Nasogastric Tube Insertion Using Different Techniques in Anesthetized Patients: A Prospective, Randomized Study

It is often difficult to correctly place nasogastric (NG) tubes under anesthesia. We hypothesized that simple modifications in technique of NG tube insertion will improve the success rate. Two hundred patients were enrolled into the study. The patients were randomized into four groups: control, guidewire, slit endotracheal tube, and neck flexion with lateral neck pressure. The starting point of the procedure was the time when NG tube insertion was begun through the selected nostril. The end point was the time when there was either a successful insertion of the NG tube or a failure after two attempts. The success rate of the technique, duration of insertion procedure, and the occurrence of complications (bleeding, coiling, kinking, and knotting, etc.) were noted. Chi2, analysis of variance, and Student's t-test were used to analyze the data. Success rates were higher in all intervention groups compared with the control group. The time necessary to insert the NG tube was significantly longer in the slit endotracheal tube group. Kinking of the NG tube and bleeding were the most common complications. The success rate of NG tube insertion can be increased by using a ureteral guidewire as stylet, a slit endotracheal tube as an introducer, or head flexion with lateral neck pressure. Head flexion with lateral neck pressure is the easiest technique that has a high success rate and fewest complications.