Nasogastric tube (NGT)

insertion and removal

Nursing Procedure
• Usually inserted to decompress
the stomach, a nasogastric tube
(NG) tube prevent vomiting
after major surgery. An NG
typically is in place for 48-72
hours after surgery, by which
time peristalsis usually resumes.
The NG tube can also be used to
assess and treat:
Upper GI bleeding
Collect gastric contents for
analysis
Perform gastric lavage
Aspirate gastric secretions
Administer medications and
nutrients
Equipments needed
 Equipments needed
• Tube (usually
#12, #14, #16
or #18 French
for a normal
adult.
 Equipments needed
• Towel or linen-saver pad
 Equipments needed
• Penlight
 Equipments needed
• 1” or 2” hypoallergenic tape or
Opsite
 Equipments needed
• Liquid skin barrier
 Equipments needed
• Gloves
 Equipments needed
• Water soluble lubricant
 Equipments needed
• Cup or glass of water with straw
(if appropriate)
 Equipments needed
• Stethoscope
 Equipments needed
• Tongue blade
 Equipments needed
• Catheter-tip or bulb syringe or
irrigation set
 Equipments needed
• Safety pin
 Equipments needed
• Ordered
suction
equipment
Equipments needed (optional)
• Metal clamp
Equipments needed (optional)
• Ice
Equipments needed (optional)
• Alcohol pad
Equipments needed (optional)
• Warm water
• (in the picture is a
hot water bag)
Equipments needed (optional)
• Large basin or plastic container
Equipments needed (optional)
• Rubber band
 Preparation
• To ease insertion, increase a stiff
tube’s flexibility by coiling it
around your finger for a few
seconds or by dipping it into warm
water.
• Stiffen a limp rubber tube by
briefly chilling it in ice.
 Procedure
• Provide privacy, wash your hands,
and put on gloves.
 Inserting an NG tube
• Explain the procedure to the
patient.
• Tell her that she may experience
some discomfort and that
swallowing will ease the tube’s
advancement.
 Inserting an NG tube
• Help the patient
into high
Fowler’s position
unless
contraindicated.
 Inserting an NG tube
• Stand at the
patient’s right
side if you’re
right-handed or
at her left side if
you’ left-handed
to ease
insertion.
 Inserting an NG tube
• Drape the
towel or linen-
saver pad over
the patient’s
chest.
 Inserting an NG tube
• To determine how long the NG
tube must be to reach the stomach,
hold the end of the tube at the tip of
the patient’s nose.
• Extend the tube to the patient’s
earlobe and then down to the xiphoid
process.
 Inserting an
NG tube

• Mark this
distance on the
tubing with
tape.
 Inserting an NG tube
• To determine which nostril will
allow easier access, use a
penlight and inspect for a
deviated septum or other
abnormalities.
 Inserting an NG tube
• Lubricate the first 3” (7.6 cm) of
the tube with a water-soluble gel.
 Inserting an NG tube
• Instruct the patient to hold her
head straight and upright.
 Inserting an NG tube
• Grasp the tube with the end
pointing downward, curve it if
necessary, and carefully insert it
into the more patient nostril.
 Inserting an NG tube
• Aim the tube downward and
toward the ear closest to the
chosen nostril.
• Advance it slowly to avoid
pressure on the turbinates and
resultant pain and bleeding.
 Inserting an NG tube
• When the tube reaches the
nasopharynx, you’ll feel
resistance.
 Inserting an NG tube
• Instruct the patient to lower her
head slightly to close the trachea
and open the esophagus.
 Inserting an NG tube
• Then rotate the tube 180 degrees
toward the opposite nostril to
redirect it so that the tube wont
enter the patient’s mouth.
 Inserting an NG tube
• Unless contraindicated, offer the
patient a cup of water with a straw.
• Direct her to sip and swallow as
you slowly advance the tube.
• This helps the tube pass to the
esophagus. (If you aren’t using
water, ask the patient to swallow.)
Ensuring proper tube placement

• Use a tongue blade and penlight

to examine the patient’s mouth
and throat for signs of a coiled
section of tubing.
Ensuring proper tube placement

• As you carefully advance the tube

and the patient swallows, watch
for respiratory distress signs,
which may mean the tube is in
bronchus and must be removed
immediately.
Ensuring proper tube placement

• Stop advancing the tube when the

tape mark reaches the patient’s
nostril.
Ensuring proper tube placement

• Attach the catheter-tip or bulb

syringe to the tube and try to
aspirate stomach contents.
Ensuring proper tube placement

• If you don’t obtain stomach

contents, position the patient on
her left side to move the
contents into the stomach’s
greater curvature, and aspirate
again.
Ensuring proper tube placement

• If you still can’t aspirate stomach

contents, advance the tube 1” to
2” (2.5 - 5 cm).
• Then inject 10cc air into the tube.
Ensuring proper tube placement

• At the same time, auscultate for

air sounds with your stethoscope
placed over the epigastric region.
• You should hear a whooshing
sound if the tube is patent and
properly positioned in the
stomach.
Ensuring proper tube placement

• If these test don’t confirm proper

tube placement, you’ll need X-ray
verification.
 Example
of a CXR
showing a
misplaced
NG tube
Ensuring proper tube placement

• Secure the NG tube to the

patient’s nose with hypoallergenic
tape, (or other designated tube
holder).
• If the patient’s skin is oily, wipe
the bridge of her nose with an
alcohol pad and allow to dry.
Ensuring proper tube placement

