This presentation will give an overview of what NG tube is, types of NG tube, indications and contraindications, how to insert NG tube and potential complications of NG tube
3. INTRODUCTION
A nasogastric tube/intubation is a common procedure of
inserting a flexible tube of rubber or plastic into the nose
through esophagus to the stomach to provides access to the
stomach for feeding ,diagnostic and therapeutic purposes
4. SCOPE
Types of NG tube
Considerations in choosing the NG tube
Indications of NG tube
Contraindication of NG tube
NG tube insertion procedure
NGT over OGT
Complications of NGT
Reference
5. TYPES OF NG TUBE
Levin tube
Salem sump tube
Moss tube
Sengstaken-Blakemore tube
6. LEVIN TUBE
The Levin tube is a rubber
or plastic tube that has a
single lumen, a length of
42 to 50 inches (106.5 to
127cm), and holes at the
tip and along the side.
7. SALEM SUMP TUBE
The Salem sump tube is a double lumen tube (one for suction
and drainage and a smaller one for ventilation) made of clear
plastic and has a blue sump port (pigtail) that allows atmospheric
air to enter the patient's stomach
Thus, the tube floats freely and doesn't adhere to or damage
gastric mucosa
The larger port of this tube (121.9 cm) serves as the main suction
conduit.
The tube has openings at 45cm, 55cm, 65cm, and 75cm as well
as a radiopaque line to verify placement
8.
9. MOSS TUBE
The Moss tube (usually inserted during surgery) has a
radiopaque tip and three lumens.
oThe first, positioned and inflated in the cardia, serves as
a balloon inflation port
o The second is an esophageal aspiration port
o The third is a duodenal feeding port
10.
11. SENGSTAKEN-BLAKEMORE TUBE
This is a medical device designed for management of upper gi
hemorrhage due to esophageal varices, usually a result of liver
cirrhosis. It consists of a flexible plastic tube containing several
internal channels and two inflatable balloons
Modern form of sengstaken-blakemore tube (Minnesota tubes)
have an opening near the upper esophagus
Esophageal and gastric balloons are inflated in esophagus and
stomach respectively
1kg traction is applied to the tube so that gastric balloon will
compress gastro-esophageal junction and reduce the blood flow to
esophageal varices to aid esophageal balloon to stop bleeding
12.
13. CONSIDERATIONS WHEN
CHOOSING NG TUBE
the use for which indicated
o Age of patient
o The intended purpose
The duration that the patient would be using the tube
The material of the tube (read instructions on the back of
the packing)
14. INDICATIONS FOR NG TUBE
This procedure is indicated either for:
Diagnostic or
Therapeutic purpose
15. DIAGNOSTIC PURPOSES OF NG
TUBE
Evaluation of upper gastrointestinal (GI) bleeding (ie, presence and
volume)
Aspiration of gastric fluid content to be analyzed
Identification of the esophagus and stomach on a chest radiograph
Administration of radiographic contrast to the GI tract
Identification of cancer cells(gastric lavage)
16. THERAPEUTIC PURPOSES OF NG
TUBE
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
17. THERAPEUTIC PURPOSES OF NG
TUBE
Administration of medication
Feeding
Bowel irrigation
NG tube can be kept following corrosive ingestion for
the development of a tract in the esophagus that
subsequently can be used for balloon dilatation
21. RELATIVE CONTRAINDICATIONS
OF NG TUBE
Coagulation abnormality
Esophageal varices (usually, a Sengstaken-Blakemore tube is
introduced, but an NG tube can be used for lower-grade
varices) or stricture
Recent banding of esophageal varices
Alkaline ingestion (the tube may be kept if the injury is not
severe)
22. EQUIPMENT FOR NGT INSERTION
1. Clean tray
2. NG tube
3. Gauze swab
4. Lubricating jelly
5. Hypoallergenic tape
6. 50 ml syringe(funnel-
tipped)
7. Inch tape
8. pH Indicator strips
9. Receiver
10. Spigot
11. Glass of water
12. Non-Sterile gloves
13. Disposable facemask
23. HOW TO DO THE PROCEDURE
Explain to patient the procedure, potential
complications, and alternatives to
treatment to get informed consent
Using hypoallergenic tape, mark the
distance which the tube is to be passed by
measuring the distance on the tube from
the bridge of the patient’s nose around the
ear lobe and down to the bottom of the
xiphisternum. Measure the length of tube
in cm that remains out of the nostril
24. Wash hands with soap and water, and assemble the
equipment required
Put on non sterile gloves
Position the patient (in sitting position if possible)
Put protective sheet on patient’s chest as in case of emetic
episode during procedure
Connect NG tube to suction tubing and suction tubing to
the bucket to minimize spillage of gastric contents
All equipment/supplies should be close at hand to avoid
unnecessary movements during procedure
25. Check the patient’s nostrils for any visible
obstructions. Clear nostrils if necessary
Lubricate about 15-20cm of the tube with a
thin coat of lubricating jelly (water based) that
has been placed on a gauze swab
Insert the proximal end of the tube into the
clearer nostril and slide it backwards and
inwards along the floor of the nose to the
nasopharynx.
o If an obstruction is felt, withdraw the
tube and try again in a slightly different
direction or use the other nostril
26. At this point a patient can be given the cup of water with
a straw in in to sip from to help ease the passage of tube
Advance the tube through the pharynx as the patient
swallows until the tape marked tube reaches the point of
entry into the external nares
o If the patient shows signs of distress, e.g. gasping or
cyanosis, remove the tube immediately
If there is a great deal of difficult in passing the tube, the
maneuver is to withdraw the tube and attempt again
after small break in contralateral nares as tube may have
become coiled in oropharynx or nasal sinus
27. In intubated patients, the use of reverse sellick’s
maneuver and freezing the ng tube may facilitate
placement of tube
Once tube has been inserted to the appropriate length it
should be secured to the patient’s nose with adhesive tape
Once the tube has been advanced to the estimated
necessary length correct location is often made obvious
by aspirating out a large amount of gastric contents
Correct location can also be confirmed by abdominal X-
Ray
The removal of NG tube is very simple procedure, but
you shouldn’t force it as it can be knotted
28. WHY IS NGTCHOOSEN OVER OGT
Risk of being chewed
Risk of displacement
Speaking difficulties
High risk of infection
29. COMPLICATIONS OF NG TUBE
Injury to the esophagus, throat, sinuses, or stomach
NG tube can cause further problems when it gets blocked or
torn, or if it comes out of place
Regurgitation & aspiration
It may cause some symptoms such as diarrhea, nausea,
vomiting, or abdominal cramps or swelling
30. REFERENCE
Bailey and love short practice of surgery 27th edition
https://emedicine.Medscape.com
https://pubmed.ncbi.nlm.nih.gov/11735012/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356491/
https://www.nursingcenter.com/journalarticle?Article_ID=3619681&Jou
rnal_ID=417221&Issue_ID=3619577