Intubation And Drainage
Learning Objectives
1.
Describe the use of nasobiliary/nasopancreatic catheters and
biliary/pancreatic stents.
2.
Discuss procedures for gastric lavage, clonic decompression, and
abdominal paracentesis.
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Nasogastric tube insertion
◦ Indications for nasogastric intubation
 Treatment of gastric distention or gastric outlet
obstruction
 Assessment and treatment of upper GI bleeding
 Certain gastric/esophageal test
 Gastric lavage
 Aspiration of gastric secretions
 Prevention of vomiting by decompressing the
stomach after major surgery and empting the upper
GI tract before emergency surgery.
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Most common tubes used
◦ Leven tube- one lumen,
◦ Salem sump tube- has a primary suctiondrainage lumen and a smaller vent lumen.
Intermittent high suction or continuous low
suction my be used with this pump
◦ Extended-use nasogastric feeding tubes. Are
made of soft, flexible plastic material, with
either a weighted or unweighted tip. May use
guidewire to faciltitate insertion.
Moss tube- is a double lumen tube with a
gastric retention balloon, a port for distal
duodenal feeding and several esophageal, gastric,
and proximal duodenal aspiration ports.
 Compat tube- is a 9fr nasojejunal feeding tube
combined with an 18fr gastric suction port
lumen. The gastric port serves for
decompression and drainage as well as
providing a port to administer medication. Use
of fluoroscopy is recommended for placement.

Intubation and Drainage
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Esophageal prostheses
◦ Provide a patent lumen for purposes of
nourishment and oral secretions in patients
with terminal, obstructive esophageal cancer.
◦ Endoscopic placement required
◦ Early 1990’s esophageal prostheses were
made of silicone rubber or latex
◦ With the advent of self expanding metal
stents these are no longer used.

Indications for placement of prothesis
◦ Malignant carinoma of the lower two thirds of
the esophagus with dysphagia becomes a
problem
◦ Esophageal-pulmonary fistulas or extrinsics
compression of esophagus.

Contraindications of placement of
prosthesis
◦ When another medical condition takes
priority
◦ For cancers that are less than 2 cm below the
upper esophageal sphincter
◦ If tumor invaion compressed the trachea
and/or bronchus
◦ If the stricture cannot be adequately diated
◦ In uncooperative or unmotivated patients.

Gastic Lavage
◦ Involves insertion of a gastric tube through
the nose or mouth.
◦ Its is indicated in patients wit acute GI
bleeding when preparing the stomach for
endoscopy after barium or food ingestion, and
for evacuating the stomach after ingestion of
toxic substances.

Different tube of gastric tubes
◦ Double-lumen orogastric “stomach pump” tube is
indicated in situations where intermittent gastric
lavage and evacuation are required.
◦ Single-lumen tube with several opening at the distal
end is usually passed orally, but it can be inserted
nasally. Allows rapid lavage and evacuation of large
volumes of fluid, but continuous irrigation is not
possible, because the same lumen must be used for
both.

Nasobiliary/nasopancreatic catheters
◦ Nasobiliary catheter (NBCs) and (NPCs)
nasopancreatic catheters are used for shortterm decompression or perfusion within the
biliary and pancreatic ductal systems.

Indication for NBC placements
◦ Decompression of obstructed bile duct in acute
suppurative cholangitis.
◦ Prevention of stone impaction after endoscopic
sphincterotomy.
◦ Temporary biliary decompression in patients who are
septic or who have sever coagulopathy
◦ Facilitating the healing process in traumatic or surgical
biliary fistulas.
◦ Management of common bile duct stones.

Nasobiliary/Nasopancreatic Catheter
Placement
◦ ERCP is performed with side viewing scope.
◦ Biliary stents
 Pigtail stent-one or both ends of the tubes or
coiled
 Barbed stents have projections or “barbs,” at each
end that result from a diagonal cut of the stent wall.

Indications for a biliary stent
◦ Relief of obstructive jaundice in patients with benign
or malignant strictures or the bile duct.
◦ Palliative treatment of inoperable or metastatic
pancreatic or periampullar neoplams.
◦ Pre-op decompression to decrease complications
associated with high bilirubin levels
◦ Maintaining biliary decompression in cases of
sclerosin
◦ Cholangitis with stricture of the extrahepatic bile
ducts
◦ Poscholecystectomy biliary leak

Pancreatic stents
◦ Indications for pancreatic stenting
Unresolved pancreatitis
Idiopathic acute pancreatitis
Pancreas divisum with syptomatology
Pancreatic duct disruption, traumatic carcinoma, and
idiopathic
 Prevention of post ERCP pancreatitis
 Pancreatic strictures and or stones
 Sphincter of Odi dyspfunction
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Metal stents
◦ Self-expanding metal stents (SEMS) are
currently available endoscopically for
esophageal, tracheobranchial, duodenal, biliary,
and colonic placement.
◦ They are permanent
◦ Not removable with surgery
◦ Only inserted endoscopically for palliation of
the patient who has been diagnosed with an
obstruction neoplasm.

Temporary Expandable Stents.
◦ With the advent of expandable polyester
silicone covered stents, we can now remove
or reposition.
◦ Useful in treating refractory benign
esophageal strictures.

Intestinal (Nasoenteric)Intubation
◦ The Cantor tube, Kaslow tube, harris tube
and the Miller-Abbott tubes were use with
the injection of mercury as a weight, but are
not used today because of the danger of
mercury.
◦ Nasoenteric tubes are longer than nasogastric
tubes.

Indications for intestinal nasoenteric intubation
◦ To aspirate intestinal contents for exmination
◦ To treat intestinal obstruction by providing intestinal
decompression, relieving dilatation porximal to the
obstruction, decreasing and diverting intestinal
secretions and gas formation, and providing intestinal
stenting.
◦ To prepare the intestinal tract for surgery by
removing intestinal contents.
◦ Cont…
To prevent post-operative nausea,
vomiting and abdominal distention.
 To provide enteral alimentation postoperatively until edema at the operatrive
site has subsided, or until peristalsis
returns
 To provide enteral alimentation when the
patient’s condition prohibits gastric
feeding

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Colon decompression
◦ Involves placement of a tube in the rectum or
colon to relieve colonic distention.
 Indications
 Patients with colonic psedo-obstruction (non-toxic
megacolon or Ogilvie’s syndrome),
 Post-operative ileus,
 Colon distention secondary to flexible sigmoidoscopy or
colonoscopy.
 Ogilvie’s syndrome occurs in elderly pt’s who have a
preexisting disease that necessitates bed rest.

Rectal tubes
◦ Small lumen decompression tube, can be
passed through the biopsy channel of a
colonoscope to the cecum. Colonoscope is
then removed while the tube is continual
advanced through the channel.
◦ Large lumen decompression tube can be used
the channel of the scope and a suture is tied
around the distal end of the decompression
tube.

Abdominal Paracentesis
◦ Involves withdrawal of fluid fro the peritoneal
space for diagnostic and therapeuitc purposes,
using a large-bore needle or a trocare and
cannula inserted in the abdominal wall.
 Indication for paracentesis
 Evaluation of ascities
 Determination of a perforated viscue following blunt trauma
or symptoms of acute abdomen and relief of dyspnea or
abdominal pain secondary to tense ascites

Contraindicated for paracentesis
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Severe coagulopathy
Thrombocytopenia
Intestinal obstruction
Abdominal wall infection
Previous multiple abdominal surgeries
Portal hypertension with abdominal collateral
circulation