NASOGASTRIC TUBE

INSERTION

02/04/22 Rosechelle B. Siupan,RN,MAN

INDICATIONS:
 Drain and Decompress the stomach by aspiration of
gastric contents (fluid, air, blood).
 Introduce fluids and medication
 Assist in the clinical diagnosis through analysis of
substances found in gastric contents.
 Obtain a specimen of the gastric contents
 In trauma settings, NG tubes can be used to aid
in the prevention of vomiting and aspiration

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CONTRAINDICATIONS:
 Patients with sustained head trauma, maxillofacial injury,
or anterior fossa skull fracture.
 Inserting a NG tube blindly through the nose has
potential of passing through the criboform plate, thus
causing intracranial penetration of the brain.
 Patients with a history of esophageal stricture,
esophageal varices, alkali ingestion at risk for
esophageal penetration.
 Comatose patients have the potential of vomiting during
a NG insertion procedure, thus require protection of the
airway prior to placing a NG tube.

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Complications:

 The main complications of NG tube insertion

include aspiration and tissue trauma.
 Placement of the catheter can induce gagging or
vomiting

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 Excessive manipulation or movement by the patient
during placement including coughing or gagging may
potentiate cervical injury.  
 Nasal irritation, sinusitis, epistaxis, rhinorrhea, skin
erosion or esophagotracheal fistula secondary to NG
placement.
 Aspiration pneumonia secondary to vomiting and
aspiration.
 Hypoxia, cyanosis, or respiratory arrest due to
accidental tracheal intubation.
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EQUIPMENT REQUIRED:
 Non-allergenic tape
 Protective pad or towel                     
 Gloves
 Basin                      
 Safety pin
 Cup of water with straw          
 Stethoscope
 60 cc Irrigating syringe           
 Water soluble lubricant
 NG tube (plastic or rubber) of appropriate size        
 Suction
 pH indicator strips

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Positioning:
 Position the patient as follows:
 If the patient is awake and alert-in a sitting position or
in high-Fowler’s.

 If the patient is obtunded or unconscious-head down,

preferably in a left side lying position.

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Length of NG tube to be inserted:
 Determine the length of the NG tube to be passed by
measuring the length from :
ADULT
 Bridge of nose to earlobe
 earlobe to xiphoid process

INFANT/CHILD
Measure tubing from bridge of nose to earlobe, then to the
point halfway between the end of the sternum and the
navel.
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Procedure:
 Don non-sterile gloves
 Identify the patient.
 Explain the procedure to the patient
 Place a protective pad/towel on the patient’s chest as well as provide the
patient with a basin to minimize contact with aspirated gastric contents.
 Inspect both of the patient’s nostrils for patency.  Have the patient blow
nose if able.
 Lubricate the first 6 inches of the NG tube liberally with a water soluble
lubricant.  Choose the largest patent nostril and begin to pass the NG
tube through the nostril to the nasopharynx; direct the tube through the
nostril aiming down and back.
 Pass tube via either nares posteriorly, past the pharynx into the
esophagus and then the stomach.

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 Once in the pharynx instruct the patient to swallow (you may offer ice
chips/water) either mimicking the action or by sipping on small amounts
of water advance the tube as the patient swallows. Swallowing of small
sips of water may enhance passage of tube into esophagus.

 If awake and alert have the patient place chin to chest to facilitate
easier passage of the tube.  Introduce the tube until the selected mark
(indicated by the tape) is reached. 

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 If resistance is met, rotate tube slowly with
downward advancement toward.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 cyanotic.
 Advance tube until mark is reached

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 Verify NG tube placement in the stomach by:
 Aspirating gastric contents with the irrigation syringe and test the
pH.
 While listening over the epigastrum with a stethoscope quickly
instill a 10-30cc air bolus with the irrigation syringe.  Air entering
the stomach will produce a “whooshing” sound.
 Ask the patient to hum or talk.  Coughing, cyanosis or choking
may indicate that the NG tube has passed through the larynx.
 Place the open end of the NG tube in a cup of water.  Persistent
bubbling may indicate that the NG tube has passed through the
larynx.
 x-ray

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 If unable to positively confirm that the NG tube has been
placed is in the stomach the tube must be removed
immediately and re-attempted.

 Once confirmed for placement, secure the NG tube by

placing one end of tape on from the bridge to the tip of
the nose and the other end wrapped around the tube
itself.  If possible the nose should be clean.

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 To deter the NG tube from dangling and possible
dislodgment:
 Curve and tape the tube to the patient’s cheek to
prevent unnecessary tugging on the nostrils.  Attach
the tube to the patient’s gown.  (Do not tape to the
patient’s forehead as this will put pressure on the
nares.
 Wrap a small piece of tape around the tube near the
connection creating a tab.
 Loop a rubber band in a slip knot near the connection
and pin to the patient’s gown.  

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 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.

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