What is the procedure for retracting a nasogastric (NG) tube when it is in the distal duodenum?

From the Guidelines

To retract a nasogastric (NG) tube from the distal duodenum, first confirm the tube's position via radiography or pH testing, then disconnect and flush the tube with sterile water, and slowly withdraw it in increments while monitoring the patient for discomfort. The procedure for retracting a nasogastric (NG) tube when it is in the distal duodenum involves several key steps to ensure patient safety and comfort.

Key Considerations

• Confirming the tube's position is crucial before attempting retraction, and this can be done via radiography or pH testing 1.
• The tube should be disconnected from any suction or feeding apparatus and flushed with 10-20 mL of sterile water to clear any residual contents, reducing the risk of aspiration or tube clogging.
• Slow withdrawal of the tube in increments of 5-10 cm is recommended, with the patient being monitored for signs of discomfort, coughing, or gagging.
• Between withdrawals, securing the tube temporarily with tape can prevent further migration and aid in maintaining the desired position.
• Maintaining the patient in a semi-upright position (30-45 degrees) during the procedure is important to reduce the risk of aspiration.

Rationale

The careful retraction technique is necessary because rapid withdrawal could cause mucosal trauma or patient discomfort, while the incremental approach allows for better control and positioning 1. The water flush before retraction helps prevent any stomach contents adhering to the tube from being deposited in the respiratory tract during withdrawal, highlighting the importance of meticulous technique in minimizing complications.

Procedure

1. Confirm Tube Position: Use radiography or pH testing to confirm the NG tube is in the distal duodenum.
2. Prepare for Retraction: Disconnect the tube from any apparatus and flush it with sterile water.
3. Retract the Tube: Slowly withdraw the tube in increments, monitoring the patient for discomfort.
4. Secure the Tube: Temporarily secure the tube with tape between withdrawals to prevent migration.
5. Final Positioning: Once the tube reaches the desired position, confirm its placement and ensure the patient's comfort and safety throughout the procedure.

From the Research

Procedure for Retracting a Nasogastric (NG) Tube

There are no specific studies provided that directly address the procedure for retracting a nasogastric (NG) tube when it is in the distal duodenum.

Available Information on NG Tube Placement

• The provided studies focus on the placement of nasogastric tubes using various methods such as fluoroscopic guidance 2, 3, electromagnetic guidance 4, and endoscopy 4.
• These studies discuss the success rates, complications, and safety of these methods, but do not provide information on the retraction procedure.
• One study mentions that most repositionings of nasogastric tubes were required because of patient noncompliance or inappropriate administration of solid medications 2.
• Another study highlights the importance of confirming the proper placement of a nasogastric tube to prevent misplacement and complications 5.

Lack of Direct Evidence

• There is no direct evidence provided to answer the question about the procedure for retracting a nasogastric tube when it is in the distal duodenum.
• The available studies primarily focus on the placement and management of nasogastric tubes, rather than their retraction.