An orogastric tube (OGT) is a flexible, hollow device inserted temporarily through the mouth and esophagus directly into the stomach. This procedure is common when the nasal passage is unsuitable or compromised. The OGT provides direct access to the gastrointestinal tract for both diagnostic and therapeutic purposes, bypassing the need for the patient to swallow.
What is an Orogastric Tube Used For
The primary uses of the orogastric tube relate to managing stomach contents.
One function is nutritional support, known as gavage feeding, which delivers liquid formula or breast milk directly into the stomach when a patient cannot safely eat by mouth. This ensures patients with impaired swallowing or those who are unconscious receive necessary calories and hydration.
The OGT is also used for gastric decompression, which involves removing excess air, fluid, or secretions from the stomach. This procedure relieves abdominal distension and reduces pressure, preventing vomiting and the aspiration of stomach contents. Decompression is relevant in cases of bowel obstruction or reduced gastrointestinal motility.
A third application is gastric lavage, the process of washing out the stomach, typically performed for poisoning or drug overdose. A larger diameter OGT may be used to quickly instill and aspirate fluids, helping to remove toxic substances before absorption. OGTs can also be used for administering certain medications or activated charcoal.
Key Situations Requiring OGT Use
The orogastric route is frequently preferred in specialized patient populations, particularly in neonatal and infant care. Newborns, especially premature infants, are obligate nasal breathers. Placing a nasogastric tube can increase resistance in their small airways, potentially causing respiratory distress.
Using an OGT preserves the nasal passages, maintaining airflow and reducing the risk of nasal trauma or septal injury. Infants requiring continuous positive airway pressure (CPAP) via nasal prongs must use an OGT, as the respiratory equipment occupies the nasal space. The OGT is also used to vent or decompress the stomach, which can become distended due to air pushed in by respiratory support.
OGTs are also selected in emergency and intensive care settings for patients who are intubated and receiving mechanical ventilation. The endotracheal tube secures the airway, and the OGT avoids the nasal bleeding or sinusitis associated with nasogastric tubes. In trauma cases involving severe mid-face or skull base fractures, the nasal route is strictly avoided due to the risk of the tube entering the brain cavity. An OGT provides a safe alternative for gastric access in these high-risk scenarios.
Choosing the Orogastric Route Over Nasal Insertion
The choice between an orogastric and a nasogastric tube depends on the patient’s condition and the tube’s intended function. OGTs are often chosen when a larger tube diameter is required, such as during gastric lavage for overdose cases. The oral cavity accommodates a wider French size tube more easily than the narrow nasal passages, allowing for quicker evacuation of stomach contents.
In unconscious or sedated patients, the OGT may be easier and quicker to place because the diminished gag reflex reduces resistance. While nasogastric tubes are generally preferred for long-term feeding due to easier securing and less oral discomfort, the OGT is better suited for acute or short-term needs. Long-term nasal use can lead to irritation, pressure sores, or chronic sinusitis.
Significant facial or cranial trauma is a primary reason to choose the orogastric route. Injury compromising the nasal bone structure or the cribriform plate makes nasogastric insertion dangerous, risking misdirection into the brain. The OGT eliminates this risk entirely. The OGT is selected when the nasal route poses a clear danger or when therapeutic necessity, such as the need for a large-bore tube, dictates its use.
When OGT Placement Should Be Avoided
OGT placement is not appropriate for all patients, and certain conditions serve as contraindications due to the risk of complications. Any known or suspected obstruction of the esophagus, such as a stricture, mass, or congenital atresia, prevents safe passage of the tube. Attempting insertion in these cases risks esophageal perforation.
Recent surgery on the esophagus or stomach necessitates caution or avoidance of OGT placement. The fresh surgical site is fragile, and mechanical trauma from insertion could disrupt sutures or cause a leak. Similarly, if a patient has ingested corrosive or caustic substances, the esophageal lining may be severely damaged. Placing an OGT in this situation raises the risk of perforating the weakened esophageal wall.
The procedure should also be avoided in uncooperative patients or those with active, uncontrolled vomiting. Gagging or vomiting during insertion increases the likelihood of the patient aspirating stomach contents into the lungs. In these scenarios, medical teams must consider alternative methods for gastric access or nutritional support.