Intubation Nasotracheal

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Procedure Guidelines



  • Decreased minute volume in-patients who are not in arrest.
  • Patients with possible spinal injuries.
  • Patients who cannot be ventilated adequately by another means.


  • Facial trauma.
  • Apnea.


  • Proper size nasotracheal tube, (1 - 2 sizes smaller than ET).
  • Water-soluble lubrication gel, (lubricate distal end of tube at cuff).
  • 10 cc syringe, (check cuff for patency).
  • Tape or endotracheal securing device.
  • BVM.
  • Suction.
  • Stethoscope.


  • Ensure spontaneous respirations are in progress and being assisted with appropriate oxygen device.
  • If C-spine injury suspected, maintain manual cervical alignment and apply the C-collar.
  • Hyperventilate patient before intubation procedure.
  • Select the most patent nasal passage.
  • With the bevel of the tube facing the nasal septum, insert the tube into the naris parallel to the hard palate.
  • Insert the tube beyond the "give" of the nasopharyngeal angle. Advance the tube during inhalation until coughing occurs or maximal breath sounds are heard.
  • Advance the tube into the trachea simultaneously with the inspiration phase of respirations.
  • Inflate the cuff with 5 - 10 cc of air and remove the syringe.
  • Ventilate the patient with a bag valve attached and watch for chest rise. Listen to abdomen to ensure that an esophageal intubation has not been done. Listen for bilateral equal breath sounds.
    • If abdominal sounds are heard, deflate the endotracheal cuff and remove the nasotracheal tube immediately and attempt intubation again.
    • If lung sounds are unequal, deflate the nasotracheal cuff and reposition the nasotracheal tube. Inflate nasotracheal cuff and reassess lung sounds. If lung sounds are still unequal, assess the patient for Pneumothorax, (simple or tension).
  • Ventilate patient.


  • Tape or use endotracheal securing device and secure nasotracheal tube in place noting depth of tube.
  • Reassess lung sounds to ensure endotracheal tube is still in proper position.
  • Continue ventilations.