Nasogastric tube insertion involves placing a plastic tube through the nose, down the esophagus and into the stomach. It is used for diagnostic, therapeutic and feeding purposes. The procedure requires measuring the tube length, lubricating and inserting the tube through the nose while the patient swallows. Placement must be confirmed through auscultation, pH testing, aspiration or x-ray before securing the tube and use. Complications can include nose bleeding, irritation and aspiration.

1. NASOGASTRIC TUBE INSERTION
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2. What is nasogastric tube insertion?
What is nasogastric tube insertion?
✓Inserting the plastic tube through the nose, down
the esophagus, and into the stomach
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3. ✓ used for diagnostic, therapeutic, preventative, and feeding
purposes.
✓ It provide for analysis purpose of GI contents.
✓ To remove stomach contents after suspected poisoning
✓ To wash the stomach after suspected poisoning
✓ To relieve vomiting and distention
✓ To administer medications who cannot swallow.
✓ To feed client with fluids when oral intake is not possible
Purpose/Indication:
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4. Before inserting the tube
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• Inform to the patient about the
procedure
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• Position the patient (Semi flower)
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• Measure the tube.
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5. ✓ By placing tip of the tube on the patient's nose and
touches the tip of the xiphoid process.
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6. After inserted check the tube in stomach or not
1. Auscultation
✓instilling air into the feeding tube with a
syringe and placed a stethoscope over the
stomach to listen for rushing air.
✓Misinterpretation of auscultation of air
insufflation is known as pseudo-confirmatory
gurgling.
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7. 2. Bubbling
✓Observing bubbles when the end of the feeding
tube is placed under water.
✓Also, the absence of bubbles does not rule out
respiratory placement if the tube’s ports are
occluded by the respiratory mucosa.
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8. 3. Aspirate Appearance
✓ assessing the appearance of aspirate from the tube.
Ordinarily,
– Small bowel aspirates are golden yellow or greenish brown
– Gastric aspirates are often grassy green, off-white, or tan.
– Respiratory secretions can be white, yellow, straw-colored
✓ Because both respiratory and gastrointestinal
aspirates may be similar in color, they may be easily
misinterpreted.
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9. 4. PH Testing
✓Determining the pH of aspirated gastric fluid
usually acidic, with a pH less than or equal to
5.5.
✓Respiratory secretions are almost always
alkaline, with a pH greater than or equal to 6.
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10. 5. Radiographic
✓The gold standard for nasogastric feeding
tube placement is radiographic confirmation
with a chest x-ray.
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11. Size of NG-Tube based on age
Infant = 5-8 Fr.
Child = 8-10 Fr.
Adult = 8-18 Fr.
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12. Intubation the client with an NG tube
• Assessment:
1- patency of the nostril
2- swallowing reflex
3- the ability of the client to cooperative
– Assess client’s medical history:
• Nosebleeds
• Nasal surgery
• Deviated septum
• Anticoagulation therapy
– Assess client’s gag reflex.
– Assess client’s mental status.
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13. Equipment:
✓-Trolley is clean
✓--NG tube
✓-Glass of water
✓-Lubricating jelly
✓PH test strips
✓Emesis basin
✓stethoscope
✓ syringe -50cc-
✓Suctioning available and ready
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14. ✓Explain the procedure to the client
✓Position the client in a sitting or high fowlers
position. If comatose-semi fowlers.
✓Determine the length of tube to be inserted.
✓Measure distance from the tip of the nose to the
earlobe and to the xyphoid process of the sternum.
✓Prepare NG tube for insertion.
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15. Fowler's Position. Used to
promote drainage or ease
breathing. Head rest is adjusted to
desired height and bed is raised
slightly under patient's knees
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17. Implementation
1- Wash Hands
2- Put on clean gloves
3- Lubricate the tube
4- Hand the client a glass of water
5- Gently insert tube through nostril to back of throat
(posterior naso pharynx).
6- Emphasize the need to mouth breathe and swallow during the
procedure.
7- Swallowing facilitates the passage of the tube through the
oropharynx.
8- Advance tube each time client swallows until desired length has
been reached.
9- Do not force tube. If resistance is met or client starts to cough,
choke or become cyanotic stop advancing the tube and pull back.
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19. 11 - Check placement of the tube.
-By Auscultation
-X-ray confirmation
-aspiration for gastric content
12- Secure the tube with tape .
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21. Nasogastric Tube Position
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22. Complications
• Nose bleeding
• Nasal irritation
• Sinusitis
• Sore throat
• Esophageal perforation
• Pulmonary aspiration
• Electrolyte imbalance: hyperkalemia and
hypernatremia
• Oral mucosal breakdown
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