Question

You are required to insert a naso gastric tube for a resident. What cautions and contraindications will you look for prior to using Xylocaine jelly as a lubricant during tube insertion

Answer 1

Naso-gastric tube insertion of Xylocaine:

Naso-gastric tube insertion mostly used in clinical practice and it could be a painful procedure for patients. These tubes are flexible lumen tubes which passed from nose to stomach. Naso-gastric tube insertions can be used for both diagnostic and therapeutic purposes. In this process pains are mainly associated with the procedure of tube insertion. These are the major outcomes have been observed in Naso-gastric tube insertion such as overall pain, nasal pain and discomfort (choking, gagging, nausea, vomiting). These points should be considered in the Naso-gastric tube insertions.

Xylocaine is local anasthetics which is used as lubricant (about 2%) in Naso-gastric tube insertions to reduce the pain in the nasopharynx.

Length of the tube should be taken from the tip of the patient’s nose to ear and then down to the xiphisternum. The Naso-gastric tube should be marked off in centimeter increments so you can just note the length. Now lubricate the tip of the tube up to the first few centimeters. In general sterile water is required.

The position of the patients should be in upright with head flexed forward i.e. chin on chest. When tube posses into nasopharynx, ask to the patients to sip a mouthful of water. Position the patient. Ideal position is sitting upright with the head flexed forward (chin on chest. As the tube passes into the nasopharynx, ask the patient to sip a mouthful of water. Then withdraw the aspirate sample by bladder syringe and test the pH of the sample. If a pH is less than 5.5, this indicates that Naso-gastric tube is in the stomach. If pH is more than 5.5, it means patients have respiratory distress. Some other factors should be considered such as if a patient is taking any protan pump inhibitors or H2 receptor antagonist.