Nasogastric Tube

2023

NG Tube
Ali Yousef
BScN
 Introduction to Feeding Method
Parenteral nutrition is intravenous administration of nutrition, which may
include protein, carbohydrate, fat, minerals and electrolytes, vitamins and
other trace elements for patients who cannot eat or absorb enough food
through tube feeding formula or by mouth to maintain good nutrition status

Enteral nutrition is the delivery of liquid formula into the GI tract via a tube
that bypasses the mouth, esophagus and, depending on the type of tube,
sometimes the stomach. Enteral feedings are designed for patients who have
a functioning GI system but have an inability to chew and swallow food, have
a high metabolic need, or lack the stamina to eat.
 Type of Enteral Nutrition
- Through Noise
• Nasogastric Tubes
• Nasoduodenal Tubes
• Nasojejunal Tubes

- Through Surgical
• Gastrostomy Tubes
• Jejunostomy Tubes

-Through Parenteral "Vein "

• Total parenteral nutrition
• Partial parenteral nutrition
 Definition of NG Tube
Nasogastric Tube " NG Tube " is a type of medical tube " thin , soft tube
made of plastic or rubber that is passed through the nose, down through
throat , Esophagus, and into the stomach .

Orogastric tube " OG tube " is the same tube inserted Through the mouth
instead of the nose .

Lavage know as therapeutic irrigation is an invasive procedure involving

cleaning and removing stomach contents " gastric lavage "

Gavage is supplying nutritional substance via a small plastic tube direct to

the stomach " Gastric Gavage "
 Type of NG Tube
• Levin tube Is a single-lumen multipurpose plastic tube that is commonly
used in NG intubation.
• Salem sump tube is A double-lumen tube with a “pigtail ”used for
intermittent or continuous suction.
 Indications of NG Tube
Therapeutic
• Administration of Medication and Nutrition " Gavage "
• Aspiration of gastric content from poisons and Drug Overdoses " Lavage "
• Gastric decompression " endotracheal intubation "
• Relief of symptoms and bowel rest in the setting of small-bowel obstruction.
• In trauma settings, NG tubes can be used to aid in the prevention of vomiting and
aspiration , assessment of GI bleeding.

Diagnostic
• Aspiration of gastric fluid content for investigations
• Evaluation of upper gastrointestinal GI bleeding ie" presence, volume"
• Administration of Radiographic Contrast in GI Tract
 Condition Require Use of NG Tube
• Neuromuscular swallow disorder such as Stroke
• Unconscious And Coma
• Physiological anorexia
• Mental health illness such as anorexia nervosa
• Neck or facial surgery
• Need a mechanical ventilator to breathe " Endotracheal intubation " .
• Malnutrition.
• Toxic ingestion "poisoning" and overdose
• Small bowel obstruction
• Intractable nausea and vomiting.
• Upper GI bleeding.
• Gastrointestinal surgery
• Before Endoscopy Procedure
 Contra-Indications of NG Tube

• Sever maxillofacial trauma :

• esophageal stricture :
due to Potential Intracranial Misplacement

• Esophageal Varices :
due to risk for esophageal perforation

• Bleeding diathesis :
tube placement may trigger variceal bleeding which can be life-threatening
minimal trauma to the pharynx, esophagus, or stomach from nasogastric tubes can
also lead to severe bleeding and, thus, tubes are avoided whenever possible.

• Nasal Condition e.g deviated septum , sinusitis , Polyp , epistaxis

• Recent nasal surgery
 Complications of NG Tube

• Discomfort from placing and removing the tubes.

• Upper Airway " epistaxis , sinusitis "
• Sore throat
• Electrolyte imbalances, such as hypokalemia " low potassium
• Injury to the cribriform plate may lead to intracranial placement .
• Esophageal perforation
• Lower Airway " Aspiration pneumonia , Pneumothorax "
• Prolonged use of NG tubes can cause irritation to the gastric lining, causing
GI bleeding and Ulcer
 Equipments of NG Tube

• Gloves & Gown

• Appropriate NG tube Size
• PH Testing Strips
• A Glass of Water " If Patient Able to Swallow and conscious"
• Lidocaine Gel aisehtsenA & tnacirbuL sa kroW
• Large Syring" 20c-50cc"
• Stethoscope
• Emesis Basin Or Apron
• Plaster
• Fluid For Gastric Lavage " N/S "
 NG Tube Size Selection
• Nasogastric tubes are sized in the French scale or French unites,
commonly Abbreviate as Fr. A NG tube comes in a variety of sizes from 6
French very small to 20 French very large .
• Sizes 6 to 12 fr are used for children and sizes 12 to 20 fr for adults.

