Q: 52 year old male is successfully intubated for impending respiratory failure. Post intubation nurse insert a nasogastric (NG) tube. Follow up x-ray showed NG-tube placed in the post-pyloric area. Your next step (select one)

A) Leave the tube as post-pyloric is ideal place
B) Pull back in gastric area


Answer: B

Post intubation NG tubes are inserted to decompress stomach from possible excessive air from air-mask bagging. There are two other vital reasons for which NG tube should not be allowed to stay in post-pyloric area. (Please note: we are not talking about naso-enteric tube for feeding). Other two reasons are:

1. Leaving NG tube in post-pyloric area may have a potential for electrolyte abnormalities.
2. Relatively, NG tubes are stiffer than enteric tubes used for feeding and may damage the duodenal mucosa.