Definition
Inserting a nasogastric tube (NG) is a critical nursing procedure used for gastric decompression, feeding, medication administration, or sampling gastric contents.
Purposes
- Decompression of stomach (to remove fluids and gas).
- To prevent or relieve nausea and vomiting after surgery or traumatic events by decompressing the stomach.
- To determine the amount of pressure and activity of GI tract (diagnostic studies).
- To give gastric lavage (to irrigate the stomach in case of active bleeding or poisoning).
- To obtain specimen (gastric contents) for laboratory studies.
- To administer medication.
- To give gastric gavage (feed directly into the stomach).
Contraindications
1. Absolute contraindications
- Severe midface trauma
- Recent nasal surgery
2.Relative contraindications
- Coagulation abnormality
- Esophageal varices
- Recent banding of esophageal varices.
Patient Position for Tube Insertion
- High Fowler’s position: Position of patient in which headend of the bed is raised 60-90°.
- Semi Fowler’s position: Position of patient in which headend of bed is raised 30-45°.
Articles
A tray containing:
- Kidney trays-2.
- Mackintosh and towel.
- Cotton-tipped applicators.
- Saline.
- Levine’s tube or Ryle’s tube, size 8-12 Fr.
- Water-soluble lubricant such as glycerin or liquid paraffin.
- Adhesive plaster and scissors.
- Gauze pieces.
- Clean syringe, size 10-20 mL.
- Measuring cup or marked drinking cup.
- Bowl with water.
- Clamp for occluding the nasogastric tube.
- Suction apparatus (optional).
- Pen light/flashlight.
- Tongue blade.
- Glass of water.
Procedure
| Nursing Actions | Rationale | |
| 1. | Before procedure Identify the patient. | Helps in determining the appropriate size of the nasogastric tube for patient. |
| 2. | Check the physician’s order for any precautions such as positioning or movement. | |
| 3. | Ascertain the level of consciousness and ability to follow instructions. | Avoids the risk of aspiration of fluid. |
| 4. | Ascertain the ability of patient to maintain desired position during insertion. | Facilitates insertion of the tube. |
| 5. | Review the patient’s medical history for any nasal lesions, bleeding polyps or deviated nasal septum. | May require change in the route of nutritional support, e.g., orogastric insertion. |
| 6. | During procedure Wash hands. | Prevents infection. |
| 7. | Explain procedure to patient. | Reduces anxiety and helps patient to assist in insertion of the tube. |
| 8. | Place the patient in a high Fowler’s position (comatose patient in semi-Fowler’s position). | Facilitates insertion of the tube and reduces risk of aspiration. |
| 9. | Place mackintosh and towel across the chest. | Prevents soiling of patient’s dress. |
| 10. | Measure the length of the tube, i.e. from tip of nose to tip of the ear lobe and to the tip of xiphoid process and mark with tape. For orogastric intubation, the tube is measured from the lips to the tip of xiphoid process of sternum. | The measured length approximates the distance from the nose to the stomach. (For duodenal or jejunal placement, an additional 20 cm to 30 cm is required). |
| 11. | Cut the adhesive tape 10 cm long and keep ready to fix the tube. | |
| 12. | Put on clean gloves. | Prevents contamination from secretions. |
| 13. | Lubricate the tip of the tube about 6-8 inches with water-soluble lubricant, using a gauze piece. | Lubrication reduces friction between mucous membrane and the tube. Water-soluble lubricant easily dissolves if it accidentally enters the lungs. |
| 14. | Insert the tube through the left nostril to the back of the throat, aiming back and down toward the ear. | Natural contours facilitate the passage of the tube. |
| 15. | Flex the patient’s head toward the chest after the tube has passed the nasopharynx. | Reduces the risk of tube entering the trachea. |
| 16. | Encourage patient to swallow by giving sips of water when possible. | Facilitates passage of tube. Swallowing closes the epiglottis over the trachea and facilitates passage of tube into esophagus. |
| 17. | Advance tube 3-4 inches each time patient swallows until desired length has been passed.Do not force tube. When resistance is met or patient starts to gag, cough, choke or become cyanosed, stop advancing tube and pull tube back. Check for position of tube in back of throat with tongue blade and flashlight. | Reduces discomfort and trauma. Tube may be coiled or kinked in oropharynx or trachea. |
| 18. | If there are signs of distress such as gasping, coughing or cyanosis, pull back the tube for some length and check if patient’s distress is relieved. If it is relieved, reinsert after few seconds. If patient develops respiratory distress again, immediately remove the tube. | The tube may have entered the trachea. |
| 19. | Perform one of the following measures to check for the placement of the tube: Aspirate gastric contents and check pH using litmus paper, if available. Place the end of the tube in a bowl of water to check for continuous air bubbles in water. Ask the patient to speak. X-ray may be done. | Aspirated contents indicate that the tube is in the stomach. Continuous air bubbles indicate that tube is in the respiratory tract. Patient will not be able to speak if tube is in the trachea. |
| 20. | Secure tube with tape and avoid pressure on nares Use a 10 cm (4 inch) piece of tape, split at one end. (Place intact end of tape over bridge of nose. Carefully wrap two ends around tube). | |
| 21. | Fasten end of tube to gown. | Reduces friction on nares when patient moves. |
| 22. | After procedure Make aptient comfortable in bed and provide oral hygiene every 4-6 hours. | Promotes comfort and integrity of oral mucous membrane. |
| 23. | Discard waste clean and replace reusable articles. | |
| 24. | Remove gloves and wash hands. | Reduces transmission of microorganisms. |
| 25. | Record type of tube placed, aspirate returned, and patient tolerance. | Documents exact procedure. |
Special Consideration
- Insufflation of air into tube followed by auscultation is no longer considered reliable in determining tube placement, because sounds transmitted by insufflation may be transmitted from the pleural space into upper abdomen, thus giving false impression of tube placement.
- Change tape of nasogastric tube as required to prevent skin irritation and inflammation.
- Prolonged use of NG tube can cause sinusitis, infections and ulcerations on the tissues of sinuses, throat, esophagus or stomach.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