• NG tube for adult patients 14-16-18French Most Common

• NG tube for pediatric patients , the correct tube size varies with the
patient’s age, to find the correct size in French, add 16 to the patient’s age
in years and then divide by 2 so that for Example 8years Old child
The Correct size is 12 French
8 18+ years
12 = 2÷ 24
 NG Tube Procedure
• Wash your hands and wear PPE .
• Introduce yourself to the patient including your name and role.
• Take a carefully medical history to ensure that there are no contraindications
• If a patient has suffered head trauma and a base of skull fracture has not
been ruled out, NG tube insertion should be avoided due to the potential risk
of entering the cranial vault and other Absolute Contraindications .
 NG Tube Procedure
• Briefly explain what the procedure will involve using patient-friendly
language: “At the moment you’re having trouble swallowing food in the
normal way. Because of this, we need to place a fine tube to allow us to
provide you with nutrition. The procedure will be uncomfortable, but it
shouldn’t be painful or take very long. If at any point it becomes too
uncomfortable and you want me to stop, just tap on my arm And try to be
relax During The Procedure.

• Position the patient in high Fowler’s position or Sitting Position on a chair

or bed support his head and shoulders with a pillow
 NG Tube Procedure
• Visually inspect condition of patient’s nasal and oral cavities , Assess and
examin for the best nostril before you begin.Do this by occluding one side
and asking the patient to sniff Air .....deviated septum , nasal congestion ?

• Gathering All Equipment Before Starting procedure

• Estimate how far the NG tube will need to be inserted: measure from the
bridge of the nose to the ear lobe and then down to 5cm below the
xiphisternum NEX Measure
• Mark measured length with a marker distance on tube Better be Plaster
 NG Tube Procedure
• Lubricate the tip of the NG tube about 4cm
• Choose the side for tube insertion and spray topical anesthetic in this
nostril To prevent Irritation and Pain and spray of Xylocaine to the back
of the throat to prevent gag Reflex at least 2 to 5 minutes before tube
insertion " Until Drug Starting Action "
• Is Better a Head was fully Extended " Backward " and Gently insert the
NG tube through the nostril "nasopharynx stage " Aim back then down to
stay passage Straight and then Close Epiglottis

• If the patient becomes distressed, pause and give them some time to
recover.
 NG Tube Procedure
• Ask the patient to swallow or Drink water To close Airway through
Epiglottis and advance the tube as the patient swallows. Swallowing of
small sips of water may enhance passage of tube into esophagus
• Note " Avoid giving patients a drink if their swallow is deemed unsafe, due
to the risk of aspiration.

• Remove tube immediately if changes occur in patient’s respiratory status,

if tube coils in mouth, if the patient begins to cough or any Significant
change in Skin and Face Colour
• Once you reach the desired nasogastric tube insertion length, fix the NG
tube to the nose with a plaster
• don’t Close Both Nostril to Allow Comfortable Respiration
 Checking NG Tube Placement
• The First With Aspirate Stomach contents and pH indicator strips
If you Can’t aspirate Ask the patient Lie down on left side repeat it Again
Gastric content has a low pH )3.5-1.5( Normal color is Green or colorless
If PH less than Four Tube In Stomach
If PH More than Six may Tube In Lung or Maybe patient Use PPI , Antacids

• Injecting Air With 20 to 30 cc Air And place Stethoscope over LUQ of

Abdomen to listen For " Swoosh Sound "
• Don’t Inject More of Air in Neonate and Infant
• Chest X ray
 Removing NG Tube
• Disconnect tube from feed if present.
• Remove tape or securement device from nose.
• Clear NG tube by inserting 10 to 20 ml of air into tube, This prevents
aspiration of tube feed falling out of tube.
• Instruct patient to take a deep breath and hold it, This prevents
aspiration; holding the breath closes the glottis.
• gently pull out tube in a swift, steady motion, wrapping it in your hand as
it is being pulled out. Dispose of tube in garbage bag.
• Clean the noise for the patient and offer mouth care as required.