Nasogastric tube 

or NG tube is used in patients suffering from dysphagia due to their inability to meet

nutritional needs despite food modifications and because of the possibility of aspiration.

The following are the nursing considerations you should watch out for:

 Provide oral and skin care. Give mouth rinses and apply lubricant to the patient’s lips and
nostril. Using a water-soluble lubricant, lubricate the catheter until where it touches the nostrils
because the client’s nose may become irritated and dry.
 Verify NG tube placement. Always verify if the NG tube placed is in the stomach by aspirating a
small amount of stomach contents. An X-ray study is the best way to verify placement.
 Wear gloves. Gloves must always be worn while starting an NG because potential contact with
the patient’s blood or body fluids increases especially with inexperienced operator.
 Face and eye protection. On the other hand, face and eye protection may also be considered if
the risk for vomiting is high. Trauma protocol calls for all team members to wear gloves, face
and eye protection and gowns.

1. Review the physician’s order and know the type, size, and purpose of the NG tube. It is widely
acceptable to use a size 16 or 18 French for adults while sizes suitable for children vary from a very
small size 5 French for children to size 12 French for older children.
2. 2 Check the client’s identification band. Just like in administering medications, it is very important
to be sure that the procedure is being carried out on the right client.
3. 3 Gather equipment, set up tube-feeding equipment or suction equipment mentioned
above. This is to make sure that the equipment is functioning properly before using it on the client.
4. Briefly explain the procedure to the client and assess his capability to participate. It is not
advisable to explain the procedure too far in advance because the client’s anxiety about the
procedure may interfere with its success. It is important that the client relax, swallow, and
cooperate during the procedure.
5. Observe proper hand washing and don non-sterile gloves. Clean, not sterile, technique is
necessary because the gastrointestinal (GI) tract is not sterile.
6. Position client upright or in full Fowler’s position if possible. Place a clean towel over the client’s
chest. Full Fowler’s position assists the client to swallow, for optimal neck-stomach alignment and
promotes peristalsis. A towel is used as a covering to protect bed linens and the client’s gown.
7. Measure tubing from bridge of nose to earlobe, then to the point halfway between the end of
the sternum and the navel. Mark this spot with a small piece of temporary tape or note the
distance. Each client will have a slightly different terminal insertion point. Measurements must be
made for each individual’s anatomy.
8. 8 Wipe the client’s face and nose with a wet towel. Wipe down the exterior of the nose with an
alcohol swab. The NG tube will stay more secure if taped on a clean, non oily nose. If the nose has
been cleaned with an alcohol swab, the tape will stay more secure and the tube will not move in
the throat—causing gagging or discomfort later.
9. Cover the client’s eyes with a cloth. This protects the client’s eyes from any alcohol fumes from
the alcohol swab.
10. Examine nostrils for deformity or obstruction by closing one nostril and then the other and
asking the client to breathe through the nose for each attempt. If the client has difficulty
breathing out of one nostril, try to insert the NG tube in that one. The client may breathe more
comfortably if the “good” nostril remains patent.The blocked nasal passage may not be totally
 occluded and thus you may still be able to pass an NG tube. It may be necessary to use the more
patent nostril for insertion.
11. Lubricate 4 to 8 inches of the tub with a water-soluble lubricant. The NG intubation 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.
12. Flex the client’s head forward, tilt the tip of the nose upward and pass the tube gently into the
nose to as far as the back of the throat. Guide the tube straight back. Flexing the head aids in the
anatomic insertion of the tube.The tube is less likely to pass into the trachea.
13. Once the tube reaches the nasopharynx, allow the client lower his head slightly. Ask the assistant
to hold the glass of water. Ready the emesis basin and tissues. The positioning helps the passage of
the NG to follow anatomic landmarks. Swallowing water, if allowed, helps the passage of the NG
tube.
14. Instruct the client to swallow as the tube advances. Advance the tube until the correct marked
position on the tube is reached. Encourage the client to breathe through his mouth. Swallowing of
small sips of water may enhance passage of tube into the stomach rather than the trachea.
15. If changes occur in patient’s respiratory status, if tube coils in mouth, if the patient begins
to cough or turns cyanotic, withdraw the tube immediately. The tube may be in the trachea.
16. If obstruction is felt, pull out the tube and try the other nostril. The client’s nostril may deflect the
NG into an inappropriate position. Let the client rest a moment and retry on the other side.
17. Advance the tube as far as the marked insertion point. Place a temporary piece of tape across the
nose and tube. In this way, you can check for placement before securing the tube. The tube may
move out of position if not secured before checking for placement.
18. Check the back of the client’s throat to make sure that the tube is not curled in the back of the
throat. On instance, the NG will curl up in the back of the throat instead of passing down to the
stomach. Visual inspection is needed in this situation. Withdraw the entire tube and start again if
such thing occurred.
19. Check tube placement with these methods. Check the tube for correct placement by at least two
and preferably three of the following methods:

A.Aspirate stomach contents. Stomach aspirate will appear cloudy, green, tan, off-white, bloody, or
brown. It is not always visually possible to distinguish between stomach and respiratory aspirates.
Special note: The small diameters of some NG tubes make aspiration problematic. The tubes themselves
collapse when suction is applied via the syringe. Thus, contents cannot be aspirated.

B. Check pH of aspirate. Measuring the pH of stomach aspirate is considered more accurate than visual
inspection. Stomach aspirate generally has a pH range of 0 to 4, commonly less than 4. The aspirate of
respiratory contents is generally more alkaline, with a pH of 7 or more.

C. Inject 30 mL of air into the stomach and listen with the stethoscope for the “whoosh” of air into the
stomach. The small diameter of some NG tubes may make it difficult to hear air entering the stomach.

D. Confirm by x-ray placement. X-ray visualization is the only method that is considered positive.20
Secure the tube with tape or commercially prepared tube holder once stomach placement has been
confirmed. It is very important to ensure that the NG tube is in its correct place within the
stomach because, if by accident the NG is within the trachea, serious complications in relation to the
lungs would appear. Securing the tube in place will prevent peristaltic movement from advancing the
tube or from the tube unintentionally being pulled out.