Orogastric Intubation
Orogastric intubation is used in a few emergency situations. Intubation can decompress a stomach in a gastric dilation-volvulus (GDV) case. In this situation, it is often performed in sedated dogs. Orogastric intubation can be performed in anesthetized and endotracheally intubated patients to achieve gastric decontamination in cases of toxicity, or to decompress the stomach during GDV surgery.
Summary of the Procedure:
| Indications | Most commonly used for relief of bloat/GDV.
Can also be used for gastric decontamination in cases of toxicity. |
| Limitations | Animals can resent the procedure. |
| Complications | Tracheal intubation, esophageal and gastric irritation, gastric perforation (rare). |
| Contraindications | Rarely identified. |
| Supplies/instruments | Large-bore stomach tubes.
Roll of 2-inch adhesive tape or mouth gag (for GDV decompression) Lubricant |
| Position | Sitting (awake animal)
Sternal, lateral or dorsal recumbency (anesthetized). |
| Restraint | Usually performed in awake or mildly sedated patient in GDV cases; usually performed under anesthesia in gastric decontamination. |
Landmarks:
The esophagus courses slightly left and dorsal to the trachea. The tube will enter the stomach at the level of the 10th-12th intercostal spaces.
Details of the Procedure:
- Normally a plastic mouth gag or role of tape is used to prevent biting of the tube. In an anesthetized dog, have an endotracheal tube in place to protect the airway.
- Measure the length of tubing required to enter the stomach.
- Lubricate tube.
- Pass the tube down the esophagus. Put your fingers over the esophagus and palpate the tube as it passes by — this can help confirm correct placement.
- In patients with GDV, placement of the tube into the stomach usually results in gas release through the tube. In some patients, the volvulus of the stomach can prevent the tube from passing. Force should not be used to place the tube, as this could cause gastric rupture.
- The best insurance to protect the patient from the tube entering the airway is to heavily sedate the animal and place an endotracheal tube prior to passing the orogastric tube. If lavage solutions or other materials are being passed through the tube into the stomach, it is recommended to first place an endotracheal tube.