Case Reports in Surgery and Invasive Procedures

All submissions of the EM system will be redirected to Online Manuscript Submission System. Authors are requested to submit articles directly to Online Manuscript Submission System of respective journal.
Reach Us +1 (202) 780-3397

Commentary - Case Reports in Surgery and Invasive Procedures (2022) Volume 6, Issue 2

Diagnostic of nasogastric feeding tube intubation using conventional versus bubble technique in intensive care unit patients.

Ramin Iranpour *

Department of Pediatrics, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

*Corresponding Author:
Ramin Iranpour
Department of Pediatrics
Child Growth and Development Research Center
Isfahan University of Medical Sciences, Isfahan, Iran

Received: 23-Feb-2022, Manuscript No. AACRSIP-22-109; Editor assigned: 25- Feb-2022, PreQC No. AACRSIP-22-109(PQ); Reviewed:11-Mar-2022, QC No. AACRSIP-22-109; Revised:15-Mar-2022, Manuscript No. AACRSIP-22-109(R); Published: 22-Mar-2022, DOI:10.35841/ aacrsip-6.2.109

Citation: Iranpour R. Diagnostic of nasogastric feeding tube intubation using conventional versus bubble technique in intensive care unit patients. Case Rep Surg Invasive Proced. 2022;6(2):109

Visit for more related articles at Case Reports in Surgery and Invasive Procedures


Inclusion of a nasogastric tube is an exceptionally normal method in numerous clinical circumstances. For the most part, it is a normal errand performed on oblivious or uncooperative patients. It is suggested after beginning adjustment in injury wounds, to diminish the gamble of goal and forestall gastric dilatation. It is additionally ordinarily utilized for enteral taking care of in patients with neurological illness. This system is, notwithstanding, related with a few notable intricacies, in around 3.1% of cases. These incorporate oesophageal hole, esophagitis, bronchopleural fistula, hitching of the cylinder, pneumothorax, laryngeal wounds, sinus disease, aspiratory drain, pneumomediastinum and coincidental arrangement into the mind, the remainder of these being more normal than we could envision and connected with high dreariness and death rates.


Nasogastric feeding tube, Bubble technique.


Specifically, it is realized worldwide that accidental intracranial inclusion might happen on account of skull base crack or facial injury, yet couple of cases have been depicted in patients with non-awful sores or a new history of endonasal medical procedure. Techniques to affirm the situation of the NGT have additionally definitely changed throughout the long term. As indicated by a nursing text by Scott during the 1930s, situation of the NGT into the larynx was viewed as uncommon and the suffocating response when the NGT is put into the aviation routes would make inaccurate situating obvious. In a similar text, the way to deciding right NGT position in the stomach was to guarantee that the stamping on the cylinder was lined up with the kickoff of the nostril, and variety among people was considered negligible. Now, we realize that detecting a malposition of the NGT to the lung just by seeing extreme respiratory misery is a fantasy even in patients with a flawless gag reflex. Truth be told it is workable for the NGT to be embedded into the aviation route with next to no unfavorable response from the patient and for the patient to be asymptomatic until a few hours after the fact and after numerous feedings [1].

It was likewise announced that the NGT might be dislodged up or downwards in any event, when the outside segment remains moored by taping. Over the most recent decade, new techniques for NGT inclusion and position affirmation have surfaced. Be that as it may, there are still episodes of wrong situation prompting inconvenient impacts. In 2014, the Singapore Nursing Board revealed an instance of death coming about because of the NGT being lost in the right bronchus. In less outrageous circumstances, NGTs which didn't pass the esophagogastric intersection (resting in the throat) expanded the gamble of goal of feeds into the lungs. Strategies for NGT position affirmation detailed in the writing incorporate X-ray, perception for presence of bubbling, auscultation with insufflation of air, litmus paper test, pH paper test utilization of biochemical markers, capnography/colorimetric capnometry, ultrasound, electromagnetic (EM) tracing, visualization and manometer techniques. This paper intends to examine the benefits and constraints of these techniques and recognize bearings for future exploration[2].

