Nasoesophageal and Nasogastric Tube Placement
Nasoesophageal (NE) and nasogastric (NG) tubes are used in hyporexic or anorexic patients, to aid in enteral nutrition. These tubes are usually used only in the hospital, and if a feeding tube for use at home is required, an esophagostomy tube is preferred. These tubes can be placed in sedated animals.
Summary of the Procedure:
| Indications | Short term feeding of liquid diets |
| Limitations | Can only deliver liquid diets (not food blended with water), only liquid medications will pass
Typically used only in hospitalized patients |
| Complications | Tracheal intubation, nasal irritation and hemorrhage, bacterial sinusitis (rare). |
| Contraindications | Bleeding disorder, nasal obstruction;
Esophageal motility disorder, absent gag reflex, comatose animals, frequent vomiting (if using to deliver fluids). |
| Supplies/instruments | 8 French feeding tubes for dogs >15 kg
5 French feeding tubes for dogs <15 kg 3.5 to 5 French tube for cats. Lubricant (Topical anesthetic drops – ophthalmic preparation – in clinical patients) (Bandaging material – in clinical patients) |
| Position | Sternal recumbency |
| Restraint | Usually performed after animal sedated. Ophthalmic topical anesthetic solution is instilled into the nose. |
Landmarks:
First landmark: Measure from the tip of the nose to the caudal pharynx or thoracic inlet.
Second landmark: Measure the tube from the tip of the nose to the level of the 8th intercostal space for nasoesophageal tube, or to the level of the 13th rib for a nasogastric tube.
Video showing landmarks prior to placing an NG tube:
When do you place nasoesophageal (NE) versus nasogastric (NG) tube?
- Both tubes provide an excellent way to feed a patient in-hospital. NG tubes are considered to be more stable and less likely to be removed compared to NE tubes. Type of tube is often based on clinician preference.
- Sometimes you won’t have a tube long enough to extend to the stomach in big dogs, electing for a NE tube by default.
Procedure:
- Measure the length of tube required from nose to landmark described above.
- Place a drop of topical lidocaine in one or both nares (in case you need to switch sides).
- Lubricate the tube with viscous lidocaine or regular lubricant.
- Extend the head and neck slightly dorsally.
- Direct the tube into the nares, and advance in a medial and ventral direction.
- If the tube will not pass beyond the nasal cavity, it has entered into the dorsal nasal cavity.
- When you reach your first landmark, tip the nose ventrally to help the tube advance into the esophagus.
** At this stage to increase safety of placement (and avoid accidental airway placement), is is recommended aspirate back on the tube end with a syringe. You should have negative pressure (or only a few ml of air before reaching negative pressure). If you aspirate a lot of air – you are in the airway and need to remove the tube. ** - If the patient is coughing, the tube could be in the airway – remove and attempt placement again. Note that not all dogs will cough when the tube is in the airway and it is recommended to use the above step to increase safety.
- Confirm tube placement by aspirating gastric contents (for NG tube), and/or taking a lateral thoracic/cranial abdominal radiograph (for NG or NE tube). Ensuring proper placement is essential prior to delivering any fluids through the tube to prevent accidental airway delivery (which can have fatal consequences). Radiograph is the safest way to document proper placement.
- Suture the tube in place by securing at the side of then are, then at the side of the face; alternatively, tissue glue can be used but is more difficult to remove.
Videos of NG tube placement:
Here is a video of our first NG tube placement attempt in this dog. With carefully for coughing, one indication that the tube is in the incorrect spot. This is not always apparent, so cough or lack of cough is not our indicator for improper or proper tube placement:
In retrospect, we had the dog’s nose tipped too far dorsally when we first started placement. Here’s our second (and successful attempt):
After placement of the NG tube, we suture it in place. We use a stay suture at the nares followed by a friction knot:
To confirm proper tube placement (i.e., tube in the esophagus rather than the airway), we take thoracic radiographs:
