Fluoroscopic nasojejunal tube insertion

Fluoroscopic
nasojejunal tube insertion • Malpositioned nasojejunal tube - Ganzer Fall bei Radiopaedia
Knipe H, Malpositioned nasojejunal tube. Case study, Radiopaedia.org (Accessed on 06 Jan 2023) https://doi.org/10.53347/rID-30003 • CC by-nc-sa 3.0 (modified)
Fluoroscopic
nasojejunal tube insertion • Esophageal perforation and its treatment - Ganzer Fall bei Radiopaedia
Bickle I, Esophageal perforation and its treatment. Case study, Radiopaedia.org (Accessed on 06 Jan 2023) https://doi.org/10.53347/rID-84523 • CC by-nc-sa 3.0 (modified)
Radiopaedia • CC-by-nc-sa 3.0 • de

Fluoroscopic nasojejunal (NJT) or nasogastric tube (NGT) insertion is a valuable procedure offered by radiologists in patient care.

The majority of nasogastric tubes are inserted on the ward level and nasojejunal tubes may be placed in theater at the time of surgery. In difficult cases, insertion under fluoroscopic guidance is undertaken.

Equipment

  • nasogastric or nasojejunal tube (with radiopaque and ideally weighted tip)
  • bowl of warm water (to immerse the tube in)
  • lidocaine infused lubricant gel or local anesthetic spray
  • adhesive sticker (to secure to nose/face after completion)

Technique

Typically the initial insertion over the pharynx into the esophagus (avoiding insertion into the larynx and tracheobronchial tree) is performed in the lateral position, reverting to the AP position for progress into the distal esophagus, stomach and small bowel.

In the case of a nasojejunal tube, the tip position at or beyond the duodenojejunal flexure (ligament of Treitz) is desirable. It may move further distally over time with peristalsis.