Curling the Tube

While you wait, prepare a small ice bath and get your hands on an oral airway. (The larger sizes work best.) Many oral airways have a groove along the side, and you’ll find that it’s quite easy to push the end of the NG tube into the groove. (Tape is another option.) (See photos 2 and 3.)
Dunk the entire NG/oral airway assembly into your cup of ice and then add just a little cold water to increase thermal conduction. (See photo 4.)
Take this interval to get the usual NG gear into place: chucks, tape, a Toomey syringe for verification of placement, the requisite cup of water and straw for the patient, and so forth.
Once your patient is ready, get him properly positioned before removing the NG tube from the ice bath.
Once the patient is all set with the cup of water in hand and you are 100% ready to go, quickly remove the tube from the ice bath and disconnect it from the oral airway. Your NG tube will have a nice curve to the very end, which will last about 45 seconds. (See photo 5.)

Navigating That Nasopharynx Advance the tube slowly and gently.

Once your NG tube reaches “terror turn” where it must reflect downward from the back of the soft palate toward the esophagus, stop for a few seconds if you meet any resistance (e.g., curses, sputtering) and let the patient become more comfortable.

Often the combination of patient relaxation and the curve you’ve placed in the tube will permit an easy progression into the hypopharynx and esophagus, at which point the patient should be encouraged to take small sips of water to facilitate passage of the tube.

Secure the tube and verify placement as usual.

First-timers will still complain, but NG tube placement veterans will be grateful because the experience has been so much less horrendous than what they have endured in the past.

Potential Risks

Remember not to “ram home” the tube with this technique because the cold NG tube has a slightly firmer tip and the patient’s esophagus is anesthetized, slightly increasing the chance of perforation with aggressive advancement.

Be gentle.

Uh-Oh

If using this cold technique doesn’t work after one or two tries, you can try the opposite extreme: Place the nasogastric tube in a basin of very warm (but not hot) water for 10 minutes or so.