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Crit Care Nurse 2004 Feb; 24(1): 10
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Letters to the Editor

Placement of a nasogastric tube

I recently read the article "Brain Tissue Oxygen Monitoring in Severe Brain Injury, II (August 2003:29–44). I found this article very insightful, but I must disagree (clarify) one point. Table 1 calls for the placement of a nasogastric tube; however, traumatically brain-injured patients may also have basilar skull fractures (the periorbital ecchymosis or Battle’s sign may not manifest itself for a few hours) and there may be associated facial fractures. Therefore, we teach that an orogastric tube should be inserted in the face of traumatically brain-injured patients. This article was cited recently during a discussion we were having in our surgical intensive care unit. Gastric decompression is important, but the nasal route should be avoided initially until all other injuries are ruled out.

Carol Rajda, RN
 Detroit, Mich

 

The authors respond

The reader raises a point that needs clarification. According to ATLS and ATCN guidelines, placement of a tube to the stomach for gastric decompression in a severely brain-injured patient should be through the oropharynx. In Table 1, the wording "nasogastric" tube was an oversight and deserves clarification. At our trauma center, all traumatically brain-injured patients receive an orogastric tube for gastric decompression. The placement in the oropharynx not only is the preferred method to prevent inadvertent placement of the tube through a basilar skull fracture but it also reduces the risk of sinus infections. Thank you for this opportunity to clarify a very important issue.

Mary Kay Bader, RN, MSN, CCRN, CNRN
 Linda R. Littlejohns, RN, MSN, CCRN, CNRN
 Karen March, RN, MN, CCRN, CNRN
 Mission Viejo, Calif

San Diego, Calif





This Article
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