From the Guidelines
A Nasogastric Tube (NGT) is not mandatory in all stroke cases.
Key Considerations
- The decision to use an NGT should be based on the individual patient's needs and ability to swallow safely, as determined by a dysphagia screening protocol 1.
- Early dysphagia screening is recommended for acute stroke patients to identify those at risk for aspiration and pneumonia 1.
- For patients who cannot safely swallow, enteral feedings (tube feedings) should be initiated within 7 days after stroke, with nasogastric tube feeding being a reasonable option for short-term (2-3 weeks) nutritional support 1.
- The use of a PEG tube may be considered for patients who require prolonged tube feedings, but it is not without risks and complications 1.
- The risk of aspiration pneumonia is not eliminated by the use of an NGT or PEG tube, and oral hygiene protocols should be implemented to reduce this risk 1.
Clinical Guidelines
- The American Heart Association/American Stroke Association recommends early dysphagia screening and individualized nutritional support for patients with acute ischemic stroke 1.
- The guidelines suggest that nasogastric tube feeding may be used for short-term nutritional support, but the decision should be based on the patient's specific needs and medical condition 1.
From the Research
Nasogastric Tube (NGT) Usage in Stroke Cases
- The usage of Nasogastric Tubes (NGT) in stroke cases is a common practice, especially for patients with dysphagia [(2,3,4,5,6)].
- However, there is no evidence to suggest that NGT is mandatory in all stroke cases [(2,3,4,5,6)].
Complications Associated with NGT
- Complications associated with NGT placement in stroke patients are common, including aspiration pneumonia, failed insertion, and tube dislodgement [(3,5)].
- The study by 3 found that 75.2% of patients experienced NGT-associated complications, and 36.4% of patients died during hospital admission or within 6 months.
Factors Influencing NGT Removal
- Factors such as age, initial disease status, and functional status can influence the removal of NGT in patients with dysphagia after stroke 6.
- The study by 6 found that younger age, better initial disease and functional status were associated with earlier NGT removal in non-brain stem stroke patients.
Efficiency and Tolerability of NGT Placement
- The efficiency and tolerability of NGT placement can be improved using techniques such as reflex placement 4.
- The study by 4 found that reflex placement was successful in 14 out of 16 patients in whom the conventional approach failed, and was associated with smaller increases in heart rate and systolic blood pressure.