inserting a nasogastric tube, you are gaining access to the stomach
and its contents. This enables you to drain gastric contents, decompress
the stomach, obtain a specimen of the gastric contents, or introduce
a passage into the GI tract. This will allow you to treat gastric
immobility, and bowel obstruction. It will also allow for drainage
and/or lavage in drug overdosage or poisoning. In trauma settings,
NG tubes can be used to aid in the prevention of vomiting and aspiration,
as well as for assessment of GI bleeding. NG tubes can also be used
for enteral feeding initially.
Nasogastric tubes are contraindicated in the presence of severe
(cribriform plate disruption), due to the possibility of inserting
the tube intracranially. In this instance, an orogastric tube may
The main complications of NG tube insertion include aspiration
and tissue trauma. Placement of the catheter can induce gagging
or vomiting, therefore suction should always be ready to use in
the case of this happening.
The potential for contact with a patient's blood/body fluids while
starting an NG is present and increases with the inexperience of
the operator. Gloves must be worn while starting an NG; and if the
risk of vomiting is high, the operator should consider face and
eye protection as well as a gown. Trauma protocol calls for all
team members to wear gloves, face and eye protection and gowns.
All necessary equipment should be prepared, assembled and available
at the bedside prior to starting the NG tube. Basic equipment includes:
Personal protective equipment
Catheter tip irrigation 60ml syringe
Water-soluble lubricant, preferably 2% Xylocaine jelly
Low powered suction device OR Drainage bag
Cup of water (if necessary)/ ice chips
pH indicator strips
- Gather equipment
- Don non-sterile gloves
- Explain the procedure to the patient and show equipment
- If possible, sit patient upright for optimal neck/stomach alignment
- Examine nostrils for deformity/obstructions to determine best
side for insertion
- Measure tubing from bridge of nose to earlobe, then to the
point halfway between the end of the sternum and the navel
- Mark measured length with a marker or note the distance
- Lubricate 2-4 inches of tube with lubricant (preferably 2%
Xylocaine). This procedure is very uncomfortable for many patients,
so a squirt of Xylocaine jelly in the nostril, and a spray of
Xylocaine to the back of the throat will help alleviate the discomfort.
- Pass tube via either nare posteriorly, past the pharynx into
the esophagus and
then the stomach.
Instruct the patient to swallow (you may offer ice chips/water)
and advance the tube as the patient swallows. Swallowing of small
sips of water may enhance passage of tube into esophagus.
If resistance is met, rotate tube slowly with downward advancement
toward closes ear. Do not force.
- Withdraw tube immediately if changes occur in patient's respiratory
tube coils in mouth, if the patient begins to cough or turns pretty
- Advance tube until mark is reached
- Check for placement by attaching syringe to free end of the
tube, aspirate sample of gastric contents. Do not inject an air
bolus, as the best practice is to test the pH of the aspirated
contents to ensure that the contents are acidic. The pH should
be below 6. Obtain an x-ray to verify placement before instilling
any feedings/medications or if you have concerns about the placement
of the tube.
- Secure tube with tape or commercially prepared tube holder
- If for suction, remove syringe from free end of tube; connect
to suction; set machine on type of suction and pressure as prescribed.
- Document the reason for the tube insertion, type & size
of tube, the nature and amount of aspirate, the type of suction
and pressure setting if for suction, the nature and amount of
drainage, and the effectiveness of the intervention.
Partially pre-freezing the tube can ease its passage.
- Infants can suck on a pacifier during the procedure.
- Don’t rely on a cuffed endotracheal tube to
prevent passage into the trachea – be sure and
confirm placement using the above methods.