Nasogastric Intubation
Basic Information 
Equipment, Anesthesia
Preparation: Important Checkpoints
• Sedation if appropriate (xylazine should provide adequate sedation for passing of the tube)
• A skilled horse handler should hold the horse with a twitch properly applied. Not all horses need to be twitched but it is helpful in most patients and creates a safer situation in most cases. One should not attempt to struggle with a horse that is throwing its head as this increases the danger of getting the tube in the wrong place (ethmoids, trachea).
• The buckets and pump should be at the ready with a helper to operate or hold the buckets.
• Alternatively the buckets can be placed on a shelf or cart or hung at nose level.
Procedure
• Stand on the same side of the horse as the nostril you wish to pass the tube in (ie, stand on the left to pass it through the left nostril).
• Mark the depth of the pharynx on the tube by placing the tube alongside the horse’s head and approximating the length from the nostril to the pharynx on the tube.
• Place the tube once behind your neck, and place the pump end in your mouth.
• With your hand closest to the horse, gently grasp the nostril with your thumb and forefinger. Take care not to occlude the opposite nostril with your other fingers.
• With your opposite hand, direct the rounded smooth end of the tube ventrally and medially in the nostril into the ventral meatus.
• Keep pressing the tube ventromedially with your thumb of the hand closest to the horse as you slowly advance the tube with the opposite hand.
• Once you have entered the pharynx, rotate the tube 90 degrees and have the horse handler flex the neck at the poll. This directs the tube more dorsally toward the opening of the esophagus rather than towards the trachea. However, this may cause the tube to become lodged in the dorsal pharyngeal recess causing pharyngeal trauma. One must be careful not to be excessively forceful when advancing the tube for this reason.
• Gently tap the dorsal portion of the arytenoids while blowing into the tube, until the horse swallows.
• When the horse swallows, pass the tube into the esophagus. This portion of the procedure requires patience and should not be rushed, due to the risk for pharyngeal or laryngeal trauma.
• TROUBLESHOOT: If one encounters difficulty getting the horse to swallow:
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