Inserting an NG tube

1. Introduce yourself, explain what you would like to do and obtain consent.

2. Ask the patient to sit on a chair or on the edge of the bed, with the neck slightly flexed.

3. Wash your hands and put on gloves.

4. Measure the distance from the tip of the patient’s nose to the ear lobe and from the ear lobe to the
xiphisternum and mark that distance on the tube with tape.

5. Place the NG tube, gauze, tube of KY jelly, Xylocaine spray and a glass of water with a straw on a
clean surface next to the patient.

6. Spray the nostril with Xylocaine.

7. Squirt jelly onto the gauze and lubricate the end section of the tube.

8. Pass the tube into the patient’s nostril and along the floor of the nose into the nasopharynx.

9. When the patient is aware of the tube in the back of the throat, ask them to tilt their head forward and
take sips of the water through a straw.

10. Each time the patient swallows, advance the tube a few cm (so that the epiglottis is closed whenever
the tube is advanced).

11. If the patient coughs violently, draw back a few cm.

12. Talk to the patient encouragingly throughout the procedure.

13. Once the tube is in the oesophagus, it should be possible to advance it quite rapidly into the stomach.

14. Check that the tube is in the correct position by injecting a small volume of air into it from a syringe
and listening with a stethoscope (wide-bore tube) or by x-raying the patient (fine-bore tube).

15. Tape the tube to the patient’s nose.

What are the indications for putting in a Ryle’s tube (wide-bore tube)?

 To empty the stomach (after GI surgery, in intestinal obstruction, after trauma or in serious illness
where there is serious risk of aspiration)
 To aspirate stomach contents for diagnostic purposes (to assess the progress of upper GI
bleeding, after some forms of poisoning)

You should use a fine-bore tube if you want to give medications enterally because it is:
 Softer and much less uncomfortable
 Less likely to cause oesophageal inflammation and stricture
Able to stay in a longer time (> 1 week)