This document discusses gastrointestinal intubation, specifically nasogastric tube insertion. It covers types of tubes, indications for use, the technique for insertion, assessing proper placement, administering enteral feeds through the tube, nursing care responsibilities, and potential complications. The key points are that nasogastric tubes can be used to decompress the stomach, administer medications or feeds, and tubes are inserted through the nose and down the esophagus into the stomach or small intestine.

1. Gastrointestinal Intubation
Nasogastric tubes Insertion
Presented By:
SIVA NAGU

2. Nasogastric tube
Gastrointestinal intubation deals with the inserting of
a rubber or plastic tube into the stomach, duodenum
or small intestine.

3. Types of Tubes
Short tubes: passed through the nose into the
stomach
Medium Tubes: tubes are passed through the nose
to the duodenum and the jejunum. Used for
feeding
Long tubes: passed through the nose, through the
esophagus and stomach into the intestines. Used
for decompression of the intestines

5.  Nasogastric tubes come in various sizes (8, 10, 12, 14, 16 and 18
Fr).

6. Indications for GI Intubation
To decompress the stomach and remove gas and
liquids
To lavage the stomach and remove ingested toxins
To administer medications and feeds
As part of the management of an obstruction
As part of the management of hematemesis
To aspirate gastric contents for analysis

7. Intubating the client with an NG
tube
Assessment:
Who needs an NGT:
 Surgical patients
 Ventilated patients
 Neuromuscular impairment
 Patients who are unable to maintain adequate oral intake
to meet metabolic/nutritional demands
To assess patency of the nares

8. Assessment cont.
Assess patient’s medical history:
 Nose bleeds
 Nasal surgery
 Deviated nasal septum
 Anticoagulation therapy
 GI history
Conduct a thorough physical examination.
Assess patient’s gag reflex.
Assess patient’s mental status.

9. Technique
Equipment:
 14 or 16 Fr NG tube
 Lubricating jelly
 pH test strips
 Tongue blade
 Flashlight
 Emesis basin
 Syringes
 1 inch wide tape or commercial fixation device
 Suctioning available and ready
 Urobag/Collection bag
 Stethoscope

10. Technique continued…
 Explain procedure to patient and relatives
 Position the client in a sitting or high Fowler’s position. If
comatosed, semi Fowler’s.
 Examine feeding tube for flaws.
 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.

11. 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

13. Implementation
1) Wash Hands
2) Put on clean gloves
3) Lubricate the tube
4) Hand the patient a glass of water
5) Gently insert tube through nostril to back of throat (posterior
naso pharynx).
Have the patient flex the head towards the chest after tube has
passed through nasopharynx.

15. Implementation Cont.
6)Emphasize the need to mouth breathe and swallow
during the procedure.
7) Swallowing facilitates the passage of the tube through
the oropharynx.
8) When the tip of the tube reaches the carina stop and
listen for air exchange from the distal end of the tube. If air
is heard remove the tube.
9) Advance tube each time client swallows until desired
length has been reached.

16. Implementation Cont.
10) Do not force tube. If resistance is met or client starts to cough,
choke or become cyanotic stop advancing the tube and pull back.
11) Check placement of the tube.
X-ray confirmation
Testing pH of aspirate
12) Secure the tube with tape or commercial device.

18. Nasogastric Tube Position

19. Evaluation
Observe the patient to determine response to
procedure.
ALERT! Persistent gagging – prolonged
intubation and stimulation of the gag reflex can
result in vomiting and aspiration.
 Coughing may indicate presence of tube in the
airway.

