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| (i) Do not intubate some patients with maxillofacial disorders, following maxillofacial surgery or trauma, esophageal tumors or surgery, laryngectomy, oropharyngeal tumors, skull fractures, unstable cervical spinal injuries (involving vertebrae 4 or above), and esophageal varices. | |
| (ii) Do explain the procedure to the patient. | |
| (iii) Do wear nonsterile gloves. | |
| (iv) Do wear a mask, eye protection, and a gown when dealing with patients prone to vomiting. | |
| (v) Be ready to apply suction when gaging/vomiting occurs. | |
| (vi) Do sit patients upright for optimal neck/stomach alignment if possible. | |
| (vii) Do examine the nostrils for obstruction; use the best side for intubation. | |
| (viii) Do measure tube from bridge of nose to earlobe, and to halfway between the inferior part of the sternum and the umbilicus. | |
| (ix) Do mark measured length with a marker. | |
| (x) Do lubricate 2–4 inches of the tube with Xylocaine (2%) jelly, squirt jelly in the nostril, and a spray of back of the throat with Xylocaine. | |
| (xi) Do partial prefreeze the NG tube to ease its passage. | |
| (xii) Do not rely on a cuffed endotracheal tube to prevent passage into the trachea. | |
| (xiii) Do pass the tube posteriorly via the nostril, past the pharynx into the esophagus and then the stomach and advance tube until the mark. | |
| (xiv) Do not advance tube against resistance. | |
| (xv) Do encourage the patient to swallow while advancing the tube. | |
| (xvi) Do facilitate swallowing with ice chips or water. | |
| (xvii) Do withdraw the tube immediately if patients experience respiratory distress, or if the tube coils in the mouth. | |
| (xviii) Do check position of the tube by syringe aspirating gastric contents. | |
| (xix) Do not inject air bolus. | |
| (xx) Do test the pH of the aspirated contents, which should below 6. | |
| (xxi) Do not rely on PH in patients on antacids, H2 antagonists, and proton pump inhibitors. | |
| (xxii) Do obtain a radiograph before delivering feeding/medication. | |
| (xxiii) X-ray confirmation is only valid at the time of the X-ray. | |
| (xxiv) Do secure tube with tape or similar holding device. | |
| (xxv) Do document the reason, the size, and type of tube used and the nature and amount of aspirate. | |
| (xxvi) Do heck manufacturer’s instructions regarding length of time tube can be left in situ. | |
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