What is the best method for nasogastric (NG) tube insertion in nursing?

Best Method for Nasogastric Tube Insertion in Nursing

The best method for nasogastric tube insertion in nursing involves proper patient positioning, adequate lubrication, measurement of appropriate tube length, and utilizing the swallow technique while advancing the tube gradually to minimize trauma and maximize success rates. 1

Preparation and Patient Positioning

• Explain the procedure to the patient to reduce anxiety and increase cooperation 1
• Position the patient upright with the head level to create the optimal anatomical pathway for tube insertion 1
• Check nasal patency by having the patient "sniff" with each nostril occluded in turn; select the clearer nostril for insertion 1
• Consider spraying the clearer nostril with lidocaine to minimize discomfort during insertion 1

Tube Measurement and Preparation

• Mark the tube at a distance equal to that from the xiphisternum to the nose via the earlobe (typically 50–60 cm) to ensure appropriate insertion depth 1
• Lubricate the tube externally with gel/water and internally with water if a guidewire is present 1
• Check that any guidewire moves freely before insertion to prevent complications 1

Insertion Technique

• Slide the tube gently backwards along the floor of the clearer nostril until visible at the back of the pharynx (10–15 cm) 1
• For cooperative patients, ask them to take a mouthful of water and advance the tube 5–10 cm as they swallow 1
• Repeat the water swallow/advance technique until the preset mark on the tube reaches the nostril 1
• If difficulty is encountered, ask the patient to tilt their head forwards or turn it to one side to facilitate passage 1

Safety Considerations

• Withdraw the tube immediately if the patient becomes distressed, starts coughing, or develops cyanosis 1
• Once in place, remove any guidewire and secure the tube carefully 1
• Check the position of the tube before use to confirm proper placement 1
• Document the tube insertion in the patient's notes 1

Special Considerations for Difficult Insertions

• For anesthetized patients, the reverse Sellick's technique (applying backward pressure on the cricoid cartilage) has shown higher success rates and shorter insertion times 2
• For patients requiring longer-term NG tubes, consider specialized fixation methods beyond standard taping to prevent accidental dislodgement 3, 4
• In patients with epidermolysis bullosa or fragile mucosa, an experienced staff member should insert a well-lubricated NGT to reduce friction on internal mucosa and minimize the risk of requiring multiple passes 1

Securing the Tube

• To secure the NGT, use a low-adherent film as a contact layer with a full-adherent tape that secures the tube to the film, avoiding direct contact with the patient's skin 1
• For patients requiring long-term NG tubes, consider specialized fixation methods such as the "mini A-shaped double loop" technique that secures the tube without facial taping or suturing 3
• Change long-term NG tubes every 4-6 weeks, alternating nostrils to prevent complications 5

Verification of Placement

• Check position of the tube before use; this is essential for patient safety 1
• While bedside auscultation is common, radiographic confirmation is recommended before initial use to prevent complications from misplaced tubes 1

Common Pitfalls and How to Avoid Them

• Avoid blind insertion without proper measurement, which can lead to improper placement or trauma 1
• Never force the tube if resistance is met; instead, withdraw slightly and try a different angle 1
• Be aware that NG tube dislodgement occurs in approximately 25% of cases; proper securing techniques can reduce this risk 5, 6
• For patients with recent variceal bleeding, avoid NG tube insertion for three days and use only fine bore tubes to minimize trauma 5