| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Correspondence |
ASCOMS, Jammu and Kashmir, India, E-mail: drmahajanr{at}yahoo.com
To the Editor:
Insertion of a gastric tube can be a difficult and frustrating experience, especially in patients who are anesthetized, paralyzed and sedated.1,2 Ozer and Benumof have found that the most common sites of impaction of orogastric and nasogastric tubes are pyriform sinuses and arytenoids cartilages, rendering its coiling in the oropharynx.3 In our experience, in addition to the impaction of tube against these structures, the basic design of the tube contributes to tube coiling in the oropharynx. The distal 6 cm of the gastric tube has multiple holes that are weak points. Once the tube is impacted against the pyriform sinuses or arytenoid cartilage, bending of the tube occurs at these weak points, thereby promoting coiling and retarding its entry into the esophagus.
We explain a technique of digital assistance to facilitate the insertion of gastric tube (orogastric or nasogastric) in anesthetized and sedated patient. The gloved index finger of the left hand is introduced into the left side of the oral cavity of the patient. Once the gastric tube is negotiated into the oropharynx, it is pulled towards the lateral pharyngeal wall with the index finger, virtually grasping it between the index finger and the lateral pharyngeal wall. As the tube is pushed to the proximal end by the right hand, the left index finger simultaneously guides the tube along the lateral pharyngeal wall into the esophagus. The fingertip provides the buttress against the holes in the distal part of the gastric tube providing it the requisite sturdiness, preventing its bending and impaction with simultaneous steering into the esophagus.
Our method is akin to that reported by Bong and colleagues, which tends to keep the gastric tube adjacent to the lateral pharyngeal wall.1 Our technique avoids some of the time consuming and technically demanding measures of failed gastric tube insertion. No lateral bending of the head, lateral neck pressure or anterior lifting of the thyroid cartilage is required.1,3,4 These maneuvers may not be possible in patients with cervical spine trauma, cervical traction or in neck surgery, where our method can be used easily. Further, digital palpation of the feeding tube in the oral cavity almost obviates the need to check the entry of the gastric tube into the esophagus or its retention in the oropharynx, if any, by direct laryngoscopic examination. This technique has been used by us approximately 90 times over the past six months and was found to be successful approximately 83% of times it was used.
References
1 Bong CL, Macachor JD, Hwang NC. Insertion of the nasogastric tube made easy (Letter). Anesthesiology 2004; 101: 266.[Medline]
2 Flegar N, Ball A. Easier nasogastric tube insertion (Letter). Anaesthesia 2004; 59: 197.
3 Ozer S, Benumof JL. Oro- and nasogastric tube passage in intubated patients. Fiberoptic description of where they go at the laryngeal level and how to make them enter the esophagus. Anesthesiology 1999; 91: 137–43.[Medline]
4 Parris WC. Reverse Sellick maneuver (Letter). Anesth Analg 1989; 68: 423.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
