Emergency Medicine

NASOGASTRIC TUBE INSERTION

486 Practical Procedures

(b) use non-dominant gloved hand to gently separate labia

minora and clean the area with saline. The hand holding

the labia must be kept in place until catheter is successfully

inserted and urine flows

(c) locate the urethral opening (inferior to the clitoris, but may

still be difficult to define), and swab anterior to posterior with

cleaning solution

(d) instil a small amount of lignocaine (lidocaine) gel into the tip

of the urethral meatus and introduce well-lubricated catheter

along urethra until urine flows.

3 Inf late the balloon with 10 mL sterile water (or as indicated on the catheter).

Stop immediately if the patient experiences pain, as catheter may have

become malpositioned within urethra (particularly in a male).

4 Once balloon is inf lated, gently retract the catheter until resistance is felt.

5 Connect bag aseptically to catheter.

COMPLICATIONS

1 Inability to pass catheter. Do not persist with multiple attempts at catheteri-

zation, but consult urology early for consideration of suprapubic catheteriza-

tion.

2 Urethral trauma, e.g. creation of a false passage.

3 Paraphimosis from failure to replace foreskin.

4 Introduction of infection, bacteraemia.

NASOGASTRIC TUBE INSERTION

INDICATIONS

1 Aspiration of stomach contents to decompress the stomach of f luid, air or

occasionally blood.

2 Reduce risk of vomiting or aspiration, such as in bowel obstruction or acute

gastric dilatation.

3 Introducing liquids to the stomach such as charcoal, oral contrast media or

enteral feed.

CONTRAINDICATIONS

1 Base of skull fracture or severe mid-face trauma.

2 Caustic ingestion or known oesophageal stricture (risk of perforation).