A nasogastric (NG) tube is a thin, flexible tube passed through a baby’s nose, down the throat, and into the stomach. This device provides nutrition, fluids, or medication when an infant cannot feed effectively or safely by mouth. Determining the correct length for insertion is a precise step. Placing the tube too short means it will not reach the stomach, while inserting it too far risks coiling or entering the lungs. Accurate measurement is paramount to ensuring the tube functions correctly and preventing serious harm to the infant.
Essential Preparation and Required Supplies
Preparation requires a specific set of tools to ensure accuracy and safety. Supplies include the correct size NG tube and water-soluble lubricant to ease passage. A measuring tape or ruler is needed to calculate the required depth, and a non-toxic marker or tape denotes the measurement on the tube. The procedure must always be performed by trained healthcare professionals, as improper technique carries significant risks.
Infant positioning is a deliberate step in preparation. The baby is typically placed supine, lying on their back, with the head held securely in the midline. This position aligns the anatomical pathway from the nose to the esophagus, facilitating smoother insertion. For younger infants, swaddling or containing the limbs helps limit movement that might disrupt the measurement process.
The Standard Measurement Technique for Infants
The most accepted method for determining NG tube length uses external anatomical landmarks to estimate the distance to the stomach. This procedure is the Nose-Ear-Mid-Umbilicus (NEMU) method, which is the most evidence-based technique for infants. Measurement begins by positioning the tube tip at the infant’s nose (the nare). The tube is then extended along the side of the face to the base of the earlobe, marking the first segment of the required length.
From the earlobe, the tube is extended downward toward the chest and abdomen. The second measurement point requires identifying two distinct bony landmarks: the xiphoid process (the lower tip of the breastbone) and the umbilicus (belly button). The second segment of the tube length is measured to the point exactly halfway between the xiphoid process and the umbilicus.
The NEMU path closely approximates the internal distance from the nostril, through the pharynx and esophagus, and into the infant’s stomach. This estimation is more accurate than measuring only to the xiphoid process (the NEX method), which often results in tubes being too shallow. Once measured across the nose, earlobe, and to the mid-umbilicus point, the total length is the intended insertion depth.
Marking the Tube and Critical Safety Checks
After determining the total length using the NEMU method, the final step before insertion is marking the tube accurately. A small piece of medical tape or a non-toxic marker creates a clear visual indicator corresponding to the calculated length. This mark indicates the maximum depth to which the tube should be inserted into the infant’s nostril.
During insertion, the healthcare professional advances the tube until the mark rests directly at the opening of the nostril. The tube often has centimeter (cm) increments printed along its length, providing a secondary reference point that should be documented. The external mark acts as a continuous safety check; if the tube is inserted beyond this point, it must be immediately withdrawn to the correct depth.
Observing the infant closely for signs of distress, such as coughing or gasping, is a safeguard, as these symptoms indicate the tube may have entered the airway. If resistance is encountered during insertion, the procedure is halted, and the tube is withdrawn. The calculated length is a precise boundary that must be respected for patient safety.