The document outlines the procedure for naso-gastric tube insertion, detailing indications, contraindications, necessary equipment, and sequential steps of the process. Key steps include obtaining informed consent, inspecting the nasal cavity, measuring the tube, lubricating, and carefully inserting the tube while confirming its position. After insertion, the tube should be fixed in place and proper disposal of materials should be conducted.

1. NASO-
GASTRIC
TUBE
INSERTION
SKILL
LAB
OSCE
Dr.B.SELVARAJ MS;Mch;FICS;
“SURGICAL EDUCATOR”
MALAYSIA

2. NASO-GASTRIC TUBE
INSERTION
DEFINITION
Insertion of NG tube through the nose into
the patient’s stomach- Ryle’s tube, Levin’s
tube- 16F size
INDICATIONS
1. Bowel obstruction- small & large & GOO
2. Tube feeding in Neurological patients who are
unable to swallow
3. For Gastric Lavage in poisoning- Oro-Gastric-
Ewald’s tube 24F
4. For instilling barium into esophagus for barium
swallow in patients who are unable to swallow.

3. NASO-GASTRIC TUBE
INSERTION
CONTRAINDICATIONS
ABSOLUTE
1. Severe facial trauma- Maxilla #
2. # Cribriform plate of sphenoid bone
3. Corrosive esophagitis
4. Recent esophageal surgery
CONTRAINDICATIONS
RELATIVE
1. Stricture esophagus- benign & malignant
2. Unstable cervical spine #
3. Bleeding diathesis
4. Compromised air way

4. NASO-GASTRIC TUBE
INSERTION
EQUIPMENTS

5. NASO-GASTRIC TUBE
INSERTION
SEQUENTIAL STEPS
1.Introduction & Informed
consent
 Introduce yourself to the
patient
 Tell the patient why and
what you are going to do?
 Tell the possible
complications also and then
obtain the informed consent.
2. Chaperone & Privacy
 Ask for a chaperone
 Maintain privacy by putting
the curtain

6. NASO-GASTRIC TUBE
INSERTION
SEQUENTIAL STEPS
3. Wear PPD, wash hands
and wear glove
 PPD/PPE: Wear apron, cap,
mask and goggles
 Wash hands
 Wear sterile glove

7. NASO-GASTRIC TUBE
INSERTION
SEQUENTIAL STEPS
4. Patient’s position
 Patient should lie in bed in
Fowler’s position- 45* angle
5. Inspect nasal cavity
 Use pen torch to visualize
any polyp or median septal
deviation in nostrils

8. NASO-GASTRIC TUBE
INSERTION
SEQUENTIAL STEPS
6. Measure length of the
tube to be inserted
 Noseloop around ear 
xiphisternum and mark
7. Apply lubricant to NGT
 Apply Xylocaine jelly liberally
to NGT tip

9. NASO-GASTRIC TUBE
INSERTION
SEQUENTIAL STEPS
8. Insert NGT gently
through floor of nostril
 Patient in sniffing position
 Gently introduce NGT
9. Ask patient to sip water
when experiencing Gag
reflex
 Epiglottis closes the tracheal
inlet

10. NASO-GASTRIC TUBE
INSERTION
SEQUENTIAL STEPS
10. Insert NGT upto the
mark
 Advance NGT upto the mark
11. Confirm the position in
the stomach
 Pushing air & hearing the
hissing sound in epigastrium
 Aspirating & testing with
litmus paper , and AXR

11. NASO-GASTRIC TUBE
INSERTION
SEQUENTIAL STEPS
12. Fix NGT to nose
 Fix NGT to nose with tape-
two tail technique
13. Thank the patient

12. NASO-GASTRIC TUBE
INSERTION
SEQUENTIAL STEPS
14. Throw the glove into yellow color bin

13. NASO-GASTRIC TUBE
INSERTION
SEQUENTIAL STEPS-RECAP
1. Introduce yourself ,Explain the procedure
and take informed consent
2. Ask for a chaperone &Provide privacy
3. Position patient
4. Don apron/ wash hands/ don gloves
5. Inspect nasal cavity
6. Measure length of tube to be inserted
(nose loop around ear xiphisternum)
& mark it
7. Put adequate jelly (at tip of tube/ nasal
cavity)
8. Insert tube gently through floor of nasal
cavity
9.Ask patient to swallow water while
inserting
10. Insert tube up to the marking
11.Confirm tube position (by aspiration of
contents/ auscultation)
12.Fix tube to nose
13.Dispose gloves
14. Thank patient