Nasogastric Tube Insertion

Introduction
 Wash hands, Introduce self, Patients name & DOB & wrist band, Explain procedure and get consent
o Risks: sores around nose/tape, could go into lungs
o Contraindications: varicies, base of skull fracture, recent epistaxis
 Warn them it will be very uncomfortable and tell them to raise their hand up if they want to stop
 Tell them they must swallow when asked

Preparation part
 Wash hands
 Clean tray inside and out
 Gather equipment around tray (think through what you need in order)
o Gloves and apron
o Vomit bowel
o Cup of water with a straw
o Nasogastric tube (wide bore = for drainage (lasts 7 days); fine bore = for feed (lasts about 12 weeks))
o Lubricant
o 10ml syringe (to aspirate)
o Saline filled 10ml syringe (to flush)
o pH paper strip
o Tape (to stick down)
 Wash hands
 Open packets and place equipment neatly in tray in plastic parts of packets (without touching the instruments themselves)
 Walk to patient

Patient part
Preparation
 Sit patient straight upright (head in normal position)
 Ask patient to blow their nose
 Measure from the patients tip of nose → ear lobe → xiphisternum with the nasogastric tube (it has measurements on it) and
remember the measurement

Procedure
 Wash hands
 Put on gloves
 Lubricate the tube
 Ask the patient to hold a mouthful of water and hold the straw in their mouth
 Gently push the tube into the nostril as close to horizontally as possible
 The patient will gag when the tube reaches the back of their throat
 Ask them to keep swallowing, and push the tube down fast when they are swallowing (feels horrible for patient)
 Continue advancing the tube until the memorised measurement
 Confirm the tube is placed in the stomach (i.e. not lungs) by one of two possible methods (in order of preference):
1. Aspirate gastric contents and drop onto pH paper (pH should be ≤6) – if you cannot aspirate, try asking the patient to lie
on their left for 30 minutes and then retry
2. Order a chest x-ray
 NG must pass vertically down the oesophagus (in the midline) until below the diaphragm
 NG must not follow the course of either of the main bronchi below the carina
 The tip of the NG tube must be visible at least 10cm beyond the gastro-oesophageal junction below the
diaphragm
 Remove tube guidewire (note: NEVER put guidewire back down after removing)
 Tape tube down at nose and over ear
 Flush with saline

To complete
 Thank patient and cover them
 Bin waste and gloves
 Clean tray, wash hands
 Document procedure and aspirate pH

© 2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision
Other points
 Check the pH and flush the tube before every feed
 Daily care: check skin around tubing, clean around nose, flush tube
 Drugs are put down separately – you can put in enteric coated / slow release drugs
 To remove: Inject 10ml air down tube and gently remove

© 2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision