Ryles tube insertion in patients with tracheostomy tube is more difficult because inflated cuff bulb compresses esophagus. In patients with permanent stoma or with uncuffed tube, procedure is no different from other routine cases.
How to insert in these patients?
1 - Suction secretions present in supra cuff region
Insertion of nasogastric tube is usually a difficult job for both, the patient and the one inserting it. Difficulty increases in the presence of tunes in the trachea (both the endotracheal tube (ET) and tracheostomy tubes (TT)). Due to the generally short course of TT in the trachea, it may be easier to insert than in the presence of ET. Deflation of the tube cuff decrease the suspected difficulty.