Nasogastric (NG) Tube

EQUIPMENT

• 2 X 10 mL syringe filled with sterile water if using feeding tube with guidewire
• Gloves
• Incontinence pad, towel and emesis basin
• Water-based lubricating jelly
• Adaptor if required for attaching to suction tubing
• 3 - 5mL syringe for aspirating (small syringe produces less negative pressure when aspirating)
• 20-60 mL syringe for flushing (large syringe produces less positive pressure when flushing)
• pH testing strip to test aspirate
• Duoderm, tegaderm tape or tube securement device
• Waterproof tape and safety pin

• Permanent marker.

  TUBE SIZE

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STEPS TO NG TUBE PLACEMENT

1. GATHER equipment
2. PREPARE feeding tube with guidewire by flushing the tube with 10mL of sterile water to dissolve internal lubricant. The tube may be inserted with or without the guidewire depending on clinician preference. If not using guidewire, remove it after flushing. Then flush with an additional 10 mL sterile water to remove any remaining lubricant gel and test for tube patency
3. PERFORM hand hygiene
4. DETERMINE which nostril is most patent
5. MEASURE the distance with the gastric tube from the nares to the earlobe, to a point midway between the Estimate of distance from nose/mouth to stomach. MARK tube with permanent ink
6. PLACE incontinence pad or towel on patient's chest and have emesis basin available
7. PLACE patient in high fowlers or sitting position or hold patient stabilizing the head in the neutral or “sniffing” position
8. DON clean gloves and coil the end of the tube around your index finger to produce a flexible curve
9. LUBRICATE tip of tube 2-4 inches
10. INSERT the tube:
    • Instruct patient to hold head straight up with neck slightly hyper extended and facing forward or assist patient to hold this position.
    • Hold the end of the tube above the lubricant and with the curve pointing downward, carefully insert the tube along the floor of the nostril, on the lateral side. For oral insertion: direct to the back center of the mouth.
    • Offer the patient sips of water to help move the tube past the oropharynx. Infants may suck on a pacifier during the procedure.
    • Advance the tube each time the patient swallows until tube reaches marked length.
    • Observe patient throughout procedure for signs of tube mal-positioning (coughing, choking, inability to talk). Withdraw tube immediately if changes occur in patient's respiratory status, if tube coils in mouth, or if the patient begins to cough, choke or changes colour.
    • Gently remove guidewire (when used) and retain at bedside for future use. Never reinsert guidewire while tube is in situ.

NASOGASTRIC TUBE PLACEMENT VIDEO 

CONFIRMATION OF NG TUBE PLACEMENT

• Flush tube with 1-5 mL of air using a 20 - 60mL syringe. THIS DOES NOT CONFIRM TUBE PLACEMENT. DO NOT flush with liquid until placement confirmed
• Aspirate 1-5 mL of fluid using a 3-5 mL syringe and note visual characteristics of aspirate
• Place a few drops on pH test strip - gastric pH should be 5 or less.