In anesthetized patients, the inclusion and affirmation of a Nasogastric Tube (NGT) could challenge, with a disappointment pace of practically half on the main endeavor in nonpartisan head position. Multiple endeavors, after a disappointment, are for the most part ineffective because of the looping, wrinkling, or hitching of the NGT. Once wrinkled, the NGT is bound to crimp at a similar site. Piriform sinuses and arytenoid ligament are the most incessant impaction destinations of the NGT. In spite of the fact that embedding a NGT is sensibly protected, mistaken arrangement might cause genuine and deadly difficulties. The removal of NG tubes has been reported in very various rates in the writing: 1.9-89.5% in grown-ups and 20.9-43.5% in children. One of the significant episodes with NGT is some unacceptable association. The plan of these gadgets is with the end goal that it is feasible to inject enteral feed or medications through an undesirable course, like an intravenous course. Accidental situation of the NGT in the respiratory framework can prompt bronchoaspiration, pneumothorax, subcutaneous emphysema, pneumonic drain, empyema, and bronchopleural fistula. These episodes might happen while a NGT is being embedded or progressed through the gastrointestinal lot, like sinusitis, nasal septal disintegration, epistaxis, and esophageal perforation. Other surprising occasions connected with NGT incorporate intracranial placement, mediastinitis, pneumomediastinum, and hole of the inward jugular vein.8 Therefore, the right arrangement of NGT expects to be checked. Different ordinary methodologies, including auscultations, gastric suction pH, and its visual assessment are carried out to check that the nasogastric tube (intragastric position) is accurately positioned. different strategies for confirmation of NGT arrangement recognized are calorimetric carbon dioxide markers, X-beam, ultrasound, endoscopy, fluoroscopy, and magnet tracking. But while the NGT must be put intraoperatively, the mid-region is under the curtains, and the majority of the above methodology are not implementable. Bubble procedure as an imaginative strategy for NGT placement. They portrayed this method as prior to embedding the NGT, a jam is applied to its proximal end. At the point when the NGT crosses gastroesophageal intersection and ventures into the stomach, the gas in the stomach should frame an air pocket at the proximal finish of the NGT. They further made sense of that no air pocket structures assuming the NGT is curled in an oral cavity and air pockets are shaped over and over when set intratracheally; if there should be an occurrence of an intragastric arrangement, a couple of air pockets show up. They effectively positioned more than 100 NGTs during general sedation utilizing this procedure. We have likewise done a pilot study on patients utilizing this procedure, and viewed it as valuable. This move was not inspected as of not long ago in the writing, so we arranged this procedure to approve [3].

The "Whoosh test" is generally utilized for affirmation of NGT position in routine practice. Using this strategy, the air is insufflated through the NGT while the epigastrium is auscultated; be that as it may, the viability of this method is profoundly sketchy. Numerous reports of its ineffectualness have added to unseen side-effects. The bronchial "thundering" sound can be confused with epigastrium sound; in this manner, it's anything but a dependable strategy. One more choice to affirm the right place of the nasogastric tube is ultrasound. Y?ld?r?m et al concentrated on the neck and subxiphoid ultrasound in 49 patients in correlation with chest radiography for check of nasogastric tube location. They found the responsiveness of neck ultrasound 91.5% and positive prescient worth 100 percent. The subxiphoid ultrasound awareness was 78.72%. They recommended that ultrasound of neck and subxiphoid could be utilized to confirm the area of the nasogastric tube. Like this, we tracked down the awareness of Bubble strategy 92.3% and positive prescient worth of 96.0%. Notwithstanding, stomach and neck ultrasonography requires aptitude in affirming the NGT position and isn't generally accessible in the working theatre [4].


  1. Chauhan D, Varma S, Dani M, et al. Nasogastric tube feeding in older patients: A review of current practice and challenges faced. Curr Gerontol Geriatr Res. 2021:6650675.
  2. Indexed at, Google Scholar, Cross Ref

  3. Mundi MS, Patel J, McClave SA, et al. Clinical Interventions in Aging. Clinical Interventions in Aging. 2018;13:1353–64.
  4. Indexed at, Google Scholar, Cross Ref

  5. Sura L, Madhavan A, Carnaby G, et al. Dysphagia in the elderly: Management and nutritional considerations.Clinical Int Aging. 2012;7:287–98.
  6. Indexed at, Google Scholar, Cross Ref

  7. Herbert G, Perry R, Andersen HK, et al. Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications . Cochrane Database Syst Rev. 2019;7(7):CD004080.
  8. Indexed at, Cross Ref

Get the App