RYLE'S TUBE / INTUBATION

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RYLE'S TUBE / INTUBATION




 A nasogastric tube is a narrow-bore tube passed into the stomach via the nose. It is used for short- or medium-term nutritional support, and also for aspiration of stomach contents - eg, for decompression of intestinal obstruction




INTUBATION LIVE DEMO


 

A wide-bore tube is used if drainage is needed; otherwise, a finer-bore tube is used. Fine-bore feeding tubes (gauge less than 9) cause less discomfort and less risk of rhinitis, pharyngitis or oesophageal erosion.

The use of a nasogastric tube is suitable for enteral feeding for up to six weeks. Polyurethane or silicone feeding tubes are unaffected by gastric acid and can therefore remain in the stomach for a longer period than PVC tubes, which can only be used for up to two weeks. For long-term enteral feeding, the use of percutaneous endoscopic gastrostomy (PEG) is associated with improved survival, better tolerance by the patient and lower incidence of aspiration.

  • Explain the procedure and obtain consent.
  • Provide a signal for the patient to stop the procedure.
  • Sit the patient in a semi-upright position with the head supported with pillows and tilted neither backwards nor forwards.
  • Examine the nostrils for deformity or obstructions to determine the best side for insertion.
  • Measure the tubing from the bridge of the nose to the earlobe, then to the point halfway between the lower end of the sternum and the navel.
  • Mark the measured length with a marker or note the distance.
  • Lubricate 2-4 inches of tube with lubricant (eg, 2% Xylocaine®).
  • Pass the tube via either nostril, past the pharynx, into the oesophagus and then into the stomach
  • Instruct the patient to swallow and advance the tube as the patient swallows (sipping a glass of water helps).
  • If resistance is met, rotate the tube slowly while advancing downwards. Do not force.
  • Stop immediately and withdraw the tube if the patient becomes distressed, starts gasping or coughing, becomes cyanosed or if the tube coils in the mouth.
  • Advance the tube until the mark is reached.
  • Check the tube's position (see below).
  • Secure the tube with tape.


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