Endoskopisch geführte Anlage von Ernährungssonden – Schritt für Schritt

Die Dysphagie ist ein häufiges Problem in der Pflege insbesondere auch auf der Stroke Unit. Die „blinde“ Anlage von Nasogastralsonden (NGS) verursacht aber häufig Komplikationen. Diese Arbeit zeigt die wesentlich sicherere Technik der endoskopisch geführten Anlage der NGS im Video und erläutert sie ausführlich im begleitenden Text.

Abstract

To prevent aspiration pneumonia and malnutrition after stroke, a nasogastric tube (NGT) is often placed. In daily clinical practice the “blind” insertion of the NGT is often associated with complications. Probe- and insertion-related traumata (erosions, ulcerations and/or bleeding) or incorrect placement of the probes may lead to further deterioration in the clinical condition of patients who have already suffered a stroke. FEES (Fibreoptic Endoscopic Evaluation of Swallowing) allows the NGT to be inserted under visual control, dramatically reducing complication rates. This paper presents the procedure for endoscopically guided placement of feeding tubes in the accompanying video.

Publikationsverlauf

Artikel online veröffentlicht:
03. Juni 2025

• Literatur

• 1 Martino R, Foley N, Bhogal S. et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005; 36: 2756-2763
• 2 Valentini L, Volkert D, Schütz T. et al. Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM). DGEM-Terminologie in der Klinischen Ernährung. Aktuel Ernahrungsmed 2013; 38: 97-111
• 3 Dziewas R, Pflug C. S1-Leitlinie Neurogene Dysphagie. AWMF-Registernummer 030–111. 2020 Zugriff am 21. April 2025 unter: https://register.awmf.org/de/leitlinien/detail/030–111
• 4 Thomsen TW, Shaffer RW, Setnik GS. Nasogastric Intubation. N Engl J Med 2006; 354: e16
• 5 Appukutty J, Shroff PP. Nasogastric tube insertion using different techniques in anesthetized patients: a prospective, randomized study. Anesth Analg 2009; 109: 832-835
• 6 Heidler MD. Nasensonden: Komplikationen und Auswirkungen auf Schluckprozesse bei Schlaganfallpatienten. Neurol Rehabil 2015; 21: 65-71
• 7 Motta APG, Rigobello MCG, Silveira R. et al. Nasogastric/nasoenteric tube-related adverse events: an integrative review. Rev Lat Am Enfermagem 2021; 29: e3400
• 8 Halloran O, Grecu B, Sinha A. Methods and complications of nasoenteral intubation. JPEN J Parenter Enteral Nutr 2011; 35: 61-66
• 9 Nascimento A, Carvalho M, Nogueira J. et al. Complications Associated With Nasogastric Tube Placement in the Acute Phase of Stroke: A Systematic Review. J Neurosci Nurs 2018; 50: 193-198
• 10 Metheny NA, Krieger MM, Healey F. et al. A review of guidelines to distinguish between gastric and pulmonary placement of nasogastric tubes. Heart Lung 2019; 48: 226-235
• 11 Norton B, Homer-Ward M, Donnelly MT. et al. A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. BMJ 1996; 312: 13-16
• 12 Rowat A, Wardlaw J, Dennis M. Changes in arterial oxygen saturation before and after enteral feeding tube insertion in dysphagic stroke patients. Age Ageing 2004; 33: 42-45
• 13 Dziewas R, Lüdemann P, Konrad C. et al. Simple method for placing nasogastric tubes in patients with dysphagia. Lancet 2001; 358: 725-726
• 14 Dziewas R, Schilling M, Konrad C. et al. Placing nasogastric tubes in stroke patients with dysphagia: efficiency and tolerability of the reflex placement. J Neurol Neurosurg Psychiatry 2003; 74: 1429-1431
• 15 Hamidon BB, Abdullah SA, Zawawi MF. et al. A prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with acute dysphagic stroke. Med J Malaysia 2006; 61: 59-66
• 16 Dziewas R, Warnecke T, Hamacher C. et al. Do nasogastric tubes worsen dysphagia in patients with acute stroke?. BMC Neurol 2008; 8: 28
• 17 Beavan J, Conroy SP, Harwood R. et al. Does looped nasogastric tube feeding improve nutritional delivery for patients with dysphagia after acute stroke? A randomised controlled trial. Age Ageing 2010; 39: 624-630
• 18 Rabaut J, Thirugnanachandran T, Singhal S. et al. Clinical Outcomes and Patient Safety of Nasogastric Tube in Acute Stroke Patients. Dysphagia 2022; 37: 1732-1739
• 19 Mahoney C, Rowat A, Macmillan M. et al. Nasogastric feeding for stroke patients: practice and education. Br J Nurs 2015; 24: 319-320
• 20 Torsy T, Saman R, Boeykens K. et al. Accuracy of the corrected nose-earlobe-xiphoid distance formula for determining nasogastric feeding tube insertion length in intensive care unit patients: A prospective observational study. Int J Nurs Stud 2020; 110: 103614
• 21 de Aguilar-Nascimento JE, Kudsk KA. Clinical costs of feeding tube placement. JPEN J Parenter Enteral Nutr 2007; 31: 269-273
• 22 Logemann JA, Kahrilas PJ, Kobara M. et al. The benefit of head rotation on pharyngoesophageal dysphagia. Arch Phys Med Rehabil 1989; 70: 767-771
• 23 Chen H, Liu L, Wang J. et al. Efficacy and safety of placing nasoenteral feeding tube with transnasal ultrathin endoscope in critically ill patients. Chin Med J (Engl) 2009; 122: 2608-2611