INSERTING A

NASOGASTRIC TUBE
Objectives:
• At the end of the lecture the student will be able to know:
1. The different types of NG tubes
2. Indications for use
3. How to insert a NG tube
4. How to tube feed
5. Indications of tube feeding
Definition:

• A nasogastric (NG) tube is a pliable tube that is inserted

through the client’s nasopharynx into the stomach.
• The tube has a hallow lumen that allows the removal of
gastric secretions and the introduction of solutions into the
stomach.
Indications:

1. To administer tube feedings and medications to clients unable to

eat by mouth or swallow a sufficient diet without aspirating food or
fluids into the lungs. (Gastric gavage)

2. To establish a means for suctioning stomach contents to prevent

gastric distention, nausea and vomiting. (Gastric decompression)
Indications:

3. To remove stomach contents for laboratory analysis/ gastric

analysis

4. To lavage the stomach in case of poisoning or overdose of

medications. (Gastric Lavage)
Equipment:
1. 14 or 16 Fr NG tube
2. Lubricating jelly
3. pH test strips
4. Tongue blade
5. Flashlight
6. Asepto bulb or catheter-tipped syringe
7. 1-inch wide hypoallergenic tape
Different Types of NG tube:

1. Short tubes – pass through the nose into the stomach

Levin Tube sizes from 14 to 18 Fr.
Gastric Sump (Salem )
Different Types of NG tube:

2. Medium tubes – tubes pass through the nose to the duodenum and the
jejunum

3. Long tubes – pass through the nose through the esophagus and stomach
into the intestines.
Equipment needed:

•NG tube
•Lubricating jelly
•pH test strips
•Tongue blade
•Penlight/flashlight
•Emesis basin
•1 inch wide tape
•Stethoscope
Equipment:
8. Safety and rubber band
9. Clamp, drainage bag, or suction machine
10.Bath towel
11.Glass of water with straw
12.Facial tissues
13.Normal saline
14.Disposable gloves
PROCEDURE:
Preparatory Phase
1. Check doctor’s order, type of NG tube to be placed, and whether
tube is to be attached to suction or drainage bag.
Rationale: Procedure requires doctor’s order.

2. Palpate client’s abdomen for distention, pain, and rigidity.

Rationale: Baseline determination of level of abdominal distention and
function later serves as comparison once tube is inserted.
3. Assess level of consciousness and ability to follow instructions.
Rationale: Determine client’s ability to assist in procedure

4. Prepare equipment at the bedside. Have a 4-inch piece of tape ready

with one end split in half.
Rationale: Ensures well-organized procedure. Tape will be used to
initially hold tube in place after insertion.
5. Wash hands and apply gloves.
Rationale: Reduces transmission of microorganisms.
6. Identify client, explain the procedure, and develop a hand signal.
Rationale: Prevents error in placing tube in wrong client. Explanation gains
client’s cooperation and ability to anticipate nurse’s action.

7. Position client in high-fowler’s position with pillows behind head and

shoulders. Raise bed to a horizontal level comfortable for the nurse.
Rationale: Promotes client’s ability to swallow during the procedure. Good
body mechanics prevent injury to the nurse.

8. Place bath towel over client’s chest.

Rationale: Prevents soiling of client’s gown.
9. Instruct to relax and breath normally while occluding one nares. Then
repeat this action for other nares. Select nostril with grater airflow.
Rationale: Tube passes more easily through nares that is more patent.
10.Measure distance to insert tube.
a. Traditional method: Measure distance from tip of nose to earlobe to
xiphoid process.
Rationale: This length approximates the distance from the nares to the
stomach. This distance varies among individuals.

b. Hanson method. First mark 50 cm point on tube, then do traditional

measurement. Tube insertion should be to midway point between 50 cm
(20 inches) and traditional mark.
11.Mark the length of tube to be inserted with small piece of tape placed
around tube so it can be easily removed.

12.Curve 10 to 15 cm (4 to 6 inches) of end of tube tightly around index finger,

then release.
Rationale: Curving tube tip aids insertion and decreases stiffness of tube.
Performance phase:
13.Lubricate 7.5 to 10 cm (3 to 4 inches) of end of tube with water-soluble
lubricating jelly.
Rationale: Minimizes friction against nasal mucosa and aids insertion of
tube.
14.Initially instruct client to extend neck back against pillow; insert tube
slowly through nares with curved end pointing downward.
Rationale: Facilitates initial passage of tube through nares and maintains
clear airway for open nares.
15. Continue to pass tube along floor of nasal passage, aiming down toward ear.
When resistance is felt, apply gentle downward pressure to advance tube. (Do not
force pass resistance).
Rationale: Minimizes discomfort of tube rubbing against upper nasal turbinates.
Resistance is caused by posterior nasopharynx. Downward pressure helps tube curl
around corner of nasopharynx.

