Contraindications to Nasogastric Feeding
The only absolute contraindication to nasogastric feeding is mechanical obstruction of the small bowel (unless the tube is being placed for decompression). 1, 2
Absolute Contraindications
The following conditions represent absolute contraindications where NG feeding must not be performed:
- Mechanical gastrointestinal obstruction (unless tube placement is specifically for decompression rather than feeding) 1, 2
- Active peritonitis 2
- Uncorrectable coagulopathy 2
- Bowel ischemia 2
- Severe functional disturbances of the bowel 3
- Gastrointestinal tract bleeding (active, severe) 3
- Severe malabsorption 3
- Severe metabolic imbalances 3
Relative Contraindications
These conditions require careful assessment and may necessitate delayed placement or alternative feeding routes:
Anatomical and Structural Issues
- Abnormal nasal anatomy 1
- Facial trauma 1
- Recent oronasal surgery 1
- Esophageal varices - NG tube insertion should be avoided for three days after acute variceal bleeding, and only fine bore tubes should be used thereafter 4
Active Gastrointestinal Bleeding
- Recent GI bleeding from peptic ulcer disease with visible vessel requires 72-hour delay before tube placement 2
- Bleeding from angiodysplasia, gastritis, or stress gastropathy poses less risk and does not require delay 2
Hemodynamic and Respiratory Compromise
- Hemodynamic instability 1, 2
- Respiratory instability 1
- Uncontrolled shock requiring increased vasopressor support 5
- Uncontrolled hypoxemia, hypercapnia, or acidosis 5
Aspiration Risk Situations
- Gastric reflux or delayed gastric emptying - these patients should receive nasojejunal rather than nasogastric feeding 4
- Unconscious patients who must be nursed flat - jejunal feeding should be used instead 4
- Severe dysmotility - increases aspiration risk though not an absolute contraindication 1
Special Clinical Scenarios During COVID-19
- Non-invasive ventilation - NG tube placement may cause airway complications and increase aerosolization risk to healthcare workers; parenteral nutrition should be considered instead 5
- Severe GI symptoms in high nutritional risk patients may necessitate delay of enteral nutrition 5
Important Clinical Caveats
Patient and family refusal represents a contraindication to NG feeding, as it is considered a medical treatment requiring consent 3. If organizational or logistic problems cannot be overcome, or if patients/carers are unlikely to comply, NG feeding should not be offered 3.
Duration considerations: NG tubes are appropriate for feeding needs up to 4-6 weeks 3. If feeding is likely to be needed beyond this timeframe, percutaneous gastrostomy should be considered 4.
Tube selection matters: Fine bore (5-8 French gauge) NG tubes should be used for feeding as large bore PVC tubes irritate the nose and esophagus and increase risks of gastric reflux and aspiration 4.