fundamentals of nursing

1. Insertion of NG tube
- MS. KHYATI CHAUDHARI

2. Introduction
Nasogastric tube feeding is common practice and many tubes are inserted daily
without incident.
However, there is a small risk that the tube can become misplaced into the lungs
during insertion, or move out of the stomach at a later stage .
Auscultation must not be used to check correct nasogastric tube (NGT)
placement as studies have shown this method to be inaccurate.
NG tubes should be aspirated and the tube position confirmed using pH
indicator stripes.

3. Definition
Gastrointestinal intubation deals with the inserting of a rubber or plastic tube
into the stomach, duodenum or small intestine.
Or
Insertion of a small-bore tube to the stomach through the nasopharynx.

4. Types of tube
1. Short tubes: passed through the nose into the stomach.
2. Medium Tubes: tubes are passed through the nose to the duodenum and the
jejunum. Used for feeding.
3. Long tubes: passed through the nose, through the esophagus and stomach
into the intestines. Used for decompression of the intestines.
 Nasogastric tubes come in various sizes (8, 10, 12, 14, 16 and 18 Fr).

5. Purposes
To feed the patient with fluids when oral intake is not possible
To dilute and remove consumed poison
To instill ice cold solution to control gastric bleeding
To relive vomiting and distension
To collect gastric juice for diagnostic purposes
To decompress the stomach and remove gas and liquids
As part of the management of an obstruction
As part of the management of hematemesis

6. Indications
 Patient who cannot eat (GIT functioning normally)
– Comatose patient
– Mechanically ventilated
 Patient who will not eat
– Patients who refuse to eat
 Elderly
 Disoriented patients
– Patients who cannot maintain adequate oral nutrition
 Patients with infection, trauma, cancer etc.
– Surgery

7. Contra-indication
Gastric surgery
Gastric Ulcers/Peptic Ulcers
Tracheoesophageal fistula
Esophageal surgery
Polyps in nose, recent nasal surgery, facial surgery
Deviated nasal septum
Patient on anticoagulant therapy

8. Articles
 A try containing -
1. Mackintosh with towel -To protect the bed and linen.
2. A Ryle’s tube (8-12 Fr ) in a bowl containing cold water -To make the tube
hard and easy for insertion .
3. Cotton tipped applicator, Saline or soda bicarbonate solution -To clean
nostrils .
4. Lubricant (liquid paraffin or glycerin) -To prevent friction between mucus
membrane and tube .
5. Adhesive plasters and scissor -Fix the tube in position

9. 6. A pair of clean gloves
7. A bowl of water, stethoscope, syringe (10-20cc) -To test the location of tube.
8. A kidney tray and a paper bag -To collect waste.

10. General Instructions
Remove the dentures ( to prevent it from dislodging and blocking the
respiratory tract)
A rubber tube may be placed in a bowl of ice to cool and stiffen
Lubricate the tube
While removing the tube, pinch the tube and pull it out gently and quickly (so
that the fluid may not trickle down the pharynx )
During introduction of the tube never use force (it may cause injury to mucus
membrane)
Watch the complications (nausea, vomiting, distension, diarrhea, aspiration,
pneumonia etc.)

11. Ng tube/Ryle’s tube
Flexible rubber or synthetic material
Transparent or opaque
Length : 36-50 inches
Gastrostomy tube : 12-15 inches
The lumen is measured by French (Fr).
When number is lower the inside diameter of tube will be smaller.

12. Ryle’s tube
Also known as Levine’s tube.
Parts :
1. Distal end
2. Proximal end
- Drainage port/lateral eye
- Radio opaque line
3. Markings

14. Sizes
Adult -16-18 FG
Pediatric- in pediatric patient, the correct tube size varies with the patient age.

15. Preliminary assessment
Check
– Doctors order for any specific instruction
– Patient ability to follow instructions
– General condition of the patient
– Articles available in the unit

16. Procedure
Identify the patient
Check the physician’s order for any precautions such as positioning or
movement.
Explain procedure to patient and relatives
Position the client in a sitting or high Fowler’s position. If comatosed, semi
Fowler’s.
Place mackintosh and towel across the chest.
Remove dentures.
Wash hands.

17. Measure NG tube from nose to tip of earlobe and earlobe to tip of xiphoid
process of sternum.
Mark distance of the tube.
Cut the adhesive tap 10 cm long & keep ready to fix the tube.
Put on clean gloves.
Clean the nostrils using cotton tipped applicator.
Lubricate the tube of about 6 to 8 inches.
Hold the tube coiled in the right hand introduces the tip into the left nostril.

19. Insert the tube through left nostril to the back of the throat, aiming back &
down towards the ear( backward than downward).
Flex the patient head towards the chest after the tube has passed the
nasopharynx.
Have the patient take the sips of water on command advance the tube 3-4
inches each time swallows.
Make sure tube is in stomach.
Once location of NG tube insured close other end of tube with spigot, secure
tube on nose using adhesive tap.

20. Method to confirm NG tube in the
stomach
1. Aspirate: attach the syringe to the end of NG tube and aspirate small amount
of gastric content & check it using litmus paper.
2. Immerse distal end of tube into bowl of water and check for air bubbles.
3. Auscultate : attach syringe to free end of the tube, place diaphragm of
stethoscope over left hypochondrium, inject 10 ml of air and auscultate
abdomen for gushing sound.
4. Ask patient to speak.
5. X ray

21. After care
Offer a mouth wash .
Clean the face and hands and dry them.
Remove the mackintosh and towel.
Make patient comfortable in bed & provide oral hygiene every 4-6 hours.
Discard waste clean and replace articles.
Remove gloves and wash hands.
Record type of tube placed, aspirate amount returned and patient tolerance.