16.If resistance is met, try to rotate the tube and see if it advances. If still resistant,
withdraw tube, allow client to rest, lubricate tube, insert into other nares.
Rationale: Forcing against resistance can cause trauma to mucosa.
17.Continue insertion of tube until just past nasopharynx by gently rotating
tube toward opposite nares.
a. Stop tube advancement, allow client to relax, and provide tissue.
b. Explain that the next step requires swallowing. Give glass of water
unless contraindicated.
Rationale: Tearing is a natural response to mucosal irritation, and excessive
salivation may occur because of oral stimulation. Sipping water aids the
passage of NG tube into esophagus.
18.With tube just above oropharynx, instruct to flex head forward, take a
small sip of water, and swallow. Advance tube 2.4 to 5 cm with each
swallow of water. If fluid are not allowed, instruct to dry swallow or suck
air through straw. Advance tube with each swallow.
Rationale: Flex position closes off upper airway to trachea and opens
esophagus
19. If clients begin to cough, gag, or choke, withdraw slightly and stop
advancement. Instruct client to breathe easily and take sips of water.
Rationale: Tube may accidentally enter larynx and initiate gag reflex.
Gagging is eased by swallowing of water.

20.If client continues to cough during insertion, pull tube back slightly.
Rationale: Tube may enter larynx and obstruct airway.

21.After client relaxes, continue to advance tube- desired distance.

23.Checking tube placement.
a. Ask client to talk.
Rationale: Unable to talk if NG tube has passed through vocal cords.
b. Inject 10 cc or air and auscultate.
Rationale: “Swooshing” sound, indicated placement.
c. Aspirate gentle back on syringe to obtain gastric contents, observing
color.
Rationale: Aspiration of contents provide means to measure fluid pH and
thus determine tube tip placement in gastrointestinal tract.
pH values and their corresponding indications
and actions:
Value Indications Actions

pH less than 5 Gastric Proceed to feed

pH 5-6 Check visual characteristics If visual characteristics

of aspirates indicate gastric aspirates,
proceed to feed.
Otherwise, do check x-ray
to confirm tube placement

pH more than 6 Intestinal or respiratory Do check x-ray to confirm

tube placement.
 Gastric Intestinal Respiratory

May be grassy green with Generally more transparent Tracheo-bronchial secretion

sediments, brown (if blood is than gastric aspirates, may may consist of off white to tan
present and has been acted appear bile stained ( color is sediment
on by gastric acid) from light to dark golden
yellow or brown-green)
May also appear clear and
colorless ( often off-white to
tan mucus or sediment)
d. X-ray confirmation. The most reliable confirmation.
*If tube is not in stomach, advance another 2.4 to 5 cm and repeat steps to
check tube position.
24.Anchoring tube.
a. Clamp end or connect it to drainage bag or suction machine.
Rationale: Drainage bag is used for gravity drainage. Intermittent
suction is most effective for decompression. Client for surgery often
has tube clamp.
b. Tape tube to nose, avoid putting pressure on nares.
Rationale: Prevents tissue necrosis. Tape anchors tube securely.
c. Fasten end of NG tube to client’s gown by looping rubber band around
tube in slipknot. Pin tuber band to gown.
Rationale: Reduces pressure on nares if tube moves.
Nasogastric Tube Placement
 d. Unless physician orders otherwise, head of bed should be elevated 30
degrees.
Rationale: Helps prevent esophageal reflux and minimizes irritation of tube
against posterior pharynx.
e. Explain that sensation of tube should decrease somewhat with time.
Rationale: Adaptation to continued sensory stimulus.
f. Remove gloves and wash hands.
Rationale: Reduces transmission of microorganisms.

25.Safety: once placement is confirmed, place a mark, either a mark or tape,

on the tube to indicate where the tube exist in the nose.
Rationale: Used as a guide to indicate whether displacement may have
occurred.
26.Documentation of relevant information.
a. Size of tube, which nostrils and clients response
b. Record aspirate pH and characteristics

27. Establish a plan for providing daily nasogastric tube care

Rationale: To provide patient comfort.

28. If suction is applied, ensure the patency of nasogastric tube is maintained.

Nursing Responsibilities:

1. Ensure that the tube remains in the intended position before administering
formula or medication.
2. Check of tube placement is performed before feeding.
3. Identify signs and symptoms of tube dislocation
4. Maintain the patency of the tube.