Name of the Procedure:

• Common Name: Stomach Tube Insertion
• Technical/Medical Name: Stomach Tube - Levine Type (HCPCS Code: B4083)

Summary

A stomach tube - Levine type is a medical procedure where a flexible tube is inserted through the patient's nose or mouth and into their stomach. This tube can be used for various purposes, such as feeding, medication administration, or stomach content removal.

Purpose

• Medical Conditions: Used for patients who cannot ingest food normally, require stomach content drainage, or need medication delivery directly to the stomach.
• Goals: To ensure proper nutrition, medication administration, and removal of stomach contents for diagnostic or therapeutic reasons.

Indications

• Symptoms/Conditions: Difficulty swallowing, impaired digestion, need for gastric decompression, or medical conditions like gastroparesis.
• Patient Criteria: Patients with compromised oral intake, those undergoing certain medical treatments or surgeries, or those who require diagnostic testing of stomach contents.

Preparation

• Instructions: Fasting for a specified period before the procedure (typically 6-8 hours), adhering to medication adjustments as directed by the healthcare provider.
• Assessments: Physical examination, confirmation of patient understanding, and sometimes imaging studies to ensure proper placement.

Procedure Description

1. Preparation: Patient is positioned comfortably, and local anesthetic may be applied to numb the nasal passage.
2. Insertion: A lubricated Levine tube is gently inserted through the nose or mouth.
3. Placement: The tube is carefully advanced into the stomach, monitored by checking gastric aspirate or using imaging technology.
4. Confirmation: Tube placement is confirmed by auscultating air insufflation or via X-ray if required.
5. Securing: The tube is secured to the patient's nose or cheek to prevent displacement.

• Tools: Levine tube, lubricant, local anesthetic, tape or fixation device.
• Anesthesia: Local anesthetic for numbing; general anesthesia is rarely used unless combined with another procedure.

Duration

The insertion process typically takes about 10-20 minutes.

Setting

Performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Primary care physician or gastroenterologist
• Nurses (for assistance and patient care)
• Radiologist (if imaging confirmation is needed)

Risks and Complications

• Common Risks: Discomfort, nosebleed, gagging, irritation.
• Rare Complications: Tube misplacement, aspiration, esophageal perforation, infection. Management involves repositioning the tube, supportive care, and monitoring.

Benefits

• Expected Benefits: Improved nutritional intake, effective medication delivery, removal of harmful stomach contents.
• Realization Timeline: Benefits are typically immediate, providing prompt relief and support.

Recovery

• Post-Procedure Care: Monitor for signs of complications, maintain tube care and hygiene, follow dietary and medication guidelines.
• Recovery Time: Immediate, with ongoing care as needed.
• Restrictions: Follow dietary restrictions, avoid activities that might displace the tube, attend follow-up appointments as necessary.

Alternatives

• Other Options: Nasojejunal tube, percutaneous endoscopic gastrostomy (PEG) tube, total parenteral nutrition (TPN).
• Pros and Cons: Other tubes might be suitable for long-term use or bypass specific digestive sections; TPN is entirely non-gastrointestinal but requires central venous access and carries more risk.

Patient Experience

• During Procedure: Mild discomfort, possible gagging or nasal irritation.
• After Procedure: Sensation of the tube, minor throat soreness, managed with lozenges or mild pain relief. Most patients adapt quickly with proper guidance and support from healthcare providers.