Periprocedural Care
Equipment
The following equipment is needed for nasogastric (NG) intubation (see the image below):
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NG tube (for adult patients) - 16-18 French
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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)
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Viscous lidocaine 2%
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Oral analgesic spray (benzocaine spray or other)
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Syringe, 10 mL
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Glass of water with a straw
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Water-based lubricant
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Toomey syringe, 60 mL
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Tape
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Emesis basin or plastic bag
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Wall suction, set to low intermittent suction
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Suction tubing and container
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Patient Preparation
Anesthesia
Various methods of topical anesthesia for NG intubation have been proved to be effective in pain relief and to improve the likelihood of successful NG intubation. [7, 8, 9, 10, 11]
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. [12] Viscous lidocaine is discussed in more detail in the Technique section below.
Alternative techniques include the following:
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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
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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
Media Gallery
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Equipment for nasogastric intubation.
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Aspiration of viscous lidocaine into a syringe.
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Instillation of viscous lidocaine 2%.
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Estimation of nasogastric tube length from nostril to stomach.
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Nasogastric tube lubrication with water-based lubricant.
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Patient flexing his neck and drinking water while a nasogastric tube is inserted.
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Auscultation over the stomach.
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Secured nasogastric tube.
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Nasogastric tube in lung.
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Nasogastric tube insertion.
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