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These include:

Bleeding (e.g. oesophageal, major epistaxis)


Pain or discomfort during insertion
Gag reflex:

Misplacement, for example:


Coiling in the nose or oropharynx
Passing into the trachea (if the patient coughs)
Passing too far into the duodenum
Entering the cranial cavity
Local tissue necrosis
Oesophageal/gastric perforation
Failure

Hints and tips for the exam


You will be performing the procedure on a manikin,
so it is prudent to tell the examiner that you would
introduce yourself to the patient, obtain informed
consent, etc.
If there is an actor present, speak to them as you
would a patient.
Prior to inserting the tube, it is often helpful to briefly
examine the nose to check for a deviated septum in
order to determine which nostril is more suitable to
use.
It is vital to give the patient good clear instructions.

Technique
Be very gentle in your approach to the patient.
Aim to pass the tube along the floor of the nasal
cavity, in a posterior direction. Do not aim superiorly
as you will meet obstruction at the cribriform plate.
With facial trauma, it is not difficult to push the NG
tube through into the cranium.
There are different types of NG tube of different sizes.
Typically, 1618F is appropriate for an adult, whereas
in children the necessary size varies with age.
Use a cold NG tube. Colder tubes are less pliable and
are therefore more likely to keep their curvature for
longer. This makes them easier to direct, and reduces
the chance of their curling in the wrong place.
Ask for a cold NG tube, fresh from the fridge.
If cold tubes are not available, placing the distal
part in ice for a few minutes or spraying it with cold
spray/cryogesic will help.

Some patients can swallow without anything in


their mouth.
Many patients prefer to swallow with a sip of
water as this then becomes similar to swallowing
a pill.
If the patient gags (they then cannot swallow) or
coughs, stop the insertion, withdraw the tube and start
again.
Insert the tube to the length you measured
before insertion. If you forget to measure this length,
insert to 3040cm, and confirm placement on a chest
X-ray.
To measure the required length, ask patient to hold
their head straight. Hold the tip of the NG tube at the
tip of the nose, run it past the tragus of the ear and
down to just below the xiphisternum, and read off
the length on the calibration markings on the NG
tube itself.
Fix the tube securely with adhesive tape. To minimise
pressure necrosis around the tube insertion point, it is
advisable to apply a skin ointment/aqueous cream
before fixing the tube with tape.
The use of lidocaine gel for the nose, and benzocaine
or lidocaine spray for the throat, can help to minimise
discomfort, but their use for this purpose is
uncommon.
In some situations, for example gastric decompression, it is advisable to attach suction (with a Yankauer
suction catheter) or aspirate with a 50mL syringe after
insertion.
Attachment to a drainage bag or spigot minimises the
spreading of gastric secretions.

Methods of confirming placement


There are several, but only a chest X-ray is considered
confirmatory:
Chest X-ray: Essentially, you must ensure that the
tip of the NG tube is lying below the diaphragm and
not in the bronchial tree.