Nasogastric Int

Nasogastric intubation(N.G.
T)
Introduction
Gastric intubation via the nasal passage (ie, nasogastric route) is a common procedure that provides
access to the stomach for diagnostic and therapeutic purposes.
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
Therapeutic indications for NG intubation include the following:
● Gastric decompression, including maintenance of a decompressed state after endotracheal intubation,

often via the oropharynx
● Relief of symptoms and bowel rest in the setting of small-bowel obstruction
● Aspiration of gastric content from recent ingestion of toxic material
● Administration of medication
● Feeding
● Bowel irrigation
Equipment
● NG tube (for adult patients) - 16-18 French
● NG tube (for pediatric patients) - In pediatric patients, the correct tube size varies with the patient's
age; to find the correct size (in French), add 16 to the patient's age in years and then divide by 2, so that
for an 8-year-old child, for example, the correct size is 12 French ([8 + 16]/2 = 12)
● Viscous lidocaine 2%
● Oral analgesic spray (benzocaine spray or other)
● Syringe, 10 mL
● Glass of water with a straw
● Water-based lubricant
● Toomey syringe, 60 mL
● Tape
● Emesis basin or plastic bag
● Wall suction, set to low intermittent suction
● Suction tubing and container
Procedure
● Introduce yourself to the patient and clarify the patient’s identity. Explain the procedure to the patient
and gain informed consent to continue.
● Gather equipment
● Don non-sterile gloves
● 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 status, if tube coils in mouth, if
the patient begins to cough or turns pretty colour
● 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.
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
● Recent banding or cautery of esophageal varices
● Alkaline ingestion
Complications
● Aspiration Pneumonia
● Tissue trauma
● Gagging or vomiting
● Epistaxis
● Esophageal perforation
● Laryngospasm
● Hypoxia
● Bradycardia
● Hyponatremia, Hypochloremia
● Water intoxication
☺All the best

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Nasogastric intubation(N.G.

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

Therapeutic indications for NG intubation include the following:

● Gastric decompression, including maintenance of a decompressed state after endotracheal intubation,

● Relief of symptoms and bowel rest in the setting of small-bowel obstruction

● Aspiration of gastric content from recent ingestion of toxic material

● NG tube (for adult patients) - 16-18 French

● Oral analgesic spray (benzocaine spray or other)

● Glass of water with a straw

● Emesis basin or plastic bag

● Wall suction, set to low intermittent suction

● Suction tubing and container

● Don non-sterile gloves

● If possible, sit patient upright for optimal neck/stomach alignment

● Examine nostrils for deformity/obstructions to determine best side for insertion

● Mark measured length with a marker or note the distance

● Advance tube until mark is reached

● Secure tube with tape or commercially prepared tube holder

Absolute contraindications for NG intubation include the following:

● Severe midface trauma

● Recent nasal surgery

Relative contraindications for NG intubation include the following:

● Recent banding or cautery of esophageal varices

☺All the best

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