Can a Nasogastric Tube (NGT) be inserted in a patient on a nasal cannula for oxygen?

NGT Insertion with Nasal Cannula Oxygen

Yes, a nasogastric tube (NGT) can be inserted while a patient is on nasal cannula oxygen, and the nasal cannula does not need to be removed during the procedure. 1

Practical Approach to NGT Insertion with Oxygen Therapy

Standard Nasal Cannula (Low-Flow)

• NGT insertion is fully compatible with standard nasal cannula oxygen delivery (1-6 L/min), as the nasal cannula interface does not create an occlusive seal and allows simultaneous passage of the NGT through the contralateral nostril 2, 1
• Insert the NGT through one nostril while maintaining oxygen delivery through the same or opposite nostril with the nasal cannula prongs 1
• The British Thoracic Society confirms nasal cannulae are the preferred oxygen delivery method for most patients due to comfort and tolerance, and they do not interfere with oral procedures or nasal access 2, 1

High-Flow Nasal Cannula (HFNC)

• HFNC (delivering 30-60 L/min) can remain in place during NGT insertion, though this requires more careful technique 2, 3
• The European Respiratory Society guidelines note that HFNC delivers oxygen through a specialized nasal cannula interface that does not require an occlusive fit, allowing simultaneous NGT passage 2, 3
• Consider temporarily reducing HFNC flow rates during NGT insertion if patient tolerance allows, then resuming full flow afterward 2

When to Consider Alternative Oxygen Delivery

Switch to face mask oxygen temporarily if:

• The patient requires non-invasive ventilation (NIV) with nasal CPAP or BiPAP, as these require an occlusive nasal interface that would prevent NGT insertion 2, 3
• During non-invasive ventilation, ESPEN guidelines specifically recommend considering parenteral nutrition or delaying NGT placement due to airway complications and mask seal issues 2
• The patient is on helmet NIV, which allows NGT insertion but may require brief disconnection 2

Critical Safety Considerations

Contraindications to NGT with Oxygen Therapy

• Do not insert NGT in patients with severe facial or skull fractures regardless of oxygen delivery method, due to risk of intracranial passage 4
• Exercise extreme caution in comatose or recently extubated patients where airway exchange catheters may be present, as these can be confused with NGTs 2
• The Difficult Airway Society explicitly warns to clearly label airway exchange catheters to prevent confusion with nasogastric tubes 2

Monitoring During Procedure

• Maintain continuous pulse oximetry during NGT insertion to ensure oxygen saturation remains adequate 2
• If oxygen saturation drops during insertion, pause the procedure and optimize oxygenation before continuing 2
• For patients with stroke or acute respiratory failure, position with head of bed elevated 15-30° during NGT insertion to prevent aspiration and maintain oxygenation 2

Technical Tips for Success

Insertion Technique

• Use generous lubrication and consider chilling the NGT to increase rigidity, which improves first-attempt success rates (88% vs 58% for standard tubes) 4, 5
• In intubated patients, esophageal guidewire-assisted insertion with manual forward laryngeal displacement achieves 99.2% first-attempt success 6
• Direct visualization with laryngoscopy may be needed in difficult cases 4, 7

Common Pitfall

The most critical error is confusing an airway exchange catheter (AEC) with an NGT in recently extubated patients—AECs must be clearly labeled and patients should remain nil by mouth until the AEC is removed 2