Acute Careniche
You are the intern covering a medical ward at 2 am. A 61-year-old woman with cirrhosis due to hepatitis C is admitted with hepatic encephalopathy; she is drowsy and not safe to swallow. Gastroscopy 18 months ago showed small oesophageal varices that were not banded. Her international normalised ratio is 1.6 and her platelet count is 74 x 10^9/L. The medical registrar has reviewed her, decided she is to be fed and given lactulose enterally, and documented in the notes that a nasogastric tube may be passed. Which one of the following is the most appropriate way to establish enteral access?