NASOGASTRIC TUBE (RYLE) STEPS

Wash your hands, introduce yourself to the patient and clarify their identity. Explain the procedure to
the patient and gain their consent to proceed.
Wash your hands
Gather your equipment:
1. Gloves
2. Fine bore nasogastric tube (feeding only) or nasogastric Ryles tube 16Fr (all other indications)
3. Water based lubricant
4. Syringe
5. Cup of water
For this procedure the patient should be positioned on the bed upright and facing forward. Put on
your gloves.
Estimate the length of the tube to be inserted. Do this by measuring the NG tube from the tip of the
nose, to the earlobe and then to the xiphisternum.
Lubricate the tip of the tube and begin to insert through one of the nostrils. If any resistance is
encountered change to the other nostril.
Your patient will usually be awake during this procedure so ensure they are not experiencing too
much discomfort.
Ask the patient to indicate when the tube is at the back of the throat, or if they have had anaesthetic
spray ask the patient to open their mouth and look for the end of the tube.
Ask the patient to take a mouthful of water and as they swallow advance the tube to the desired
length.

1. Lubricate the distal end.
2. Insert slowly through the nose, if gag reflex, withdraw it and ask the pt to swallow several times
and try to introduce again, if obstruction -> rotate the tube BUT never force it, if obstruction
persists, use the other nostril.
3. Severe gag and retching -> tube is curling into the mouth or the oesophagus.
4. Coughing, wheezing and cyanosis -> trachea entered.
5. Secure it by tape, avoid tight curve prevent necrosis of the nares.
How to confirm the site (stomach)
1. Passes easily.
2. No gag or retching.
3. No cyanosis, coughing and wheezing.
4. Free return of gastric contents.
5. Aspiration of gastric contents.
6. Inject 10 ml air while listening at the epigastriumgurgling.

Care of the tube:
1. Irrigate with saline.avoid blockage.
2. Fluid chart.
3. Good oral hygiene to avoid parotitis.by mouth washes.
4. Nasal decongestant to prevent otitis..as irritation of Eustachian tubes into the nasopharynx may
lead to their obstruction.