Assisting in Nasogastric Tube Insertion 1 1

ASSISTING IN
NASOGASTRIC TUBE
INSERTION
BY: MARISSE C. ARROYO, RN, MN
DEFINITION
■ Nasogastric Tube (NGT) – a flexible tube
made of rubber or plastic that is inserted
through one of the nostrils down the
nasopharynx and esophagus down into
the alimentary tract.
■ In some instances, the tube is passed
through the mouth and pharynx,
although this route may be more
uncomfortable for the adult client and
may cause gagging.
■ Nasoenteric Tube – a longer tube (at
least 40 inches for an adult) inserted
through one nostril down into the upper
small intestine.
RATIONALE EQUIPMENT
■ Hypoallergenic tape
■ Water-soluble lubricant
■ To administer tube feedings and
medications to clients who are ■ Glass of water and drinking straw basin pH chemstrip
comatose, semiconscious, or
unable to consume sufficient ■ Stethoscope
nutrition orally. ■ Penlight
■ To establish a means for ■ NGT Fr 14 or 16 (depending on the size of the person)
suctioning stomach contents to
prevent gastric distention, nausea, ■ Guidewire or Stylet for small-bore tube
and vomiting.
■ Solution basin filled with warm water (if plastic tube is
■ To obtain gastric specimens for used) or Ice (if rubber tube is used)
analysis.
■ To lavage (wash) the stomach in
■ 20 – 50 ml syringe with an adapter or Asepto Syringe with
case of oral ingestion of poisonous small-bore tube
substance or overdose of ■ Clean gloves
medications.
■ Tissues and towel
■ Suction apparatus if required
Type of NGT
PLANNING AND IMPLEMENTATION
ACTION IMPLEMENTATION
1. Review client’s medical record • To confirms doctors order for inserting a nasogastric
and history. tube; history of nasal or sinus surgery or problem.
2. Gather the equipment. • To facilitate an efficient procedure.
3. Wash hands. • To prevent the spread of microorganisms.
4. Check client’s armband; • To verify correct client; explanation of procedure
explain procedure, showing reduces anxiety and increases client cooperation.
items.
5. Raise the bed the bed and place • To facilitate passage of the tube into the esophagus
it in a high Fowlers position (45 to and swallowing.
60 °) or assist the client to a
Fowlers position, at least a 45°
angle or higher, with a pillow
behind client’s shoulder; provide
for privacy.
■ Place comatose clients in semi-
Fowler’s position.
ACTION RATIONALE
6. Place towel over patient’s chest, with • To prevents soiling of gown and bedding and protects
tissues in reach. Don clean gloves. nurse from contamination with bodily fluids; lacrimation
can occur during insertion through nasal passages.
7. Examine nostrils with penlight and assess
as client breathes through each nostril. • To determine the most patent nostril to facilitate insertion.
8. Using the NG tube, measure the distance

from the of the nose to the earlobe and then • To approximate length of tube needed to reach stomach.
to the xiphoid process of the sternum and
mark this distance on the tube with a piece
of tape.
■ If tube is to go below stomach (naso-
duodenal or naso-jejunal), add an
additional 15 to 20 cm.
9. Have client below nose, and encourage
• To help clears nasal passage without pushing
swallowing of water if level of consciousness microorganisms into inner ear; to facilitate passage of
and treatment plan permit. tube.
NGT Insertion
ACTION RATIONALE
10. Lubricate first 4 inches of tube with • To facilitate passage into the nares.
water-soluble lubricant.
11. Ask patient to slightly flex the neck
backward. • To make insertion easier.
12. Insert tube as follows:

■ Gently insert the tube into nostril; aim • To promote passage of tube with minimal trauma
tube toward back of throat and down. to mucosa.
■ Ask client to tip the head forward once • To facilitate passage of the tube into the
the tube reaches the naso-pharynx – this esophagus instead of the trachea. Tube may
is usually where the client starts to gag. stimulate gag reflex.
■ If client continuous to gag, stop a • To allow client rest, reduce anxiety and prevent
moment. vomiting.
■ When client feels tube in back throat, • To ensure tip’s placement. Tube may be coiled or
use flashlight or penlight to locate tip of kinked.
tube.
■ Advance the tube several inches at a
time as the client swallows ice chips or
water.
ACTION RATIONALE
■ If resistance is met, rotate tube slowly with • To assist in advancing the tube past the oropharynx. The
downward advancement toward client’s action of swallowing facilitates the insertion process.
closest ear; do not force tube. With each swallow; the tracheal opening is closed to
prevent inspiration.
■ Withdraw the tube immediately if there are
signs of respiratory distress.
■ Advance the tube until the taped mark is • To prevent trauma to the bronchus or lung. To enable the
reached tube to reach the stomach.
13. Secure the tube by taping it to the
bridge of the client’s nose. • To prevent tube displacement.
■ Wipe body oils off tip of nose and allow
drying.
■ Split a 4 inch strip of tape lengthwise 2
inches.
■ Place the intact portion of the tape on the
bridge of the nose and wrapping the split
ends around the tube.
■ Tape to cheek as well if desired.
ACTION RATIONALE
14. Check placement of tube: • To ensure correct placement in the stomach.
■ Attach syringe to free end of tube and rapidly • To ensure correct placement in the stomach. A “whoosh”
inject 30cc of air and at the same time sound will be heard if the tube is correctly placed.
auscultate over the epigastric area. Amount of air varies for pediatric patient or if patient has
had gastric surgery.
■ Aspirate gastric contents; assess color and
quality of the content. If required, measure • pH below 4, tube is in stomach; pH range of 6 to 7 indicates
with pH indicator strip. Follow protocol intestinal sites or pleural fluid from tracheobronchial tree.
regarding insertion of contents versus • To prevent leakage of gastric contents.
discarding.
• To confirm correct placement; if nasoduodenal or nasojejunal
■ If prescribed, obtain x-ray; keep client on the feedings are required, passage through pylorus may require
right side until x-ray is taken. several days.
15. Connect the distal end of the tube to • To establish an appropriate pathway for intervention.
suction, draining bag, or adapter according
to the purpose of this nursing intervention.
• To enhance the level of comfort and to secure the tubing

16. Secure the tube with tape, or with
system.
rubber band and safety pin, to client’s gown.
ACTION RATIONALE
17. Instruct client about movements that can • To reduce anxiety and to teach client how to
dislodge the tube. prevent tugging on tube with head
movement.
18. Gastric decompression:
■ Remove syringe from free end of the tube, and
connect tube to suction tubing; set machine on • To perform decompression as prescribed by
type of suction and pressure as prescribed. the doctor; intermittent or continuous
suctioning is determined by type of tube
■ Levine tubes are connected to intermittent low inserted.
pressure.
■ Salem sump or Anderson tube is connected to
continuous low suction.
■ Observe nature and amount of gastric tube or
drainage.
■ Assess client for nausea, vomiting, and • To provides information about patency of
abdominal distention. tube and gastric contents.
ACTION RATIONALE
19. Provide oral hygiene and cleanse nares with a • To promote comfort.
tissue.
• To prevent the spread of microorganisms;
20. Remove gloves, dispose of contaminated materials protect other workers from coming into contact
in proper container, and wash hands/hand hygiene. with objects contaminated with body fluids.
21. Position client for comfort, and place call light • To promote comfort and safety.
within easy reach.
VARIATION:
INSERTING A NASO-INTESTINAL TUBE:
■ Add 3 to 4 cm (8 to 10cm) to the length measured

for the nasogastric tube and mark it with tape. ■ To enable advancement of the tube through the
pyloric sphincter.
■ After inserting the tube into the stomach, position
the client bon his / her right side ■ To determine placement in the intestine.
■ When the tube has advanced to the premarked
point, test the pH to as the aspirate.
■ Have proper placement confirmed by x-ray and
tape the tube in place when confirmation is
received.
EVALUATION DOCUMENTATION
■ The reason for the tube insertion
■ The type of tube inserted
■ If suction is applied: the type (intermittent or continuous) of suctioning and pressure setting
■ The nature and amount of aspirate and drainage
■ The client’s tolerance of the procedure
■ The effectiveness of the intervention, such as nausea relieved

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ASSISTING IN

8. Using the NG tube, measure the distance

12. Insert tube as follows:

• To enhance the level of comfort and to secure the tubing

■ Add 3 to 4 cm (8 to 10cm) to the length measured

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