Nasogastric (NG) Tube Insertion

✅ Introduction

Nasogastric tube insertion is a common and essential nursing procedure used for feeding, medication administration, and gastric decompression. This guide provides a step-by-step breakdown with clear instructions, human interactions, precautions, equipment, site anatomy, documentation tips, and real-life examples.

🎯 Objectives

• To safely insert a nasogastric tube.

• To maintain patient comfort and dignity.

• To monitor and prevent complications.

  
  

📋 Indications

• Gastric decompression in bowel obstruction.

• Enteral feeding in patients unable to swallow.

• Administration of medications.

• Sampling of gastric contents.

⚠️ Contraindications

• Severe facial trauma

• Esophageal varices

• Recent nasal or esophageal surgery

• Coagulopathy or nasal obstruction

  
  

🧰 Articles Required

Item	Purpose
NG tube (appropriate size)	Main device
Lubricating jelly (water-based)	Smooth insertion
Gloves and apron	Infection control
Towel or protective sheet	Patient cleanliness
Glass of water with straw	Swallowing aid (if conscious)
Syringe (50 ml, catheter tip)	Aspirate gastric contents and confirm placement
pH strip or litmus paper	Confirm gastric placement
Adhesive tape or NG fixation device	Secure tube
Kidney tray	Collection of secretions
Stethoscope	Placement confirmation
Penlight and tongue depressor	Nasal and throat inspection
Chart and pen	Documentation

👩‍⚕️ Nurse-Patient Communication

1. Knock before entering.

2. Greet the patient politely: “Good morning, Mr. Patel! I’m Nurse Asha, here to assist with a procedure that will help you receive nutrition and medication.”

3. Explain the purpose and steps of the procedure in their preferred language.

4. Gain consent and answer any questions.

5. Ensure privacy and comfort using screens and drapes.

   
   

   Procedure Steps

Steps	Action
1	Apply lubricant to the tip of the NG tube
2	Gently insert tube into selected nostril, direct backward then downward
3	Ask patient to swallow sips of water (if conscious) as tube is advanced
4	Continue insertion until marked point is reached
5	Temporarily secure tube to cheek with tape
6	Confirm position: - Aspirate gastric contents and test pH (should be <5.5) - Optional: Air bolus (20–30 mL) and auscultate epigastric region
7	Once confirmed, permanently secure tube with fixation device
8	Connect tube to required system (e.g., feeding syringe, suction)
9	Document the procedure in patient’s record

📍 Sites of Insertion

• Primary: Nasal passage → Esophagus → Stomach

• Tube should never enter:

  • Trachea (can cause coughing, aspiration)

  • Lungs (can cause pneumothorax)

  
  

📌 Sites for Insertion

• Insert through nares (preferred) into:

  • Nasopharynx → Oropharynx → Esophagus → Stomach

🪜 Step-by-Step Procedure

1. Preparation

• Verify physician’s order.

• Wash hands and wear PPE.

• Position patient in high Fowler’s position (60–90°).

• Drape a towel over the patient’s chest.

• Inspect nostrils for obstruction or injury.

  
  

2. Tube Measurement

• Measure from tip of nose → earlobe → xiphoid process.

• Mark length with tape or pen.

📍 Sites of Insertion

• Primary: Nasal passage → Esophagus → Stomach

• Tube should never enter:

  • Trachea (can cause coughing, aspiration)

  • Lungs (can cause pneumothorax)

  • 
    

3. Lubrication

• Lubricate 4–6 inches of the tube with water-soluble jelly.

4. Insertion

• Gently insert tube through selected nostril.

• Ask patient to swallow water to assist movement.

• Advance gently with each swallow.

• Monitor for coughing, cyanosis, or distress (may indicate airway entry).

5. Confirm Placement

• Aspirate stomach contents and test pH (should be 1–5).

• Inject air and auscultate epigastrium (whooshing sound indicates gastric entry).

• X-ray confirmation is gold standard (especially for initial placement).

6. Secure the Tube

• Fix with tape across nose or NG tube holder.

• Leave free end capped or connect to feeding system.

7. Documentation

• Date and time of insertion

• Size and type of tube

• Which nostril used

• Method of confirmation

• Patient’s response

• Any complications

⚠️ Precautions

• Never force the tube.

• Discontinue immediately if patient becomes cyanotic or coughs excessively.

• Avoid repeated attempts on the same side.

• Ensure proper hygiene and handwashing.

⚠️ Possible Complications / Abnormalities

Abnormality	Signs	Response
Misplacement into airway	Coughing, choking, cyanosis	Remove tube immediately
Nasal bleeding or trauma	Blood from nostril	Stop, reassess, possibly use other nostril
Aspiration	Coughing, dyspnea	Remove tube, monitor respiratory status
Infection (sinusitis, otitis)	Fever, discharge	Monitor, report to physician

💡 Common Abnormalities and Responses

Observation	Possible Cause	Nursing Action
Coughing, gagging, cyanosis	Tube entering trachea	Withdraw immediately
Nose bleeding	Mucosal injury	Pause, apply cold compress, reassess
High pH in aspirate	Non-gastric placement	Do not use, re-confirm
Coiling in mouth	Incomplete advancement	Reposition and retry

📝 Example Case

Patient: Mr. Arun, 55-year-old male post-stroke Procedure: NG tube inserted via right nostril. Length measured 60 cm. Confirmed placement by pH (3) and air insufflation. Patient tolerated well. Feeding initiated.

📝 Record-Keeping

• Date and time of insertion

• Size and type of NG tube

• Side of nostril used

• Confirmation method (pH, auscultation)

• Patient’s tolerance

• Output (if for drainage)

• Signature and designation

👁️ Precautions

• Always confirm placement before any feeding or medication

• Check nostril daily for skin breakdown

• Label the tube with date of insertion

• Flush the tube regularly if used for feeding

• Keep head elevated during and 30 mins after feeding

🧠 Tips for Students

• Practice on models/manikins.

• Always prepare the patient and explain.

• Know your equipment thoroughly.

• Never skip confirmation.

✅ Summary Checklist

✔ Correct tube size

✔ Patient positioned upright

✔ Proper measurement and lubrication

✔ Gentle insertion with swallowing

✔ Confirmation by pH/stethoscope/x-ray

✔ Documentation