How to Perform OroGastric Intubation

• Indications:
  The indications for orogastric (OG) tubes are generally the same as for NG tubes. However, because they are generally not

  • tolerated well by the awake patient, they are used in intubated patients and newborns. The OG tube is the preferred tube for decompressing the stomach in the head trauma patient with a potential basilar skull fracture.
    • Acute gastric dilatation
    • Gastric outlet obstruction
    • Upper gastrointestinal bleeding
    • Ileus
    • Small bowel obstruction
    • Enteral feeding
  • Contraindications:
    Recent esophageal or gastric surgery
  • Anesthesia:
    None
  • Equipment:
    • Levin or Salem sump tube
    • Water-soluble lubricant
    • Catheter-tip syringe (60 ml)
    • Stethoscope
  • Positioning:
    Supine
  • Technique:
    • Measure tube from mouth to earlobe and down to anterior abdomen so that last hole on tube is below the xiphoid process. This marks the distance the tube should be inserted.
    • Apply lubricant liberally to tube.
    • Because the patients in whom OG tubes are used are generally unable to cooperate, the tube should be placed into the mouth, directed posteriorly, until the tip begins to pass downward into the esophagus.
    • Advance the tube slowly and steadily. If any resistance is encountered, stop and withdraw the tube completely. Repeat step c.
    • If the tube advances easily, with little resistance, continue until the premeasured distance is reached. Resistance, gagging,

      • • fogging of the tube, or hypoxia suggests errant placement of the tube into the trachea.
        • Confirm correct placement into stomach by injecting 20 ml of air with the catheter-tip syringe while auscultating over the epigastric area. Correct placement is also confirmed by aspiration of a large volume of fluid.
        • Irrigate tube with 15–20 ml of saline every 4 hours. Salem sump tubes will require injection of 15–20 ml of air through the sump (blue) port every 4 hours to maintain proper functioning.
        • Constant low suction may be applied to Salem sump tubes, whereas Levin tubes should have only low intermittent suction.
        • Monitor gastric residuals if tube is used for enteral feeding. Obtain a chest radiograph to confirm placement before using for enteral feeding.
        • Monitor gastric pH every 4–6 hours and correct with antacids for pH < 4.5.
      • Complications and Management:
        • Pharyngeal discomfort and gagging are a problem with OG tubes when they are placed in awake and alert patients, and essentially eliminates their use in such patients except in conjunction with an oral endotracheal tube.
        • Tracheal intubation
          • Correct placement in the esophagus is usually evident by the ease of advancement of the tube. Any resistance suggests tracheal intubation or coiling within the posterior pharynx.
          • Obtain a chest radiograph to confirm placement prior to use for enteral feeding.
        • Gastritis
          • Usually manifests itself as mild, self-limited upper gastrointestinal bleeding.
          • Prophylaxis consists of maintaining gastric pH > 4.5 with antacids via the tube, IV histamine₂ receptor blockers, and removal of tube as soon as possible.