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flexible nasendoscope (Olympus Flexible Nasendoscope Model

ENFGP, Hythe,UK). It is cut from the proximal end (Fig. 1) so

the introducing end is intact (not ragged).

4. A dorsal split is cut with a scalpel or a pair of scissors

along the full length of the guide tube (Fig. 2).

5. The guide tube is filled with a lubricant (KY Gel) (Fig. 3).

6. The precut guide tube is fed to the flexible nasendoscope

and together inserted down to the postcricoid area (Figs. 4 and 5).

7. The guide tube is held in place while the nasendoscope is

pulled out (Fig. 6).8. Then, the fine-bore feeding tube is inserted through the

guide tube).

9. Finally, the guide tube is pulled out while the fine-bore is

held in place. The dorsal slit in guide tube allows it to be easily

separated from the fine-bore NG tube (Fig. 7).

10. The fine-bore NG tube is secured to the patient in the

normal fashion.

DISCUSSION

The main advantage of using a fiber optic nasendo-

scope is that the NG tube can be confidently passed under

direct vision into the esophagus with great maneuverabil-

ity. The dorsal split in the guide tube facilitates the

sheathing on and the subsequent removal of the guidetube from the flexible nasendoscope. It must be noted that

the split has to be placed in the dorsal aspect of the scope

to prevent the scope being detached from the tube in

flexion (in the posterior nasal space).

A Seldinger technique for replacing a blocked NG

tube has been described before by means of railroading a

Ryles tube over a guide wire that has been passed down

the blocked NG tube.2 We, however, propose that our

technique, which is also based on the Seldinger principle,

can be used for primary placement of a fine-bore NG tube

in appropriate cases.

BIBLIOGRAPHY

1. Kelly G, Lee P. Nasendoscopically-assisted placement of anasogastric feeding tube. J Laryngol Otol 1999;113:839840.

2. Panagamuwa C, Gane MB, Hajioff MA. A novel method forreplacement of a blocked fine bore nasogastric tube. JLaryngol Otol 2003;117:883884.

Fig. 5. Introducing nasendoscope and guide tube together to post-cricoid region.

Fig. 6. Removing nasendoscope while leaving guide tube in place.

Fig. 7. Removing guide tube after NG tube has been fed through.

Laryngoscope 116: April 2006 Doshi and Anari: NG Tube Insertion

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