From the Guidelines
To manage gagging and spitting in a patient with a nasogastric (NG) tube, ensure proper tube placement and secure fixation, and consider using a smaller diameter tube, applying a water-soluble lubricant, and administering medications such as metoclopramide or ondansetron as needed. The most recent and highest quality study 1 provides guidance on managing dysphagia in stroke patients, which can be applied to managing gagging and spitting in patients with NG tubes. Key considerations include:
- Using fine bore (5–8 French gauge) nasogastric (NG) tubes to reduce throat irritation, as recommended by guidelines for enteral feeding in adult hospital patients 1
- Applying a water-soluble lubricant like lidocaine gel 2% to the tube before insertion to provide local anesthesia, as described in the guidelines for placing a nasogastric tube 1
- Positioning the patient in a semi-upright position (30-45 degrees) to decrease reflux and aspiration risk
- Providing proper oral care, including regular mouth rinses with normal saline or diluted mouthwash, to reduce irritation and prevent complications from saliva pooling
- Considering medications such as metoclopramide 10mg IV/PO every 6 hours or ondansetron 4-8mg every 8 hours to reduce nausea and vomiting, as suggested by the ESPEN guideline on clinical nutrition in neurology 1 It is essential to prioritize the patient's comfort, safety, and nutritional needs when managing gagging and spitting with an NG tube in place, and to consider the latest evidence and guidelines when making clinical decisions.
From the Research
Managing Gagging and Spitting with NG Tube in Place
To manage gagging and spitting in a patient with a Nasogastric (NG) tube in place, several techniques and considerations can be applied:
- Verification of NG Tube Placement: It is crucial to ensure the NG tube is correctly placed to prevent complications such as misplacement into the airways 2. Techniques for verifying placement include aspiration of gastric contents 3, epigastric auscultation, and capnography 4, 5.
- Techniques for NG Tube Insertion: The method of NG tube insertion can influence the success rate and complications. Techniques such as using a ureteral guidewire as a stylet, a slit endotracheal tube as an introducer, or head flexion with lateral neck pressure can increase the success rate of NG tube insertion 6.
- Prevention of Gagging and Spitting: While the provided studies do not directly address gagging and spitting, ensuring the NG tube is not causing irritation or discomfort can help minimize these issues. Proper securing of the tube and monitoring for any signs of distress are important.
- Monitoring and Adjustment: Continuous monitoring of the patient's condition and adjustment of the NG tube as necessary can help manage any issues that arise, including gagging and spitting.
Considerations for NG Tube Management
- Complications: Awareness of potential complications such as bleeding, coiling, kinking, and knotting of the NG tube 6 and inadvertent tracheobronchial placement 2 is essential for timely intervention.
- Verification Methods: Combining methods like colorimetric capnography with epigastric auscultation can provide a high degree of accuracy in ensuring correct NG tube placement without the need for radiography 5.