43752 Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report)

Name of the Procedure:

Naso- or oro-gastric tube placement with fluoroscopic guidance
Common Names: NG tube placement, OG tube placement
Technical Term: Fluoroscopically guided nasogastric or orogastric tube placement

Summary

This procedure involves inserting a tube through the nose (naso-) or mouth (oro-) into the stomach, guided by real-time imaging (fluoroscopy) to ensure correct placement. It requires a physician's expertise to perform safely and accurately.

Purpose

This procedure is typically used to:

• Relieve gastric distension
• Administer medications or nutrients directly to the stomach
• Remove gastric contents for analysis or decompression The goal is to provide relief from symptoms, facilitate nutrition, and ensure proper gastric functioning.

Indications

• Severe vomiting or inability to swallow
• Need for gastric decompression due to obstruction
• Administration of enteral nutrition in patients unable to eat
• Aspiration of gastric secretions for diagnostic purposes

Preparation

• Patients may be asked to fast for a specified duration before the procedure.
• Relevant diagnostic tests, such as blood work or imaging, may be required.
• Pre-procedure instructions will include details about medication adjustments or discontinuations.

Procedure Description

1. The patient is positioned appropriately to facilitate tube insertion.
2. Local anesthetics or mild sedation may be administered to ensure patient comfort.
3. A lubricated nasogastric or orogastric tube is gently inserted through the nose or mouth.
4. Fluoroscopy is used to guide the tube’s progression and confirm proper placement in the stomach.
5. Once the tube is in place, additional imaging confirms correct positioning, and the tube is secured.

Duration

The procedure typically takes 15-30 minutes.

Setting

The procedure is usually performed in a hospital setting, specifically in the radiology or endoscopy suite.

Personnel

• Physician (typically a radiologist or gastroenterologist)
• Radiologic technologist
• Nurse or medical assistant
• Anesthesiologist (if sedation is required)

Risks and Complications

• Common: discomfort, nasal or throat irritation, minor bleeding
• Rare: accidental placement into the lungs, perforation, infection
• Complications are managed through careful monitoring and appropriate interventions.

Benefits

• Immediate relief from symptoms such as discomfort from gastric distension
• Accurate delivery of medication and nutrition
• Diagnosis or therapeutic intervention made possible through direct gastric access
• Benefits are typically realized immediately or within hours of the procedure.

Recovery

• Patients are monitored for a short period after the procedure to ensure tube stability and patient comfort.
• Instructions on tube care and monitoring are provided.
• Follow-up appointments may be scheduled to assess the tube’s function and patient’s condition.

Alternatives

• Percutaneous endoscopic gastrostomy (PEG) tube placement
• Total parenteral nutrition (TPN)
• Medications to manage symptoms non-invasively
• Pros and cons of each alternative will vary based on patient-specific conditions and needs.

Patient Experience

During the procedure, the patient may feel discomfort or gagging as the tube is inserted. Sedation or local anesthesia helps minimize these sensations. Post-procedure, patients might experience mild throat soreness or irritation. Pain management options and comfort measures are provided to ensure patient comfort.