Duodenal Intubation (cont.)

Transnasal intubation is more comfortable for the patient than peroral intubation. A suggested method of intubation is as follows:

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).
Outside the body, insert the torque cable into the catheter. Withdraw the torque cable 5 cm to make the tip of the catheter soft and flexible. Hold the catheter with the thumb and index finger approximately 6 cm proximal to the distal end. 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 the patient swallows. This will direct the catheter 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 position. Advance the catheter, and its tip should pass by gravity into the antrum of the stomach.