iPhoneIcon_BigPassing the orogastric tube can be difficult or sometimes impossible. Unfortunately a lot of patients really need their OGs and in a time-critical scenario you don’t want to spend too much time struggling with it. Here is a simple trick a senior colleague showed me. Many of you probably already know of this technique and may already be doing it. My colleague says he has been doing this since back in the seventies. I find that hard to believe as he was born in the late 1960s.

Anyway, the idea is to intubate the oesophagus with a large ET-tube and then to use the ETT as an introducer to railroad the OG-tube down the oesophagus.

Here’s how to do it:

FullSizeRenderPrepare an large ET tube by cutting away the cuff balloon and removing the connector part.





FullSizeRenderCut the tube down the middle.






FullSizeRenderIntubate the oesophagus with the cut ETT. Blindly or with a laryngoscope. As any EM-registrar can tell you, intubating the oesophagus with an ET tube is super easy.



FullSizeRenderRailroad the OG tube down the cut ET tube, down the oesophagus and into the ventricle.





FullSizeRenderSeparate the OG and ET tubes by pushing the OG through the cut ETT side. Remove the ETT while the OG stays in place.





FullSizeRenderNaturally, I wanted to claim this technique as my own invention with a formal write-up. Unfortunately, as always in my case…, someone already published it. 🙁

This entry was posted in Airway management, Anesthesia, Emergency Medicine, Intensive Care, Prehospital Medicine, Uncategorized. Bookmark the permalink.

8 Responses to OWN THE O.G.

  1. Jordan Schooler says:

    This is a great technique. I think I first heard about it when Weingart described it for the esophageal temperature probe. I haven’t had it fail yet.

  2. Pingback: Own the OG | AmboFOAM

  3. Fredrik Granholm says:

    Since the situation when you can´t get the OG tube down in the right hole is a super annoying situation I´m greatful for the tip. Waiting for a way with the awake patients as well 😉

  4. Rob says:

    It works! Cardiac arrest patient today, easily intubated during CPR with a grade 1 view, followed by the easiest OG I have ever placed. Magic!

  5. Ulf says:

    Someone tried it the nasal route? For a nasal gastric feeding tube?

    • Mads Astvad says:

      Ulf: Yup, definitely possible to do NG tubes with this technique. Load NG through nose, use macgill or similar to retrieve from mouth, then do all of the above steps with the free end and voila. Works wonderfully.

  6. Tor P says:

    Check out this article: Nasogastric Tube Insertion Using Different Techniques in Anesthetized Patients: A Prospective, Randomized Study. @ http://www.ncbi.nlm.nih.gov/pubmed/19690254 .

    I have been using the flexion + lateral pressure with good success for the last few years. Best of all it doesn’t require any extra equipment. In another study they looked with a bronchoscope as another operator tried to pass a blind OG-tube, turns out the most common problem is that the tip goes into the folds of the laryngeal inlet and gets stuck. The lateral pressure compresses the folds thus reducing the chance the tip gets hung up.

    • Thomas D says:

      Interesting article, thanks for posting! Flexion is definitely the best and easiest way to improve NG/OG tube passage, but lots of other good tricks in that article as well!

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