NGT

NASOGASTRIC TUBE INSERTION

ANATOMY

Indication
By 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

Contraindications

Nasogastric
tubes
are
contraindicated in the presence of
severe facial trauma
(cribriform plate disruption), due
to the possibility of inserting the
tube intracranially. In this instance,
an orogastric tube may be
inserted.

Complications

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.

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. 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.

Equipments:

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

PROCEDURE:

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

status, if
tube coils in mouth, if the patient begins to cough or turns pretty colours

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.

Thank

you