From the Guidelines
Nasogastric (NG) tubes are generally preferred over nasojejunal (NJ) tubes for enteral nutrition in the Intensive Care Unit (ICU) due to their ease of insertion and lower risk of complications 1.
Key Considerations
- Indications for NJ tubes: NJ tubes may be considered for patients with severe gastroesophageal reflux disease or those at high risk of aspiration, in which case medications such as metoclopramide or erythromycin may be administered to promote gastric emptying 1.
- Tube Placement and Verification: The position of NG tubes can be verified using pH testing, while NJ tubes require confirmation by x-ray 8-12 hours after placement 1.
- Duration of Tube Placement: The duration of NG or NJ tube placement is typically limited to 4-6 weeks to minimize the risk of long-term complications, such as sinusitis or esophageal stricture 1.
- Alternative Options: For patients requiring enteral nutrition for more than 4-6 weeks, gastrostomy or jejunostomy feeding should be considered 1.
Important Factors
- Multidisciplinary Team Approach: A multidisciplinary team approach after enteral access placement provides improved patient care, with dietitians, nurses, and advanced practice clinicians playing important roles 1.
- Postprocedural Considerations: NG and NJ tubes can be used immediately after confirmation of placement, and a bridling technique can reduce unintentional dislodgement and allow for greater caloric intake 1.
From the Research
Comparison of Nasogastric (NG) and Nasojejunal (NJ) Tube Feeding
- The comparison between NG and NJ tube feeding in the Intensive Care Unit (ICU) has been studied in various research papers 2, 3, 4, 5.
- A study published in 1999 found that endoscopic placement of nasojejunal feeding tubes in ICU patients is a safe, quick, and reliable option for enteral nutrition, with full caloric goal rates achieved in 85% of patients 2.
- Another study published in 2004 found that small bowel feeding tubes, such as NJ tubes, allow the dysfunctional stomach of the critically ill to be bypassed, reducing the rate of gastrointestinal complications and probably the risk of pneumonia 3.
- A 2021 study found that video-assisted placement of NJ feeding tubes using the Integrated Real-Time Imaging System (IRIS) technology was successful in 58% of cases, but had a high success rate (96.8%) for gastric placement 4.
- A 2018 study found that indwelling nasointestinal tubes for enteral nutrition support in patients with severe craniocerebral trauma undergoing mechanical ventilation had better outcomes compared to NG tubes, including lower blood urea nitrogen and APACHE II scores, and shorter duration of mechanical ventilation and hospitalization time 5.
Key Differences Between NG and NJ Tube Feeding
- NG tubes are easier to place than NJ tubes, but may be associated with gastrointestinal intolerance and a higher risk of pneumonia 3.
- NJ tubes are more difficult to place, but allow the dysfunctional stomach to be bypassed, reducing the rate of gastrointestinal complications and probably the risk of pneumonia 3.
- The use of prokinetic agents, such as metoclopramide, may improve the tolerance of enteral nutrition in patients with NG tubes 3.
Current Recommendations
- NG feeding is preferred for almost all patients in the ICU, but NJ feeding may be considered in patients with gastrointestinal intolerance or those who require bypassing of the stomach 3.
- The use of video-assisted placement of NJ feeding tubes using IRIS technology may not be recommended for post-pyloric placement due to its low success rate, but may be useful for gastric placement 4.