1. NASOGASTRIC TUBE INSERTIONNASOGASTRIC TUBE INSERTION
(A SELF-INSTRUCTIONAL PACKAGE)(A SELF-INSTRUCTIONAL PACKAGE)
ByBy
Arianne L. Garcia, RNArianne L. Garcia, RN

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4. Nasogastric Tube InsertionNasogastric Tube Insertion
Overview
Definition
Indications
Procedure
Complications
Preparation/
Equipments
Contraindications
Post Test Actual Video
Comprehension
Check 1
Comprehension
Check 2

5. An alternative feeding method to ensure adequateAn alternative feeding method to ensure adequate
nutrition includesnutrition includes enteralenteral (through the(through the
gastrointestinal system) methods. Enteralgastrointestinal system) methods. Enteral
Nutrition (EN), also referred to asNutrition (EN), also referred to as total enteraltotal enteral
nutrition (TEN),nutrition (TEN), is provided when the client isis provided when the client is
unable to ingest foods or the upperunable to ingest foods or the upper
gastrointestinal tract is impaired and the transportgastrointestinal tract is impaired and the transport
of food to the small intestine is interrupted.of food to the small intestine is interrupted.
OverviewOverview

6. Enteral feedings are administeredEnteral feedings are administered
through nasogastric and small-through nasogastric and small-
bore feeding tubes or throughbore feeding tubes or through
gastrostomy or jejunostomygastrostomy or jejunostomy
tubes.tubes.
OverviewOverview

7. DefinitionDefinition
Nasogastric tubeNasogastric tube is a tube that is passedis a tube that is passed
through the nose and down through thethrough the nose and down through the
nasopharynx and esophagus into thenasopharynx and esophagus into the
stomach, abbreviated as NGT. It is astomach, abbreviated as NGT. It is a
flexible tube made of rubber or plastic,flexible tube made of rubber or plastic,
and it has bidirectional potential.and it has bidirectional potential.

8. The word “nasogastric" is a hybrid of theThe word “nasogastric" is a hybrid of the
Latin “naso" from "nasus" for nose orLatin “naso" from "nasus" for nose or
snout and the Greek “gastric" fromsnout and the Greek “gastric" from
"gaster" meaning the paunch or belly."gaster" meaning the paunch or belly.
The term "nasogastric" was coined inThe term "nasogastric" was coined in
1942.1942.
A commonly used NGT is theA commonly used NGT is the Levin tubeLevin tube
DefinitionDefinition

9. IndicationsIndications
A person may need a stomach tubeA person may need a stomach tube
inserted to:inserted to:
•empty the stomach after a drugempty the stomach after a drug
overdose or accidental poisoningoverdose or accidental poisoning
•drain the stomach after major trauma,drain the stomach after major trauma,
so the person can't inhale stomachso the person can't inhale stomach
contents into the lungscontents into the lungs

10. •treat malnutrition by giving feedings throughtreat malnutrition by giving feedings through
the tube. Tube feeding is also used when athe tube. Tube feeding is also used when a
person is unable to eat normally, such as afterperson is unable to eat normally, such as after
a strokea stroke
•keep the stomach relaxed after major surgerykeep the stomach relaxed after major surgery
to the abdomen, such as an abdominalto the abdomen, such as an abdominal
explorationexploration
•prevent distension of the stomach when theprevent distension of the stomach when the
person has a bowel obstructionperson has a bowel obstruction
IndicationsIndications

11. ContraindicationsContraindications
•Patients with sustained head trauma, maxillofacial injury, or anterior fossaPatients with sustained head trauma, maxillofacial injury, or anterior fossa
skull fracture. Inserting a NGT blindly through the nose has potential ofskull fracture. Inserting a NGT blindly through the nose has potential of
passing through the criboform plate, thus causing intracranial penetrationpassing through the criboform plate, thus causing intracranial penetration
of the brain.of the brain.
•Patients with a history of esophageal stricture, esophageal varices, alkaliPatients with a history of esophageal stricture, esophageal varices, alkali
ingestion at risk for esophageal penetration.ingestion at risk for esophageal penetration.
•Comatose patients have the potential of vomiting during a NG insertionComatose patients have the potential of vomiting during a NG insertion
procedure, thus require protection of the airway prior to placing a NGT.procedure, thus require protection of the airway prior to placing a NGT.
Caution should be utilized when passing a NGT in a patient withCaution should be utilized when passing a NGT in a patient with
suspected cervical spine injury.suspected cervical spine injury.
•Excessive manipulation or movement by the patient during placementExcessive manipulation or movement by the patient during placement
including coughing or gagging may potentiate cervical injury.including coughing or gagging may potentiate cervical injury.
•Manual stabilization of the head is required during the procedure.Manual stabilization of the head is required during the procedure.
ContraindicationsContraindications
•Patients with sustained head trauma, maxillofacialPatients with sustained head trauma, maxillofacial
injury, or anterior fossa skull fracture. Inserting a NGTinjury, or anterior fossa skull fracture. Inserting a NGT
blindly through the nose has potential of passingblindly through the nose has potential of passing
through the criboform plate, thus causing intracranialthrough the criboform plate, thus causing intracranial
penetration of the brain.penetration of the brain.
•Patients with a history of esophageal stricture,Patients with a history of esophageal stricture,
esophageal varices, alkali ingestion at risk foresophageal varices, alkali ingestion at risk for
esophageal penetration.esophageal penetration.
•Comatose patients have the potential of vomitingComatose patients have the potential of vomiting
during a NG insertion procedure, thus requireduring a NG insertion procedure, thus require
protection of the airway prior to placing a NGT.protection of the airway prior to placing a NGT.

