Difficult nasogastric tube insertions.

NGT insertion is a procedure that is done frequently in Emergency Departments. A step-by-step procedure has been presented. There are certain circumstances that may make NGT insertion difficult. They are esophageal narrowing, comatose or intubated patients, and patients who have sustained severe facial or skull injuries. A number of strategies have been suggested to facilitate the passage of the NGT. These include generous lubrication, chilling the tube, grasping the alae of the thyroid and lifting anteriorly, using two fingers in the mouth to facilitate passage of the tube, and direct visualization. Complications, although rare, may occur. Examples of complications that are reported in the literature include mucosal ulcerations, submucosal passage of a tube, accidental passage of an NGT into the brain, and esophageal perforation. Generous lubrication, direct visualization, and the use of fluoroscopy, as well as knowledge of these complications, may help to decrease or prevent their incidence.