- Aspiration of stomach contents to decompress the stomach of fluid, air, or blood.
- Introducing fluids to the stomach such as charcoal, enteral feeding and oral contrast media.
- Reducing the risk of vomiting or aspiration such as in bowel obstruction
- Sometimes used to in still air into the stomach to detect a gastric perforation on erect CXR
- Caustic ingestion or esophageal strictures (risk of perforation)
- Coagulopathy (epistaxis risk)
- Base of skull fracture
- Severe mid-face trauma (risk of cribriform plate disruption with NGT entering the brain!)
- Coagulopathy or facial trauma, consider an orogastric tube placement.
- Ameliorate the pain and gagging associated with tube placement by using vasoconstrictors (e.g. 0.05% oxymetolazine spray), topical anesthetics, and antiemetics — ALWAYS use these if time permits.
- 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
- Suspect an esophageal location if the patient immediately burps upon insufflation when checking position.
- 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.
- Nebulised lignocaine (4 mL of 10%) or lignocaine lubricating gel should be administered prior to insertion of the tube to reduce discomfort and increase patient compliance.
- DO NOT use the NGT for any fluid administration until CXR confirmation of position.
- 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
- Options if unable to place NGT (unconscious patient)
- Use McGills forceps
- Use ETT with a slit in the lesser curvature as guide
- Use soft well lubricated NPA
- Anterior manipulation of laryngeal cartilage
- Fibreoptic scope placement using guidewire