12. ContraindicationsContraindications
Caution should be utilized when passing aCaution should be utilized when passing a
NGT in a patient with suspected cervicalNGT in a patient with suspected cervical
spine injury.spine injury.
•Excessive manipulation or movement byExcessive manipulation or movement by
the patient during placement includingthe patient during placement including
coughing or gagging may potentiatecoughing or gagging may potentiate
cervical injury.cervical injury.
•Manual stabilization of the head isManual stabilization of the head is
required during the procedure.required during the procedure.

13. Comprehensive Test 1Comprehensive Test 1
Answer the following Multiple Choice Questions. Read eachAnswer the following Multiple Choice Questions. Read each
question carefully then just click on the letter you think would bequestion carefully then just click on the letter you think would be
the right answer.the right answer.
Question # 1 Question # 2 Question # 3

14. Comprehensive Test 1Comprehensive Test 1
Question #1Question #1
It is provided when the client is unable to ingestIt is provided when the client is unable to ingest
foods or the upper gastrointestinal tract is impairedfoods or the upper gastrointestinal tract is impaired
and the transport of food to the small intestine isand the transport of food to the small intestine is
interrupted.interrupted.
a.a. TENTEN
b.b. NineNine

15. Question #2Question #2
The commonly used NGT is called ____________?The commonly used NGT is called ____________?
a.a. Levis TubeLevis Tube
b.b. Levin TubeLevin Tube
Comprehensive Test 1Comprehensive Test 1

16. Question #3Question #3
NGTNGT treat _________ by giving feedings through thetreat _________ by giving feedings through the
tube.tube.
a.a. ObesityObesity
b.b. MalnutritionMalnutrition
Comprehensive Test 1Comprehensive Test 1

19. EquipmentsEquipments

20. Nasogastric tubeNasogastric tube

21. Viscous lidocaine 2%Viscous lidocaine 2%

22. Oral analgesic spray (Benzocaine)Oral analgesic spray (Benzocaine)

23. Oral syringe, 12 mLOral syringe, 12 mL

24. Glass of water with a strawGlass of water with a straw

25. Water-based lubricantWater-based lubricant

26. Toomey syringe, 60 mLToomey syringe, 60 mL

27. TapeTape

28. Emesis basin or plastic bagEmesis basin or plastic bag

29. Wall suction, set to low intermittentWall suction, set to low intermittent
suctionsuction

30. Suction tubing and containerSuction tubing and container

31. Safety pinSafety pin

32. GlovesGloves

33. StethoscopeStethoscope

34. Protective pad or towelProtective pad or towel

35. ProcedureProcedure

36. Explain the procedure,Explain the procedure,
benefits, risks,benefits, risks,
complications, andcomplications, and
alternatives to the patientalternatives to the patient
or the patient'sor the patient's
representative.representative.

37. Examine the patient’s nostril for septal deviation. To determineExamine the patient’s nostril for septal deviation. To determine
which nostril is more patent, ask the patient to occlude eachwhich nostril is more patent, ask the patient to occlude each
nostril and breathe through the other.nostril and breathe through the other.

38. Instill 10 mL of viscous lidocaine 2% (for oral use) down theInstill 10 mL of viscous lidocaine 2% (for oral use) down the
more patent nostril with the head tilted backwards, and askmore patent nostril with the head tilted backwards, and ask
the patient to sniff and swallow to anesthetize the nasal andthe patient to sniff and swallow to anesthetize the nasal and
oropharyngeal mucosa. In pediatric patients, do not exceed 4oropharyngeal mucosa. In pediatric patients, do not exceed 4
mg/kg of lidocaine. Wait 5-10 minutes to ensure adequatemg/kg of lidocaine. Wait 5-10 minutes to ensure adequate
anesthetic effect.anesthetic effect.
Aspiration of viscousAspiration of viscous Instillation of viscousInstillation of viscous
lidocaine into an oral syringe.lidocaine into an oral syringe. lidocaine 2%.lidocaine 2%.

