Nasogastric Intubation Periprocedural Care

Updated: May 26, 2017
  • Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Vikram Kate, MBBS, MS, PhD, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS  more...
  • Print
Periprocedural Care

Equipment

The following equipment is needed for nasogastricn (NG) intubation (see the image below):

  • NG tube (for adult patients) - 16-18 French
  • NG tube (for pediatric patients) - In pediatric patients, the correct tube size varies with the patient's age; to find the correct size (in French), add 16 to the patient's age in years and then divide by 2, so that for an 8-year-old child, for example, the correct size is 12 French ([8 + 16]/2 = 12)
  • Viscous lidocaine 2%
  • Oral analgesic spray (benzocaine spray or other)
  • Syringe, 10 mL
  • Glass of water with a straw
  • Water-based lubricant
  • Toomey syringe, 60 mL
  • Tape
  • Emesis basin or plastic bag
  • Wall suction, set to low intermittent suction
  • Suction tubing and container
Equipment for nasogastric intubation. Equipment for nasogastric intubation.
Next:

Patient Preparation

Anesthesia

Various methods of topical anesthesia for NG intubation have been proved effective in pain relief and improve the likelihood of successful NG intubation. [1, 2, 3, 4, 5]

The use of viscous lidocaine (ie, the sniff and swallow method) was found to significantly reduce the pain and gagging sensation associated with NG tube insertion. [6]  Viscous lidocaine is discussed in more detail in the Technique section below.

Alternative techniques include the following:

  • Nebulization of lidocaine 1% or 4% through a face mask (≤4 mg/kg; not to exceed 200 mg per dose in adults) is an option; the authors recommend that a preservative-free lidocaine (ie, intravenous lidocaine) be used for nebulization in order to minimize the risk of allergic reaction
  • An anesthetic spray that contains benzocaine or a tetracaine/benzocaine/butyl aminobenzoate combination may be applied to the nasal and oropharyngeal mucosa; be advised that incidents of methemoglobinemia after a single use of benzocaine topical sprays have been reported to the US Food and Drug Administration (FDA); for more information, see  Anesthesia, Topical

Positioning

The patient should be seated in an upright position.

Previous