There are relatively few contraindications to nasogastric intubation. However, severe complications can occur if a NGT is inserted in the presence of one of the following conditions.

Maxillofacial trauma

 

Esophageal abnormalities

 

Altered mental status

MAXILLOFACIAL TRAUMA

NGTs are contraindicated in patients sustaining significant maxillofacial trauma because the cribriform plate may be disrupted providing a portal for NGT entry into the cranial vault. 17 (See the Anatomy and Complications sections for further discussion.) Additionally, caution should be exercised with head trauma patients who are at high risk for elevated intracranial pressure, as NGT insertion may trigger even further elevations in the ICP. 16

ESOPHAGEAL ABNORMALITIES

Patients with a history of recent caustic ingestion are at high risk of esophageal perforation and should not have a NGT placed without prior consultation with the gastroenterologist who will perform the subsequent endoscopy. 4

Other patients with known esophageal pathology (e.g. diverticulae, strictures) are also at high risk of esophageal perforation and the risks of NGT insertion should be carefully considered before proceeding.

Traditional teaching suggests that NGT insertion is contraindicated in patients with esophageal varices, out of fear that blind passage of the tube may initiate or exacerbate variceal bleeding. However, several studies have shown that NGT passage in these patients is safe, and that varices should not be considered a contraindication to NGT insertion. 9 , 18

ALTERED MENTAL STATUS

Patients with altered mental status who are unable to maintain adequate airway protection are at high risk of aspirating gastric contents during NGT insertion, especially if vomiting occurs during the procedure. If such a patient requires a NGT, definitive airway management with a cuffed endotracheal tube should be performed prior to the NGT insertion.

 

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