The document provides an overview of nasogastric (NG) tubes, including their types, indications, contraindications, and the procedure for insertion. Key types discussed include the Levin tube, Salem sump tube, Moss tube, and Sengstaken-Blakemore tube, each serving specific therapeutic and diagnostic purposes. It also highlights potential complications associated with NG tube use, such as injury to the esophagus and regurgitation, as well as equipment needed for insertion.

1. NG TUBE
By Athanase YAMFASHIJE
MS

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

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

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

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

19. CONTRAINDICATIONS FOR NG
TUBE
 Absolute
 Relative

20. ABSOLUTE CONTRAINDICATIONS
Severe face trauma or skull base fracture
Recent nasal surgery
Esophageal trauma or obstruction

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