Nasogastric (NG) Tube insertion

Indications and Contraindications

1. Wide bore NG (e.g Ryle’s)

Emptying of stomach content – secondary bowel obstruction.

1. Fine bore NG

Nutritional input e.g patient NBM (fine bore).

Contraindication

1. Basal skull fracture
2. Facial/oropharyngeal trauma
3. Caution in the following patients (d/w seniors):

• oesophageal varices
• coagulopathy.

Equipment

1. Gloves + Apron
2. NG tube ( appropriate size)
3. Lubricant jelly
4. Glass of water with straw
5. Bowl
6. Drainage bag
7. Adhesive tape

Introduction

1. Wash hands

Wash your hands using the Ayliffe technique

2. Introduce yourself

Introduce yourself and give your name and grade

3. Check patient details

Clarify patients identity by confirming their name and asking for their DOB

4. Describe examination

Explain what examination you are performing and what this involves

5. Gain verbal consent

Pre-Procedure

1. Ensure adequate patient position - sat up in chair/bed.
2. Measure length of tube from nostril → angle of jaw → xiphisternum. This will give you an estimate of how far to insert.
3. Wash hands and glove up

Procedure

1. Lubricate NG with the jelly insert in to nostril,
2. Advance towards occipital region (back of head)
3. Continue to advance NG tube.
4. If slight resistance felt, advance in a twisting motion but do not force it if this doesn’t help.
5. Check in the patient’s mouth to ensure NG is not coiling up.
6. Once tube reaches the back of their throat, ask them to take a sip and advance as they swallow.
7. Continue to the measured mark from earlier.
8. Secure with tape around nostril and attach drainage bag.

Confirmation

End of Procedure

1. Thank patient

Let the patient know you have finished examining them and thank them for their time. Be courteous.

2. Accurate documentation

Document in the patient’s notes (most wards have NG stickers) Date, time, indication, location, complications and confirmation modality. It is important to inform the nursing staff NOT to use the NG until the CXR has been done and confirmation given, if awaiting xray.

Complications

1. Patient discomfort
2. Epistaxis
3. Oesophageal inflammation
4. Oesophageal/gastric perforation
5. Misplacement → Lungs.

Top Tips

1. Place NG in fridge for 20 minutes prior to procedure, this hardens it and makes it easier to pass.
2. If difficulty passing NG tube, consider passing it orally if the patient is unconscious (ITU).
3. After passing NG document this in notes including the type of tube, time passed and when position checked on CXR. Inform nursing staff as soon as satisfactory so they can start feeds.
4. Try the other nostril if unsuccessful at first.
5. Sometimes keeping the NG tube in the fridge helps stiffen them, making it easier to pass.
6. Add more lube!
7. Seek senior help if struggling.