Nasogastric Tube

NASOGASTRIC TUBE
- A tube that is passed through the nose and down through the nasopharynx and esophagus into the
stomach.
- Abbreviated NG tube. It is a flexible tube made of rubber or plastic, and it has bidirectional potential.
The sizes are further broken down by age groups.
- Neonatal
- Pediatrics
- Adults
DIFFERENT TYPES:
1. Levin tube:
2. Salem sump tube:
3. Moss tube:
NGT INSERTION:
 Gastric intubation via the nasal passage
- is a common procedure that provides access to the stomach
 A nasogastric (NG) tube is used for a procedure.
INDICATIONS:
Diagnostic indications for NG intubation include the following:
 Evaluation of upper gastrointestinal (GI) bleeding (ie, presence, volume)
 Aspiration of gastric fluid content
 Identification of the esophagus and stomach on a chest radiograph
 Administration of radiographic contrast to the GI tract
 Identification of cancer cells
Therapeutic indications for NG intubation include the following:
 Gastric decompression
 Relief of symptoms and bowel
 Aspiration of gastric content
 Administration of medication
 Feeding
 Bowel irrigation
CONTRAINDICATIONS:
- Absolute contraindications for NG intubation include the following:
 Severe midface trauma
 Recent nasal surgery
- Relative contraindications for NG intubation include the following:

 Coagulation abnormality
 Esophageal varices or stricture
 Recent banding of esophageal varices
 Anastomosis in the esophagus and the stomach
 Alkaline ingestion
COMPLICATIONS:
- The main complications of NG tube insertion include aspiration and tissue trauma.
UNIVERSAL PRECAUTIONS:
- 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.
Equipment:
- All necessary equipment should be prepared, assembled and available at the bedside prior to starting the
NG tube. Basic equipment includes:
 Personal protective equipment
 NG/OG tube
 Catheter tip irrigation 60ml syringe
 Water-soluble lubricant, preferably 2% Xylocaine jelly
 Adhesive tape
 Low powered suction device OR Drainage bag
 Stethoscope
 Cup of water (if necessary)/ ice chips
 Emesis basin
 pH indicator strips
Nursing Considerations:
 During insertion, if concern exists that the NG tube is in the incorrect place, ask the patient to speak.
 The NG tube may coil in the nasopharynx or oropharynx.
 Another option (applicable only in patients who are sedated and paralyzed) is to place two or three fingers
through the patient’s mouth into the oropharynx.

 Lifting the thyroid cartilage anterior and upward might open the esophagus and allow passage into the
proximal esophagus.
 A method of freezing an NG tube with distilled water was shown to increase the success rate of insertion for
intubated patients.
 Direct laryngoscopy or video laryngoscopy can aid in placing an NG tube in sedated patients by enabling
visualization of the tip entering the esophagus.
 Provide oral and skin care. Give mouth rinses and apply lubricant to the patient’s lips and nostril.
 Verify NG tube placement.
 Wear gloves. Gloves must always be worn while starting an NG because potential contact with the patient’s
blood or body fluids increases especially with inexperienced operator.
 Face and eye protection.

Procedures:
1. Gather equipment
2. Don non-sterile gloves
3. Explain the procedure to the patient and show equipment
4. If possible, sit patient upright for optimal neck/stomach alignment
5. Examine nostrils for deformity/obstructions to determine best side for insertion
6. Measure tubing from bridge of nose to earlobe, then to the point halfway between the end of the sternum and
the navel
7. Mark measured length with a marker or note the distance
8. 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.
9. Pass tube via either nare posteriorly, past the pharynx into the esophagus and then the stomach.
10. 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.
11. If resistance is met, rotate tube slowly with downward advancement toward closes ear. Do not force.
12. Withdraw tube immediately if changes occur in patient's respiratory status, if tube coils in mouth, if the patient
begins to cough or turns pretty colours
13. Advance tube until mark is reached
14. 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.
15. Secure tube with tape or commercially prepared tube holder
16. If for suction, remove syringe from free end of tube; connect to suction; set machine on type of suction and
pressure as prescribed.
17. 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.
Removal of NGT:
1. Check physician’s order for removal of nasogastric tube.
2. Explain procedure to patient and assist to semi-Fowler’s position.
3. Gather equipment.
4. Perform hand hygiene. Don clean disposable gloves.
5. Place towel or disposable pad across patient’s chest. Give tissues to patient.
6. Discontinue suction and separate tube from suction. Unpin tube from patient’s gown and carefully remove
adhesive tape from patient’s nose.
7. Attach syringe and flush with 10 mL normal saline solution or clean with 30 to 50 cc of air. (optional).
8. Instruct patient to take a deep breath and hold it.
9. Clamp tube with fingers by doubling tube on itself. Quickly and carefully remove tube while patient holds
breath.
10. Place tube in disposable plastic bag. Remove gloves and place in bag.
11. Offer mouth care to patient and facial tissues to blow nose.
12. Measure nasogastric drainage. Remove all equipment and dispose according to agency policy. Perform hand
hygiene.
13. Record removal of tube, patient’s response, and measure of drainage. Continue to monitor patient for 2 to 4
hours after tube removal for gastric distention, nausea, or vomiting.

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NASOGASTRIC TUBE

The sizes are further broken down by age groups.

2. Salem sump tube:

- is a common procedure that provides access to the stomach

 A nasogastric (NG) tube is used for a procedure.

Diagnostic indications for NG intubation include the following:

 Evaluation of upper gastrointestinal (GI) bleeding (ie, presence, volume)

 Aspiration of gastric fluid content

 Identification of the esophagus and stomach on a chest radiograph

 Administration of radiographic contrast to the GI tract

 Identification of cancer cells

Therapeutic indications for NG intubation include the following:

 Relief of symptoms and bowel

 Aspiration of gastric content

 Recent nasal surgery

- Relative contraindications for NG intubation include the following:

 Recent banding of esophageal varices

 Anastomosis in the esophagus and the stomach

with the inexperience of the operator.

 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

 The NG tube may coil in the nasopharynx or oropharynx.

through the patient’s mouth into the oropharynx.

visualization of the tip entering the esophagus.

 Verify NG tube placement.

blood or body fluids increases especially with inexperienced operator.

 Face and eye protection.

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