A novel technique for NGT fixation: Secure, simple, and safe

Abstract

Nasogastric tubes are often vitally important in post-operative management. Usually required for short term use, they are easily taped to the nose and face. Occasionally, longer term use is needed, such as in post esophageal reconstruction, where substitution and fixation of the NGT becomes an issue. We describe a novel method of NGT fixation that can be used for prolonged periods of time with minimal risk of dislodgement and without the need for suturing.

Introduction: Nasogastric tubes (NGT) are a common practice in many clinical scenarios, and an easy and available method that is often essential for the prevention of life-threatening adverse complications such as aspiration pneumonia [1]. A common challenge arises in securing the NGT in place. Here, we describe a simple method to securely anchor an NGT tube for a prolonged period without the need to suture.

Method: Steps of tube Fixation: 1. Distance between xiphisternum and mastoid process is measured and marked [Position A, Fig. 1]. This mark will correspond to the portion of the tube in the pharynx once the NGT is inserted. 2. A silk suture is tied to the NGT at the point marking the pharynx [Position A]. The two loose ends are not cut. 3. The NGT is inserted routinely through the nose. 4. Through the mouth, the NGT (and marked suture) is visualized using a laryngoscope. 5. Using a Magill forceps, the loose ends of the suture are pulled through the mouth. 6. The two loose ends are fed through a sleeve (small size feeding tube, cut to size) as to not cause irritation to the lips or the mucosa of the mouth and palate. 7. The two ends of the suture are tied around the nasal end of the NGT [Position B, Fig. 1] This method effectively creates a mini- "A-shaped"- double loop around the nasopharynx without interrupting the patency of the NGT, securing the tube safely without risk of dislodgement [Fig. 1]. It is of note that when marking the pharyngeal level on the NGT prior to insertion, it should be done with an overestimation of the distance by about 1,2 cm as the tube will be minimally pulled out after securing it using the method we described. (Fig. 1) DISCUSSION: Commonly used method of NGT fixation includes the triangular/Butterfly taping of the NGT to the tip of the nose. This can be challenging in patients with facial burns, facial hair, or simply uncooperative patients, where prolonged restraining is not a feasible option. Stitching of the NGT to the face or cheek has also been used in practice, but this could raise many complications including bleeding, or facial scarring [2]. With the method we described above, the NGT can be safely and easily secured in place without anchoring material on the face. It also negates the need for stitching. Additionally, it can be done with readily available tools and materials, without the need for high levels of training. While possible without sedation or anesthesia, this technique is best performed at the primary operation while the patient is under general anesthesia.

Conclusion: This method of Nasogastric Tube fixation is a safe and secure method to maintain the long-term positioning of an NGT. When using this method, we did not note any dislodgement, minimal mucosal and lip irritation, and only minimal patient discomfort. It obviates the need for suture fixation.

Keywords: NGT Fixation; Nasogastric Tube Anchoring; Oral Anchoring of NGT; Prolonged Insertion of NGT.