I. Indications

  1. Prolonged Positive Pressure Ventilation
  2. Preferred route in newborns
    1. Keeps nose open for ventilation
  3. Gastric Lavage

II. Preparation: Tube Measurement (estimating length)

  1. NEX Method
    1. Bridge of nose to earlobe to xyphoid process
    2. Note centimeter mark at this point of tube
  2. Scalzo method
    1. Oral Insertion Length: (0.22 x height in cm) + 13

III. Protocol: Newborns

  1. Size: 8 French
  2. Technique
    1. Gently insert tube to pre-measured distance
    2. Aspirate gastric contents to a 20 cc syringe
    3. Leave tube open after Stomach contents removed
    4. Tape tube to lower side of cheek

IV. Protocol: Large tube placement (historically used for Gastric Lavage)

  1. Tube size
    1. Child: 16 to 32 French
    2. Adult: 32 to 50 French
  2. Technique
    1. Spray posterior pharynx with topical benzocaine
    2. Patient's head hyper-flexed forward
    3. Insert lubricated Orogastric Tube
      1. Insert as patient swallows
      2. Advance tube immediately after each gagging episode
    4. Confirm intragastric placement
      1. Insert air via syringe and auscultate Stomach
      2. Remove gastric contents gently

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