From the Guidelines
Nasogastric (NG) tube insertion should be performed by experienced medical or nursing staff using fine bore (5–8 French gauge) tubes, with position checked using pH testing prior to every use. The procedure involves passing a flexible tube through the nose, down the esophagus, and into the stomach. To perform this procedure, gather all necessary equipment including the appropriate sized tube, lubricant, tape, pH paper, and a cup of water with a straw. Position the patient upright if possible, and measure the tube length by placing it from the tip of the nose to the earlobe and then to the xiphoid process, marking this distance with tape. Lubricate the tube tip and insert it into the nostril, directing it posteriorly and downward. Ask the patient to swallow small sips of water as you advance the tube to facilitate passage through the esophagus.
Key Considerations
- Verify proper placement by aspirating gastric contents and testing the pH (which should be acidic, typically 1-4), as recommended by 1.
- Never rely solely on air auscultation for confirmation as this method is unreliable, according to 1.
- Once placement is confirmed, secure the tube to the patient's nose with tape.
- Complications may include trauma to nasal passages, inadvertent placement into the lungs, or esophageal perforation, so careful technique and proper verification are essential.
- Contraindications include severe facial trauma, basilar skull fractures, and recent nasal surgery, and NG tube insertion should be avoided for three days after acute variceal bleeding, as stated in 1.
Long-term Use
- Long term NG and NJ tubes should usually be changed every 4–6 weeks, swapping them to the other nostril, as recommended by 1.
- Gastrostomy or jejunostomy feeding should be considered whenever patients are likely to require enteral feeding for more than 4–6 weeks, according to 1.
From the Research
Indications for Nasogastric Tube Insertion
- Nasogastric tubes are used for decompression of the stomach in the presence of bowel obstruction in critically ill patients 2
- They are useful as a conduit for the administration of medications and sometimes for short-term parenteral nutrition 2
- Nasogastric tubes are essential and resuscitative tools in multiple medical specialties for acute and chronic care 2
Procedure for Nasogastric Tube Insertion
- The placement of nasogastric tubes is relatively routine, but they must be inserted and maintained safely and effectively to avoid serious and possibly even fatal associated complications 2
- Various techniques have been introduced to facilitate nasogastric tube insertion using anatomic landmarks and a group of devices, but there is no consensus on a standard method 3
- Nebulized lidocaine can be administered before nasogastric tube insertion to decrease patient discomfort 4
Confirming the Correct Position of the Nasogastric Tube
- Capnography is a more accurate method than epigastric auscultation for assessing the accuracy of nasogastric tube placement in intensive care unit patients 5
- Radiography can be used to confirm the correct placement of the nasogastric tube 5
- It is recommended that more than one method be applied to detect and confirm the correct insertion of the nasogastric tube 5
- Various methods can be used to confirm the tube's position, including checking the pH of the aspirate and using a chest X-ray 6