39. Estimate the length of insertion by measuringEstimate the length of insertion by measuring
the distance from the tip of the nose, aroundthe distance from the tip of the nose, around
the ear, and down to just below the left costalthe ear, and down to just below the left costal
margin. This point can be marked with a piecemargin. This point can be marked with a piece
of tape on the tube. When using the Salemof tape on the tube. When using the Salem
sump nasogastric tube (Kendall, Mansfield,sump nasogastric tube (Kendall, Mansfield,
Mass) in adults, the estimated length usuallyMass) in adults, the estimated length usually
falls between the second and third preprintedfalls between the second and third preprinted
black lines on the tube.black lines on the tube.

40. Position the patient sitting upright with the neck partially flexed. Ask the patient to hold the cup of water in his or herPosition the patient sitting upright with the neck partially flexed. Ask the patient to hold the cup of water in his or her
hand and put the straw in his or her mouth. Lubricate the distal tip of the nasogastric tube.hand and put the straw in his or her mouth. Lubricate the distal tip of the nasogastric tube.
Nasogastric tube lubrication with water-based lubricant.Nasogastric tube lubrication with water-based lubricant.

41. Gently insert the nasogastric tube along the floor ofGently insert the nasogastric tube along the floor of
the nose and advance it parallel to the nasal floor (ie,the nose and advance it parallel to the nasal floor (ie,
directly perpendicular to the patient's head, not angleddirectly perpendicular to the patient's head, not angled
up into the nose) until it reaches the back of theup into the nose) until it reaches the back of the
nasopharynx, where resistance will be met (10-20nasopharynx, where resistance will be met (10-20
cm). At this time, ask the patient to sip on the watercm). At this time, ask the patient to sip on the water
through the straw and start to swallow. Continue tothrough the straw and start to swallow. Continue to
advance the nasogastric tube until the distance of theadvance the nasogastric tube until the distance of the
previously estimated length is reached.previously estimated length is reached.

42. Patient flexing his neck and drinking waterPatient flexing his neck and drinking water
while a nasogastric tube is inserted.while a nasogastric tube is inserted.

43. Stop advancing and completely withdraw the nasogastric tube if, at any time, the patient experiences respiratoryStop advancing and completely withdraw the nasogastric tube if, at any time, the patient experiences respiratory
distress, is unable to speak, has significant nasal hemorrhage, or if the tube meets significant resistance.distress, is unable to speak, has significant nasal hemorrhage, or if the tube meets significant resistance.

44. Verify proper placement of the nasogastric tube by auscultating a rush of air over theVerify proper placement of the nasogastric tube by auscultating a rush of air over the
stomach using the 60 mL Toomey syringe or by aspirating gastric content. The authorsstomach using the 60 mL Toomey syringe or by aspirating gastric content. The authors
recommend always obtaining a chest radiograph in order to verify correct placement,recommend always obtaining a chest radiograph in order to verify correct placement,
especially if the nasogastric tube is to be used for medication or food administration.especially if the nasogastric tube is to be used for medication or food administration.

45. Apply Benzoin or another skinApply Benzoin or another skin
preparation solution to the nose bridge.preparation solution to the nose bridge.
Tape the nasogastric tube to the nose toTape the nasogastric tube to the nose to
secure it in place. If clinically indicated,secure it in place. If clinically indicated,
attach the nasogastric tube to wall suctionattach the nasogastric tube to wall suction
after verification of correct placement.after verification of correct placement.

46. Comprehensive Test 2Comprehensive Test 2
Answer the following true or false questions by just clicking theAnswer the following true or false questions by just clicking the
answer of your choice.answer of your choice.
Question # 1 Question # 2 Question # 3

47. Comprehensive Test 2Comprehensive Test 2
Question #1Question #1
When inserting a NGT you have to measure firstWhen inserting a NGT you have to measure first
the distance from the tip of the nose, around thethe distance from the tip of the nose, around the
ear, and down to just below the left costal margin.ear, and down to just below the left costal margin.
a.a. TrueTrue
b.b. FalseFalse

48. Question #2Question #2
Obtaining a chest x-ray is the most reliable means ofObtaining a chest x-ray is the most reliable means of
ensuring proper placement of the Nasogastric tube.ensuring proper placement of the Nasogastric tube.
a.a. TrueTrue
b.b. FalseFalse
Comprehensive Test 2Comprehensive Test 2

49. Question #3Question #3
NGT promote distension of the stomach when theNGT promote distension of the stomach when the
person has a bowel obstruction.person has a bowel obstruction.
a.a. TrueTrue
b.b. FalseFalse
Comprehensive Test 2Comprehensive Test 2

52. ComplicationsComplications
The main complications of NGT insertionThe main complications of NGT insertion
include aspiration and tissue trauma. Placementinclude aspiration and tissue trauma. Placement
of the catheter can induce gagging orof the catheter can induce gagging or
vomiting, therefore suction should always bevomiting, therefore suction should always be
ready to use in the case of this happening.ready to use in the case of this happening.
More serious complications include esophagealMore serious complications include esophageal
perforation, aspiration, pneumothorax, and,perforation, aspiration, pneumothorax, and,
rarely, intracranial placement.rarely, intracranial placement.

