© Springer International Publishing Switzerland 2017Andrew Loveitt, Margaret M. Martin and Marc A. Neff (eds.)Passing the Certified Bariatric Nurses Exam10.1007/978-3-319-41703-5_29
29. Nasogastric Tube Placement in the Bariatric Patient
Department of General Surgery, Rowan University, Stratford, NJ, USA
The nasogastric tubes (NGTs) are a commonly used instrument in the field of surgery. Most NGTs are single- or double-lumen tubes made of flexible plastic which are inserted through the nasal passageways down the throat and into the stomach. Measured markings and standardized techniques allow for the blind insertion of NGTs on a routine basis by physicians and nurses. NGTs are used to decompress the stomach, remove gastric contents in the case of a blockage, and also administer medications or feeding in patients unable to swallow on their own.
In the case of postoperative bariatric patients, routine NGT placement is not recommended . The gastric anatomy is drastically different from normal, and a fresh staple line is vulnerable to direct trauma leading to a leak. This presents a quandary for providers as nausea, vomiting, and postoperative ileus are known complications after bariatric surgery and are often treated with NGT placement in non-bariatric surgery patients. If absolutely necessary, NGTs may be placed by a physician or designee. They must be extremely gentle, stop at the first sign of resistance, and preferably place the tube under direct visualization, such as using upper endoscopy.
Even after a bariatric surgery patient’s staple line has healed, they should not undergo blind NGT insertion unless it is an absolute emergency. Normal gastric anatomy is forgiving when an overly long NGT is inserted, as the tube simply coils in the stomach and continues to function. In a gastric sleeve or Roux-en-Y patient, the tube does not have enough room to turn and can damage or perforate the stomach, leading to leakage of contents into the abdominal cavity and emergent need for surgery . Some bariatric centers provide patients with a medical alert-type bracelet which instructs prehospital and hospital personnel not to blindly insert NGTs.
Finally, when NGTs are inserted and portable x-rays are used to verify placement, the radiologist and staff should be informed of the patient’s bariatric surgery history . Case reports exist where patients had gastric perforations from NGTs, and the radiologists did not identify them due to the lack of information on the patient’s altered anatomy . The patient’s post-bariatric status should be included in every shift sign out as well as when ordering tests.
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A patient presents to the emergency department complaining of nausea and intractable vomiting. They underwent an uncomplicated sleeve gastrectomy 2 weeks prior. Which of the following is the best first step in patient care?
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