A simple technique for nasogastric feeding tube insertion

Nasogastric tubes are increasingly used in the management of a diverse group of patients who generally require short-term enteral feeding. Various techniques of insertion have been described emphasizing the fact that as yet there is no simple and safe method. Nasogastric intubation in head and neck cancer patients may be especially difficult following radiotherapy due to difficulties in swallowing secondary to edema, mucositis, abnormal anatomy and altered sensation. In this paper, we describe a simple technique that evolved from experience of passing enteral feeding tubes in head and neck cancer patients. The feeding tube is inserted through the appropriate nasal cavity, and at 21 cm (8 inches) from the anterior nares in the average adult (corresponding to a few millimeters above the arytenoids), the patient is asked to vocalize by saying 'eeeee' in a high pitched tone. The tube is then advanced into the esophagus while the patient is vocalizing. This technique has been successfully carried out in 22 consecutive patients, thereby avoiding the use of more invasive methods.