INSERTING A NASOGASTRIC TUBE

Before inserting the nasogastric tube determine the size of tube to be

inserted and whether or not the tube is to be attached to suction.

Purposes:

• To administer the feedings and medications to clients unable to eat by

mouth or swallow a sufficient diet without aspirating food or fluids into
the lungs.

• To establish a means for suctioning stomach contents to prevent

gastric distention, nausea and vomiting.

• To remove stomach contents for laboratory analysis

• To lavage (wash) the stomach in case of poisoning or overdose of

medications

Equipments:

• Large- or small –bone tube ( plastic or rubber)

• Solution basin filled with warm water ( if a plastic tube is being used )
or (if a rubber tube is being used)

• Nonallergenic adhesive tape, 2.5 cm (1 in)

• Disposable Gloves

• Water- soluble lubricant

• Facial tissues

• Glass of water and drinking straw or medicine cup with water

• 20to 50 ml syringe with an adapter

• Basin

• Stethoscope

• Clamp( optional)
 • Suction apparatus if required

• Gauze square or plastic specimen bag and elastic band

• 5ml or 12 ml syringe

Procedure:

1. Prepare the client

• Explain to the client what you plan to do. The passage of gastric tube is
not painful, but it is unpleasant because the gag reflex is activated
during insertion

• Assist the client to have a high fowlers position if health permits and
support the head or a pillow

2. Assess the client nares

• Ask the client to hyperextend the head and using a flashlight observe
the intactness of the tissues of the nostrils, including any irritations or
abrasions

• Examine the nares for any obstructions or deformities by asking the

client to breathe through one nostril while occluding the other

• Select the nostril that has the greater airflow.

3. Prepare the tube

4. Determine how far to insert the tube

• Use the tube to marked off the disturbance from top mark off the
distance from the tip of the clients nose from the tip of the earlobe to
the tip of the sternum
 • For infants and young children , measure from the nose to the point of
the earlobe and then to the point midway between the umbilicus and
the xiphoid process ( NEX TECHNIQUE ) -50 cm

5. INSERT THE TUBE

• Don gloves

• Lubricate the top of the tube with water soluble lubricant. To reduce
friction. Do not use oil. Oil may cause lipoid pneumonia

• Insert the tube with its natural curve toward the client, into the
selected nostril. Ask the client to hyperextend the neck, and gently
advance the tube toward the nasopharynx.

• Once the tube reaches the oropharynx (throat) the client will feel the
tube in the throat and may gag and retch.

-Ask the client o tilt the head head forward and encourage the client to
drink and swallow

6. Ascertain correct placement of the tube

• Auscultate air insufflations

7. Secure the tube by taping it to the bridge of the client’s nose.

• Cut 7.5 cm (3 in) of tape, and split it lengthwise at one end leaving a
2.5 cm (1 in) tab at the end.

• Place the tape over the bridge of the client’s nose, and bring the split
ends under the tubing and back up over the nose.

INDICATIONS:

Use of a nasogastric tube is indicated to:

1. Decompress the stomach by aspiration of gastric contents (fluid, air,

blood).
 2. Introduce fluids (lavage fluid, tube feedings, and activated charcoal)
into the stomach.
3. Assist in the clinical diagnosis through analysis of substances found in
gastric contents.

CONTRAINDICATIONS:

Nasogastric tubes are contraindicated or used with extreme caution in

people with particular predispositions to injury from tube placement. These
may include:

• Patients with sustained head trauma, maxillofacial injury, or anterior

fossa skull fracture. Inserting a NG tube blindly through the nose has
potential of passing through the cribriform plate, thus causing
intracranial penetration of the brain.
• Patients with a history of esophageal stricture, esophageal varices,
alkali ingestion at risk for esophageal penetration.
• Comatose patients have the potential of vomiting during a NG insertion
procedure, thus require protection of the airway prior to placing a NG
tube.