A nasogastric (NG) tube is a flexible tube inserted through the nose, down the throat and esophagus, and into the stomach. It delivers liquid nutrition and medication, or removes air and fluids from the stomach. NG tube placement is a complex procedure. Only trained healthcare professionals should perform it to ensure patient safety and prevent complications. This overview explains the process for educational understanding.
Preparation for Nasogastric Tube Placement
Before NG tube insertion, professionals ensure patient comfort and success. They assess medical history, health, cooperation, nasal history (e.g., broken nose, deviated septum), and swallowing. Patient identification and allergies are also confirmed.
Gathering equipment is crucial. This includes an NG tube, water-soluble lubricant, medical tape or a fixation device, a syringe, a stethoscope, and pH test strips. An emesis basin, tissues, and water with a straw are kept ready. The patient is positioned in a high Fowler’s position (seated upright at 60-90 degrees) to facilitate insertion.
To determine tube length, the professional measures from the patient’s nose tip to the earlobe, then to the xiphoid process (bottom of the sternum). This length is marked on the tube. This ensures the tube reaches the stomach effectively.
The Nasogastric Tube Placement Procedure
Insertion begins with lubricating the tube tip. Approximately 3-4 inches are coated with water-soluble lubricant to aid passage through the nasal cavity and pharynx, reducing discomfort. Some tubes have built-in lubricant that activates with water.
The lubricated tube is gently inserted into a nostril (typically with better airflow) and advanced slowly. Insertion is directed downwards and backward, aiming towards the ear, following the nasal passage’s curvature. As it passes the nasopharynx, the patient flexes their head forward, chin to chest.
This position helps close the trachea and open the esophagus, guiding the tube correctly. The patient is asked to swallow (often by sipping water) to facilitate advancement down the esophagus. Each swallow propels the tube forward, preventing curling in the throat or tracheal entry.
The tube is advanced with each swallow until the pre-measured mark reaches the nostril. The professional monitors for distress (e.g., coughing, gagging, choking), which could indicate airway misplacement. If resistance or discomfort occurs, the tube is withdrawn, repositioned, and reattempted.
Confirming and Securing the Nasogastric Tube
After NG tube insertion, confirming its precise stomach location is crucial to prevent complications. One method is auscultation: air is injected into the tube while a stethoscope is placed over the stomach to listen for a “whoosh” sound. Auscultation alone is unreliable due to false positives.
Another method involves aspirating fluid from the tube and testing its pH with pH strips. Gastric contents are typically acidic (pH 1-5.5), confirming stomach placement. If pH is higher, especially with acid-reducing medications, this method may be less conclusive.
The most definitive method for confirming NG tube placement is a chest X-ray. An X-ray visually confirms the tube’s exact position, distinguishing gastric from pulmonary placement. This is important before administering nutrition or medication to avoid risks of inadvertent lung placement.
Once placement is confirmed, the tube is secured to the patient’s nose or cheek to prevent dislodgement. This is typically done using medical tape or a fixation device. Ensuring the tube is not resting directly against the nostril helps prevent skin irritation. The tube is often fastened to the patient’s gown with tape, allowing slack without pulling.
Post-Placement Care and Monitoring
After NG tube placement and securement, ongoing care and monitoring ensure functionality and patient well-being. Regular assessment of patient comfort and skin integrity around the insertion site identifies irritation or pressure injury. Tube patency is important; routine flushing may prevent blockages.
The NG tube is used for its purpose: administering liquid feeds, medications, or draining stomach contents. When administering feeds, the head of the bed is kept elevated to at least 30 degrees to minimize aspiration risk. This vigilance ensures the tube serves its purpose effectively.
Potential complications can arise despite careful placement and care. These include skin irritation around the nostril, sinusitis, or nosebleeds. Tube occlusion (blockage) or accidental dislodgement are also possibilities. Any signs of these issues or respiratory distress should be promptly reported for intervention.
An NG tube is removed when no longer medically necessary. This often occurs when the patient can tolerate oral intake, has regained normal bowel function, or no longer requires gastric decompression. Sometimes, a trial clamping is performed to ensure the patient can manage without it before removal.