20. Evaluation Cont.
 Note the location of external site marking on the tube
 Documentation
 Size of tube, which nostril and patient’s response.
 Record length of tube from the nostril to end of tube.
 Record aspirate pH and characteristics

21. Testing Placement
 Wash hands and put on clean gloves
 Draw up 30cc of air into the syringe and attach to end of the NG
tube. Flush tube with 30cc of air prior to attempting to aspirate
fluid. Draw back on the syringe to obtain 5 to 10 cc of gastric
aspirate.
 If unable to aspirate:
 Advance tube – may be in air space above aspirate level
 If intestinal placement suspected, withdraw tube 5 to 10 cm
 Have the patient lie on his/her left side wait 10-15 mins and attempt
aspiration again.

22. Testing Placement cont.
Observe appearance of aspirate:
 From patient with enteral feeding – appearance of
enteral feed
 Bile stained
 From stomach (non fed)– green, bloody, brown.
 Pleural fluid – pale yellow and serous

23. Testing Placement Cont.
 If after repeated attempts, it is not possible to aspirate
fluid from a tube that was originally established by x-ray
examination to be in the desired position and there are
NO risk factors for dislocation, tube has remained in
original position and the client is NOT experiencing any
difficulty the nurse may assume the tube is correctly
placed.

24. Nursing responsibilities
Following verification by x-ray of tube placement.
The nurse is responsible for ensuring that the tube
has remained in the intended position before
administering formula or medication through the
tube.
Verification of placement is performed before each
intermittent feeding and at least once every 12
hour shift for continuous feedings and prior to
medication administration.

25. Enteral Nutrition
What is it:
 The administration of nutrients directly into the GI tract.
The most desirable and appropriate method of providing
nutrition is the oral route, but this is not always possible.
 Nasogastric feeding is the most common route
 Nurses are the main healthcare professional responsible
for intubation

26. Administering Enteral Feeds
Indications:
 Clients who are unable to maintain adequate oral intake to
meet metabolic demands
 Surgical cases
 Ventilated patients
 Neuromuscular impairment
Generally these clients have been referred to the
Dietician.

27. Administering Enteral Feeds
Contraindications:
 Clients with diffuse peritonitis.
 Severe pancreatitis
 Intestinal obstruction
 Paralytic ileus.

28. Nursing Care
 Confirm satisfactory tube positioning before starting
tube feed and Q shift (aspirate for pH and color)
 Residual volume – aspirate with syringe min Q shift
(usually q4h). If residual volume is greater than 100cc
notify physician.
 Right product, right time, right client, right rate…..check
and chart.
 Give the feeds as per the dietician's advice
 Monitor intake and output

29. Nursing Care Cont.
Flush tube with a min of 30-50cc water prior to initiating
feed, when feed is finished, before and after the
administration of medications and q4-6h around the clock.
For immune compromised clients use sterile water
For non-immune compromised use tap water (refer to
policies of the institution
Change feed bag and tubing q24h, need to label and chart
Elevate the HOB to 30 degrees to prevent aspiration.
Note blood values – BUN, creatinine, lytes,glucose.

30. Nursing Care Cont.
 Monitor blood glucose
 Keep tube feeding formulas at room temperature.
 Give 10-20 ml of plain water through the tube as RT
hygiene (prevents the visibility of given feed)
 A Registered Dietician determines the caloric
requirements for each client and orders the formula to
be use, the rate and the appropriate amount of water to
be used to flush the tube.
 Wash the feeding syringe and measuring cup soon
after feeding.

31. When to Check the placement of the tube?
Before each feed
Before giving medications
After transferring the patient from one place to another
Key points to be followed:
Do not feed the patient before shifting
Do not shift the patient soon after feeding
Do not give more than 100 ml each time you feed

32. Complications
Clogged/Blocked Tube- most common
Dumping Syndrome: solution with high osmolality- water
moves into stomach and intestines from the fluid
surrounding the organs and vascular system causing
dehydration, hypotension and tachycardia
Aspiration : ensure head of bed is elevated at least 30
degrees while feeds are being administered

33. Complications Cont.
Dehydration- diarrhoea is a common problem.
Electrolyte imbalance: hyperkalaemia and
hypernatraemia
Oral mucosal breakdown
Nasal irritation