NASOGASTRIC TUBE INSERTION

Adult: 16-18 F Pediatric: the correct tube size varies with the patients age. To find the correct size, follow the formula: (age of the patient+ 16) 2 =..F

Indication
By inserting a nasogastric tube, you are gaining access to the stomach and its contents. to drain gastric contents, decompress the stomach, obtain a specimen of the gastric contents, or introduce a passage into the GI tract to treat gastric immobility, and bowel obstruction. It will also allow for drainage and/or lavage in drug overdosage or poisoning. In trauma settings, NG tubes can be used to aid in the prevention of vomiting and aspiration, assessment of GI bleeding. (presence and volume) NG tubes can also be used for enteral feeding initially.

Contraindication
base of skull fractures, severe facial fractures especially to the nose

obstructed esophagus
esophageal varices, and/or obstructed airway who have had gastric bypass surgery

Technique:1.
Explain procedure Benefits, risk, complication and alternatives to the patient / patients representative

2.

Examine: nostril (obstruction? Septal deviation) Determine which nostril more patent? (Ask patient occlude each nostril and breathe through the other)

3.

Measurement Tip of noseearlobe 1-2 inches below xiphoid process Marked with a piece of tape on the tube

4.

Position: sitting upright with neck partially flexed Ask patient hold a cup of water and put straw in mouth

5.

Create a curling of distal end , lubricate the distal tip of NG tube

6.

Gently insert the NG tube along the floor of nose with the slight curve pointing down and advance it parallel to the nasal floor until it reaches the back of the nasopharynx, where resistance will be met

7.

Sip water and start swallow Continue to advance the NG tube until the distance of previously estimated length is reached

8.

Stop advancing and completely withdraw the NG if Patient experiences SOB, Unable to speak Significant nasal hemorrhage Tube meets significant resistance

9.

Verify proper placement of NG tube Auscultation : over epigastrium region, insert air through the syringe, any rumbling sound? Aspirate some gastric content for litmus testing (blue red) CXR: verify correct placement

10.

Secure the tube with tape If clinically indicated, attach the NG tube to wall suction/ drainage bag after verification of correct placement.

1. Choose the correct tube**

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2. Explain to the patient what he/ she is about to do & also reassure the patient
3. Prepare NG tube -Measure from naso-tragus-stomach (xiphoid) - lubricate 4. Inspect nasal passage -Make sure no evidence of bleeding or swollen mucosa 5. Use thumb and forefinger of free hand push backwards tip of nose and with other hand pass NG tube along floor of nose beyong the turbinates 6. Once NG tube is in the oropharynx, ask the patient to swallow. Insert up to measured distance 7. When NG is in place, the following test should be done to ensure placement in the stomach a.Free flow of stomach content, aspirate further to confirm stomach content use Litmus paper to test for acid (blue pink) b. Inject 40-50CC air into stomach and auscultate for bubbling sound in the epigastric region

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**candidate score 0 mark if choose wrong tube

Complication
Minor complications :-Nose bleeds -Sinusitis -Sore throat More significant complications :-erosion of the nose where the tube is anchored -esophageal perforation -pulmonary aspiration -a collapsed lung, or -intracranial placement of the tube