This document discusses nasogastric tube insertion. It provides indications for NG tube insertion including for diagnostic evaluation of upper GI bleeding and administration of medications or feeding. Therapeutic uses include gastric decompression and relief of small bowel obstruction symptoms. Contraindications include severe midface trauma, recent nasal surgery, and esophageal varices. The document outlines the equipment, patient preparation, insertion technique, complications, and confirmation of proper placement.

1. NASOGASTRIC TUBE
INSERTION
Dr. Pramesh Prasad Shrestha
FCPS Resident
Department of GI surgery and Digestive Diseases

2. INDICATIONS FOR NG TUBE INSERTION
• Diagnostic:
• Evaluation of Upper GI beeding
• Aspiration of gastric fluid content for investigations
• Identification of the esophagus and stomach on chest radiograph
• Administration of Radiographic Contrast in GI Tract

3. INDICATIONS FOR NG TUBE INSERTION
• Therapeutic:
• Gastric decompression, including maintenance of a decompressed state after
endotracheal intubation.
• Relief of symptoms and bowel rest in the setting of small-bowel obstruction
• Aspiration of gastric content from recent ingestion of toxic material
• 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

4. CONTRAINDICATIONS OF NG TUBE INSERTION
• Absolute Contraindications:
• Severe midface trauma
• Recent nasal surgery
• Relative Contraindications:
• 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)

5. Equipments required
• NG Tube
• For adults: 14-18 FrG
• For pediatric patients:
(For 8 Year old child, correct size is (8+16) /2= 12)
• Water-soluble Lubricant (2% Lignocaine)
• Syringe
• Sethoscope
• Adhesive Tape
• Container for Vomitus
2
16Age

6. Patient Preparation
• Positioning: Upright Position with neck partially flexed
• Anesthesia: 2% Lignocaine Jelly/ Lignocaine spray

7. Technique
• Explain the procedure and obtain verbal consent
• Examine the patient's nostrils for sepptal deviation, to determine
which nostril is more patent
• Estimate the length of insertion by measuring the distance from the
angle of the mouth/nose to the tragus of ear to the tip of
xiphisternum.

8. Technique
• Position the patient upright with the neck partially flexed
• Lubricate the entire required length of NG tube
• Gently insert the NG tube along the floor of the nose and advance it
perpendicular to head, (not angled up into the nose.)
• Resistance will be met at 10-20cm, then ask the patient to swallow
his/her saliva or provide with a cup of water with straw to sip.
• Continue to advance the NG tube until the measured distance is
reached.

9. Technique
• If, at any time during insertion, the patient experiences respiratory
distress, is unable to speak, or has significant nasal hemorrhage, or if
the tube meets significant resistance, stop advancing the tube and
withdraw it completely.
• Verify proper placement of NG tube by auscultating a rush of air over
the stomach using the 60ml irrigation syringe or by aspirating gastric
content.
• Confirmation can be done by Chest X-ray.
• Once confirmed, Fix the tube in place with adhesive tape over the ala
of nostrils

10. Complications
• Patient discomfort
• Epistaxis
• Respiratory tree intubation
• Esophageal perforation

11. Thank You!!