• Apply liquid skin barrier to make

the tape more adherent to the
skin.
Ensuring proper tube placement

• You’ll need about 4” (10 cm) of

1”tape.
• Split one end of the tape up the
center about 1 ½” (3.8 cm).
• Make tabs on the split ends (by
folding sticky sides together).
Ensuring proper tube placement

• Stick the uncut tape end on the

patient’s nose so that the split in
the tape starts about ½” (1.3 cm)
to 1 ½” from the tip of her nose.
Ensuring proper tube placement

• Crisscross the tabbed ends around

the tube.
• Then apply another piece of tape
over the bridge of the nose to
secure the tube.
Ensuring proper tube placement

• Alternatively, stabilize the tube

with Opsite or a prepackaged
product that secures and
cushions it at the nose.
Ensuring proper tube placement
• To reduce discomfort from the weight
of the tube, tie a slipknot around the
tube with a rubber band, and then
secure the rubber band to the
patient’s gown with a safety pin, or
wrap another piece of tape around
the end of the tube and leave a tab.
• Then fasten the tape tab to the
patient’s gown.
Ensuring proper tube placement

• Attach the tube to suction

equipment, if ordered, and set the
designated suction pressure.
Ensuring proper tube placement

• Provide frequent nose and mouth

care while the tube is in place.
• An NG tube may be inserted or
removed at home.
*Confirming NG tube placement

• When confirming NG tube

placement, never place the tube’s
end in a container of water.
• If the tube is malpositioned in the
trachea, the patient may aspirate
water.
*Confirming NG tube placement

• Besides, water without bubbles

doesn’t confirm proper placement.
• Instead, the tube may be coiled in
the trachea or the esophagus.
 Removing an NG tube
• Explain the procedure to the
patient and that it may cause
some discomfort.
 Removing an NG tube
• Assess bowel function by
auscultating for peristalsis or
flatus.
 Removing an NG tube
• Help the patient into semi-
Fowler’s position.
• Then drape a towel or linen-saver
pad across her chest to protect
her from spills.
 Removing an NG tube
• Put on gloves.
• Using a catheter-tip syringe, flush
the tube with 10ml of normal
saline solution to ensure that the
tube doesn’t contain stomach
contents that could irritate
tissues during tube removal.
 Removing an NG tube
• Untape the tube from the patient’s
nose, and then unpin it from her
gown.
• Please wear gloves!!!
 Removing an NG tube
• Clamp the tube by folding it in
your hand.
 Removing an NG tube
• Ask the patient to hold her breath to close
the epiglottis.
• Then withdraw the tube gently and
steadily. (when the distal end of the tube
reaches the nasopharynx, you can pull it
quickly.)
• Please wear gloves!!!
 Removing an NG tube
• Assist the patient with thorough
mouth care, and clean the tape
residue from her nose with
adhesive remover.
 Removing an NG tube
• Monitor the patient for signs of GI
dysfunction.
 Pointers
• If the patient has a nasal
condition that prevents nasal
insertion, pass the tube orally
after removing any dentures, if
necessary.
 Pointers
• First coil the end of the tube
around your hand.
• This helps curve and direct the
tube downward at the phaynx.
 Pointers
• While advancing the tube.
• Observe for signs that it is
entered the trachea, such as
choking or breathing difficulties in
a conscious patient and cyanosis
in an unconscious patient or a
patient without a cough reflex.
 Pointers
• If these signs occur, remove the
tube immediately.
• Allow the patient time to rest; then
try to reinsert the tube.
 Pointers
• After tube placement, vomiting
suggest tubal obstruction or incorrect
position.

• Assess immediately to determine the

cause.
 Complications of NG intubation

• Although nasogastric (NG)

intubation is a common
procedure, it does carry risk.
 Complications of NG intubation
(Long-term concerns)
• Potential complications of prolonged
intubation includes:
 Esophagitis
 Esophagotracheal fistula
 Gastric ulceration
 Pulmonary and oral infection
 Sinusitis
 Skin erosion at the nostril
Complications of NG intubation
(Suction reactions)
• Additional complications include:
 Electrolyte imbalances
 Dehydration
Complications of NG intubation
(Suction reactions)
• Vigorous suction ,ay damage the
gastric mucosa and cause
significant bleeding, possibly
interfering with endoscopic
assessment and diagnosis.
 Using an NG tube at home
• If your patient will have a
nasogastric (NG) tube in place at
home, find out who will insert the
tube.
• If he will have a home care nurse,
tell him to expect her.
 Using an NG tube at home
• Make a list; check it twice
• If the patient or a family member
will perform the procedure, you’ll
need to provide additional
instruction and supervision.
 Using an NG tube at home
• Use this checklist to prepare
teaching topics:
How and where to obtain
equipment needed for home
intubation.
How to insert the tube.
Using an NG tube at home
How to verify tube placement by
aspirating stomach contents.
How to correct tube misplacement.
How to prepare formula for tube
feeding.
How to store formula, if
appropriate.
Using an NG tube at home
How to administer formula through
the tube.
How to remove and dispose of an
NG tube.
How to clean and store a reusable
NG tube.
Using an NG tube at home
How to use the NG tube for gastric
decompression, if appropriate.
How to set up and operate
suctioning equipment.
How to troubleshoot suctioning
equipment.
How to perform mouth care and
other hygenic procedures.
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“Nurses Informations”