Basilar Skull Fracture and Oral Grastro Tube (OGT)

ckh23, BSN, RN · Dec 8, 2012

I wouldn't say that an OGT with a basilar skull fracture is an absolute contraindication. Plenty of people in the trauma unit have an OGT with a basilar skull fx. Was it specifically an OGT or an NGT. An NGT would be a different story.

This picture should show you why you don't put an NGT in a people with head/facial trauma.

http://ars.els-cdn.com/content/image/1-s2.0-S1079210400996197-gr1.jpg

emtb2rn, BSN, RN, EMT-B · Dec 8, 2012

If the pt is tubed you can slide the ogt right down alongside the ett.

akulahawkRN, ADN, RN, EMT-P · Dec 8, 2012

With a basilar skull fracture, an OGT doesn't get anywhere near the base of the skull, if it's properly inserted. NGT is contraindicated because it can go through the fracture and into the cranial vault. Same for "nasal trumpet" or NPA airway adjuncts. If the patient is conscious when it's placed, an OGT could cause too much movement as the patient has to swallow to assist in placement. Patient movement could be the contraindication, more than anything else.

Just could be.

ckh23, BSN, RN · Dec 8, 2012

With a basilar skull fracture, an OGT doesn't get anywhere near the base of the skull, if it's properly inserted. NGT is contraindicated because it can go through the fracture and into the cranial vault. Same for "nasal trumpet" or NPA airway adjuncts. If the patient is conscious when it's placed, an OGT could cause too much movement as the patient has to swallow to assist in placement. Patient movement could be the contraindication, more than anything else. Just could be.

I hope awake patients aren't getting OGTs.

Esme12, ASN, BSN, RN · Dec 8, 2012

I think you need to ask your preceptor again the question......OGT is the recommendation for a basilar skull fracture.....it the NGT that is considered contraindicated.

http://www.ramcjournal.com/2008/mar08/spurrier.pdf

Sun0408, ASN, RN · Dec 8, 2012

I have placed many OGT on our trauma pts with facial fx, orbital, skull fx etc.. An NGT is contraindicated.

sandrang1993 · Dec 11, 2012

So i guess it's NGT that's not recommended. Only because it might traumatize e injury further? Probably because of e fracture?

KelRN215, BSN, RN · Dec 11, 2012

So i guess it's NGT that's not recommended. Only because it might traumatize e injury further? Probably because of e fracture?

No, because the NG could end up in the brain... and kill the patient. See the article Esme posted.

Esme12, ASN, BSN, RN · Dec 11, 2012

Since you did not look at the article (which I suggest you do for it is very good.) I will explain.... for this mistake will kill someone!

The cribriform plate is the name given to a specific area of the human skull. It is part of the ethmoid bone, which is responsible for separating the brain from the nasal cavity. The cribriform plate attaches to a structure located on the frontal bone of the skull known as the ethmoidal notch. The roof of this structure also connects to the nasal cavities in the skull.

The cribriform plate is located directly posterior to the nares and is part of the ethmoid bone. It is very porous in nature and weaker than the surrounding portions of the ethmoid. It is easily fractured, and can be seen is association with basilar skull fractures. This is one source for rhinorrhea in patients with these fractures....the runny nose is actually CSF! (cerebral spinal fluid!)

So you insert the NGT into the brain.....an unintentional frontal lobotomy.

http://www.skullbaseinstitute.com/papers/craniofacial-skull-base-trauma.htm

FDW630 · Dec 11, 2012

This picture should show you why you don't put an NGT in a people with head/facial trauma.
http://ars.els-cdn.com/content/image/1-s2.0-S1079210400996197-gr1.jpg

Eep!!

nurseprnRN, BSN, RN · Dec 12, 2012

I am a third yr nursing student. I would like to know why is it that when a patient as Base of Skull Fracture, he or she is unable to have OGT inserted? This was asked by my preceptor and I cant figure out the answer. Would it be because of the skull anatomy which includes the temporal, occipital, sphenoid and the ethmoid bone?

Because your instructor is confused, or because you are. It's NG tubes, nasogastric, that you don't put into people with fractures in the base of their skulls, because you can shove it right into their brains. OGT, orogastric tubes, inserted through the mouth into the esophagus and thence to the stomach, can be placed carefully to be sure they don't divert upwards towards that fractured skull floor and that they don't track right down next to the ET tube into the lungs.