NASOGASTRIC TUBE

INSERTION
JOJO B. JUSTO RN, MSN
NASOGASTRIC TUBE : INSERTION

Nasogastric Intubation
• refers to the process of placing a soft plastic
nasogastric (NG) tube through a patient's nostril,
pass the pharynx and down the esophagus into a
patient's stomach.
NASOGASTRIC TUBE
Indications
 Diagnostic
 Evaluation of upper gastrointestinal (GI) bleed (ie,
presence, volume)
 Aspiration of gastric fluid content
 Identification of the esophagus and stomach on a chest
radiograph
 Administration of radiographic contrast to the GI tract
Indications
 Therapeutic
 Gastric decompression, including maintenance of a
decompressed state after endotracheal intubation, often via the
oropharynx
 Relief of symptoms and bowel rest in the setting of small-
bowel obstruction
 Aspiration of gastric content from recent ingestion of toxic
material
 Administration of medication
 Feeding
 Bowel irrigation
Contraindications
 Absolute contraindications
 Severe midface trauma
 Recent nasal surgery

 Relative contraindications
 Coagulation abnormality
 Esophageal varices or stricture
 Recent banding or cautery of esophageal varices
 Alkaline ingestion
TYPES OF PROCEDURES

GASTRIC GAVAGE - a means of supplying

nutritional substance via a small plastic tube direct to the
stomach

GASTRIC LAVAGE - commonly called

stomach pumping or gastric irrigation, is the process of
cleaning out the contents of the stomach using a tube
NASOGASTRIC TUBE : INSERTION

EQUIPMENT
• Nasogastric tube of appropriate size (8–18 French)
• Stethoscope
• Water-soluble lubricant
• Normal saline solution or sterile water, for irrigation, depending
on facility policy
• Tongue blade
• Irrigation set, including a Toomey/asepto syringe (20–50 mL)
• Flashlight
• Non-allergenic tape (1 wide)
• Tissues
 TYPES OF NASOGASTRIC
TUBES
The Levin Tube -is a one-lumen nasogastric
tube
TYPES OF NASOGASTRIC
TUBES
The Salem-Sump Tube.

This tube is a two-lumen piece of

equipment.

It has a drainage lumen and a smaller

secondary tube that is open to the
atmosphere.
TYPES OF NASOGASTRIC
TUBES
The Miller-Abbott Tube.

This tube is also a two-lumen

nasogastric tube.

There is a rubber balloon at the tip of

one tube; the other tube has holes
near its tip.
SIZES
 Adult - 16-18F
Size FG-8 FG-10 FG-12 FG-14 FG-16 FG-18 FG-20
Colour Code Blue Black White Green Orange Red Yellow

 Pediatric - In pediatric patients, the correct tube size

varies with the patient’s age.
Infection Control
 Hand Washing
 Wear a set of gloves
 Wearing face and eye protection
 Wear disposable apron.
IMPLEMENTATION
 Verify for physician order.
 Identify Client & Introduce yourself
 Explain the procedure
 Assemble the Materials needed
NURSING RESPONSIBILITY
 Inserting and removing the tube
 Assessing correct placement
 Securing the tube
 Meeting patient comfort needs
 Monitoring patient responses
 IMPLEMENTATION
Explain the procedure, benefits, risks, complications,
and alternatives to the patient or the patient's
representative.

Examine the patient’s nostril for septal deviation.

To determine which nostril is more patent, ask
the patient to occlude each nostril and breathe
through the other.
INSERTING NGT (Gastric Intubation)

1. Inform the patient and explain the procedure.

2. Place in high-fowler’s position.
3. Measure length of NGT to be inserted.( tip of the
nose to the tip of the earlobe to the xiphoid
process)-NEX technique
- Mark the tube with a piece of tape
Infant
– Measure from the tip of
the nose, around the ear
and down to the
umbilicus.
4. Lubricate tip of the tube with water-soluble
lubricant.
5. Hyperextend the neck. Gently advance the tube
towards the nasopharynx.
6. Tilt the patient’s head forward once the tube
reaches the oropharynx (throat) and ask to swallow,
as the tube is advanced.
7. Offer small sips of water from a glass with straw and encourage to swallow
 Stop if the patient gags, wait for few min. before proceeding

 Withdraw if gagging continues

8. Assess for correct placement by:

 Check pH: should be less than 4.0
 Inserting 5-20 ml of air into a stethoscope placed over the epigastric area
and listen for a swooshing or gurgling sound sound
 Aspirate gastric content, which is yellowish or greenish in color
 Immerse tip of the tube in water, no bubbles should be produced
 Taking X-ray: MOST RELIABLE METHOD
SECURE THE NG TUBE
 9. Secure tube to the bridge of the nose with tape and to the gown
SECURE THE NG TUBE
 9. Secure tube to the bridge of the nose with tape and to the gown
DOCUMENTATION
 Date and time of procedure
 Indication for insertion
 Type of tube used
 Distance tube inserted (if appropriate)
 The nature of the aspirate
 Methods used to check location of the tube insertion
 Any procedural comments
Click icon to add picture

ADMINISTERING TUBE FEEDING

JOJO B. JUSTO, RN, MSN
NURSING RESPONSIBILITY
Assess:
 For any clinical signs of malnutrition or

dehydration.
 For allergies to any food in the feeding.
 For the presence of bowel sounds.
 For any problems that suggest the tolerance of

previous feedings.
NURSING RESPONSIBILITY
Determine:
 Type amount and frequency of feedings.
 Tolerance of previous feedings.
ADMINISTERING TUBE
FEEDING
EQUIPMENT
 Correct amount of feeding solution.
 60 ml catheter-tip syringe
 Emesis basin
 Clean gloves
 pH strip or meter OR stethoscope
 large syringe or calibrated plastic feeding bag
 measuring container
 water at room temperature (60 ml)
ADMINISTERING TUBE
FEEDING
1. Assist client to a semi-fowler’s position in bed or
sitting position in a chair, or slightly elevated right
side-lying position.
2. Assess tube placement.
- The most effective method checking NGT
placement:
a. Radiograph
b. Checking pH of aspirated gastric contents
c. Aspiration of gastric content
3. Assess residual feeding contents.
- If 100 mL or more, verify if the feeding will be given

- Reinstill the gastric contents in the stomach.

4. Administer the feeding.

- introduce feeding slowly to prevent flatulence, crampy

pain and reflex vomiting

- Warm the feeding at room temperature

5. Height of feeding is 12 inches above the tube’s point of

insertion into the client.
- This allows slow introduction of feeding.
6. Instill 50 to 100 mL of water.
- To cleanse the lumen of the tube.

7. Clamp the NGT before all of the water is instilled.

- To prevent entry of air into the stomach.

8. Ask the client to remain in fowler’s position or in

slightly elevated right lateral position for at least 30
minutes.
- To prevent aspiration of feeding

9. Do after care.
10. Documentation
REMOVING A NGT
Important points:
- Ask the client to take a deep breath and to hold it.

(this closes the glottis, thereby preventing accidental

aspiration of any gastric contents.)
THE END