserted a nasogastric tube incorrectlyBr J Nurs 2002; 11: 931Anon. Crossref, MedlineGoogle Scholar

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