METHOD OF INSERTION
Length of insertion
estimated by measuring from the patient’s nose to ear then down to the xiphoid cartilage
Awake patients
sit patient upright
consider nebulised lignocaine, vasoconstrictor spray and lignocaine gel if time (there usually is time!)
ensure the tube is well lubricated with KY or lignociane gel
the tube is advanced and directed horizontally and medially along the floor of the nose and down into the posterior pharynx (“noses go back, they don’t go up!”)
assist insertion by asking the patient to swallow, or have the patient drink water
withdraw the tube promptly into the oropharynx if the patient has excessive choking, gagging, coughing, a change in voice, or the appearance of condensation on the inner aspect of the tube
Unconscious patients
blind approach: fingers in pharynx if neuromuscular blockade, flex neck, manipulate the mandible, larynx and/or cricoid anteriorly
laryngoscopic guidance and use McGills to feed tube into esophagus
Trouble-shooting insertion
the most common sites of resistance at the laryngeal level are the arytenoid cartilages and piriform sinuse
Do not attempt to re-use a NGT that has already used for a failed insertion
Use a fresh tube from the fridge (the colder the better), as these are more rigid and less pliable, and are therefore easier to pass
If the tube continually curls up in the pharynx, flex the patient’s neck as much as possible and re-insert, which may change the angle sufficiently to pass an obstruction
Try placing patient’s head in the lateral position or applying lateral neck pressure (may help prevent impaction of the tube on the arytenoids and in the piriform fossa)
METHOD OF INSERTIONLength of insertionestimated by measuring from the patient’s nose to ear then down to the xiphoid cartilageAwake patientssit patient uprightconsider nebulised lignocaine, vasoconstrictor spray and lignocaine gel if time (there usually is time!)ensure the tube is well lubricated with KY or lignociane gelthe tube is advanced and directed horizontally and medially along the floor of the nose and down into the posterior pharynx (“noses go back, they don’t go up!”)assist insertion by asking the patient to swallow, or have the patient drink waterwithdraw the tube promptly into the oropharynx if the patient has excessive choking, gagging, coughing, a change in voice, or the appearance of condensation on the inner aspect of the tubeUnconscious patientsblind approach: fingers in pharynx if neuromuscular blockade, flex neck, manipulate the mandible, larynx and/or cricoid anteriorlylaryngoscopic guidance and use McGills to feed tube into esophagusTrouble-shooting insertionthe most common sites of resistance at the laryngeal level are the arytenoid cartilages and piriform sinuseDo not attempt to re-use a NGT that has already used for a failed insertionUse a fresh tube from the fridge (the colder the better), as these are more rigid and less pliable, and are therefore easier to passIf the tube continually curls up in the pharynx, flex the patient’s neck as much as possible and re-insert, which may change the angle sufficiently to pass an obstructionTry placing patient’s head in the lateral position or applying lateral neck pressure (may help prevent impaction of the tube on the arytenoids and in the piriform fossa)
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