- With the patient supine, introduce an anesthetic gel
(2% viscous Xylocaine) into the nostril to be intubated. Have the
patient "sniff" the gel while the opposite nostril is occluded. It is
also helpful to anesthetize the posterior pharynx with a topical spray,
such as 10% lidocaine (Xylocaine).
- Before introducing the feeding tube into the patient,
inject approximately 10 cc of water into its lumen to activate its
Hydromer lubricant. Then, insert the stylet into the catheter to stiffen
it. Bend the distal end of the stylet into a gentile curve to increase
the torquability of the feeding tube. Before introducing the tube,
stretch and bend its weighed end to make it more flexible and curved
and, thus, easier to pass through the nose.
- Choose the most patent nostril for tube placement.
With the patient's neck hyperextended, introduce the catheter tip
gently into the nostril. Direct the catheter tip to the medial
inferior wall of the nasal cavity. At no time should the catheter be
forced against a resistance. If resistance is encountered, fluoroscopic
guidance should be used to proceed further.
- When approximately 5 cm of the catheter
have been inserted, have the patient flex his neck. Push the
catheter gently while encouraging the patient to swallow. This will
direct the catheter past the cricopharyngeus muscle and into the
esophagus.
- Continue pushing the catheter until resistance is
met. After the tip of the catheter enters the stomach, turn the patient
into the right lateral or RAO position. Advance the catheter, and its
tip should pass by gravity into the antrum of the stomach.
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