Patients who develop postoperative ileus tend to recover faster without the placement of an NG tube. Prophylactic placement of NG tubes in patients with abdominal surgery is not recommended. Similarly, intractable nausea or emesis, whether caused by medications, intoxication, or other reasons, can be an indication for the placement of a nasogastric tube in order to prevent aspiration. Eventually, the fluids will build up enough that nausea will progress to emesis, putting the patient at risk for aspiration, an event with mortality as high as 70% depending on the volume of fluid aspirated. These fluids will build up, causing abdominal distension, pain, and nausea. Small bowel obstruction from adhesions or hernias, ileus, obstructing neoplasms, volvulus, intussusception, and many other causes may block the normal passage of bodily fluids such as salivary, gastric, hepatobiliary, and enteric secretions. The most common indication for placement of a nasogastric tube is to decompress the stomach in the setting of distal obstruction. A common pre-procedure maneuver is to loop the tube over one of the patient’s ears and place the tip at the patient’s xiphoid process and use this as an estimate for the length of the tube that should be inserted. All methods for estimation will have some margin of error. There are several methods to estimate the depth that an NG should be placed. Thus if one intended to place a tube through the nares and place it in the middle of the stomach, then approximately 55 cm of the tube should be inserted. While the stomach is a highly distensible structure and therefore, can vary in length, the empty stomach is generally around 25 cm long. The esophagus starts at the upper esophageal sphincter, the cricopharyngeus, and runs down through the diaphragm to the stomach for a length of approximately 25 cm. The length of the pharynx from the base of the skull to the start of the esophagus is 12 to 14 cm. 5 to 7 cm posterior to the nares the nasal sinus connects to the nasopharynx, which is continuous with the oropharynx. The nares are the anterior opening of the nasal sinuses.
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