53. Post TestPost Test
1. What is the other name of Enteral Nutrition?___________.1. What is the other name of Enteral Nutrition?___________.
2. What is the normal pH of the stomach that will determine2. What is the normal pH of the stomach that will determine
the correct placement of the tube?____________________.the correct placement of the tube?____________________.
3. The commonly use nasogastric tube is called ____________.3. The commonly use nasogastric tube is called ____________.
4. By inserting this tube, you are gaining access to the4. By inserting this tube, you are gaining access to the
stomach and its contents. What do you call that tube?stomach and its contents. What do you call that tube?
5. Excessive ____________________ or ___________________5. Excessive ____________________ or ___________________
during placement including coughing or gagging mayduring placement including coughing or gagging may
potentiate cervical injury.potentiate cervical injury.
6. Give me 5 Equipments used in NGT insertion6. Give me 5 Equipments used in NGT insertion
7. Give me 3 ways on how you could verify the tube7. Give me 3 ways on how you could verify the tube
placement.placement.
8. Give me 2 serious complications of NGT insertion.8. Give me 2 serious complications of NGT insertion.
Click on the numbers to
reveal the answers

54. 1.1. Total enteral nutritionTotal enteral nutrition
(TEN)(TEN)
Answers to Post Test.Answers to Post Test.

55. 2. pH 5.5 or below2. pH 5.5 or below
Answers to Post Test.Answers to Post Test.

56. 3. Levin Tube3. Levin Tube
Answers to Post Test.Answers to Post Test.

57. 4. Nasogastric Tube4. Nasogastric Tube
Answers to Post Test.Answers to Post Test.

58. Answers to Post Test.Answers to Post Test.
5. Manipulation or5. Manipulation or
movement by themovement by the
patientpatient

59. 6. Equipments during NGT insertion6. Equipments during NGT insertion
 Nasogastric tubeNasogastric tube
 Viscous lidocaine 2%Viscous lidocaine 2%
 Oral analgesic spray (Benzocaine spray or other)Oral analgesic spray (Benzocaine spray or other)
 Oral syringe, 12 mLOral syringe, 12 mL
 Glass of water with a strawGlass of water with a straw
 Water-based lubricantWater-based lubricant
 Toomey syringe, 60 mLToomey syringe, 60 mL
 TapeTape
 Emesis basin or plastic bagEmesis basin or plastic bag
 Wall suction, set to low intermittent suctionWall suction, set to low intermittent suction
 Suction tubing and containerSuction tubing and container
 Safety pinSafety pin
 GlovesGloves
 StethoscopeStethoscope
 Protective pad or towelProtective pad or towel

60. 7. Verifying Tube Placement7. Verifying Tube Placement
 Chest X-rayChest X-ray
 Aspirating gastric contents with the irrigation syringeAspirating gastric contents with the irrigation syringe
 While listening over the epigastrum with aWhile listening over the epigastrum with a
stethoscope quickly instill a 30cc air bolus with thestethoscope quickly instill a 30cc air bolus with the
irrigation syringe. Air entering the stomach willirrigation syringe. Air entering the stomach will
produce a “whooshing” sound.produce a “whooshing” sound.
 Ask the patient to hum or talk. Coughing, cyanosisAsk the patient to hum or talk. Coughing, cyanosis
or choking may indicate that the NGT has passedor choking may indicate that the NGT has passed
through the larynx.through the larynx.
 Place the open end of the NGT in a cup of water.Place the open end of the NGT in a cup of water.
Persistent bubbling may indicate that the NGT hasPersistent bubbling may indicate that the NGT has
passed through the larynx.passed through the larynx.

61. 8. Complications8. Complications
esophageal perforation,esophageal perforation,
aspiration,aspiration,
pneumothorax,pneumothorax,
and, rarely, intracranial placement.and, rarely, intracranial placement.

62. I hope you have enjoyed your experienceI hope you have enjoyed your experience
and have learned some newand have learned some new
information about Nasogastric Tubeinformation about Nasogastric Tube
Insertion.Insertion.