NASOGASTRIC TUBE

Question 1

OUTLINE THE INSERTION OF A NASOGASTRIC TUBE

Answer 1

Pre-procedure:
1. Prepare the equipment, explain the procedure, reassure & assess the
pt, & provide privacy. Confirm the pt’s identity. Position the pt in
sitting position & ask her to blow her nose if needed.
2. Perform hand hygiene & put on gloves/ PPE.
3. Select a patent nostril. If ordered, apply intranasal anaesthetic &
wait for 5 minutes.
4. Uncoil the NGT & measure from the nose tip to the ear lobe to the xiphoid process.
5. Lubricate the first 10cm of the NGT
Insertion:
6. Tilt the pt’s head back and pass the tube slowly along floor of cavity.
At the nasopharynx tilt head forward and ask the woman to swallow /
drink as NGT advances down oesophagus to the pre-measured mark.
Mild resistance may occur; do not advance against significant
resistance.
7. Aspirate 0.5-1mL & test on pH strip. If correct placement pH is <5.5.
 If unable to aspirate: Turn the woman onto her side; inject 10-
20ml air; wait 15-30mins & try again; advance the NGT by 10-
20cm (adults); consider x-ray (contraindicated if pregnant).
 If aspirate pH >5.5 or any doubt about placement: Do not feed.
Seek medical advice.
8. If aspirate pH <5.5 wipe nose with tissue, and secure NGT with tape. May use safety pin to attach to clothing.
9. Spigot NGT or attach to a drainage system.
Post-procedure:
10. Reposition the pt, discard the equipment appropriately and perform hand hygiene.
11. Document in the medical records (date, time, reason of insertion; type, size,
length of NGT; nostril used, number of attempts; any complications; method of placement confirmation)
12. Regularly check & provide nostril pressure care.
13. Provide advice & assistance with mouth care while the NGT is in situ.
14. Confirm tube placement regularly before feeds /meds & at least every 24hrs & after any events (e.g. coughing,
fit, suction, vomiting) where movt may occur

Question 2

WHAT ARE THE AIMS OF AN NGT?

Answer 2

x. To aspirate and drain gastric contents for diagnostic/therapeutic reasons.
xi. To administer fluid/medication.
xii. To maintain adequate nutrition

Question 3

WHAT ARE THE INDICATIONS FOR AN NGT?

Answer 3

(i) Feeding in absence of swallow reflex in unconscious pt.
(ii) Decompression of GIT e.g. paralytic ileus
(iii) Gastric lavage
(iv) Analysis of stomach content
(v) Physical injury to oral cavity
(vi) Inflammation or ca esophagus
(vii) Premature babies to prevent aspiration

Question 4

LIST THE EARLY COMPLICATIONS OF AN NGT

Answer 4

I. Early (during insertion)
(i) Mucosal damage
(ii) Laryngo- tracheal obstruction?
(iii) Esophageal or gastric perforation
(iv) Bleeding
(v) Accidental naso-tracheal intubation
(vi) Accidental transbrochial perforation
(vii) Nausea and vomiting

Question 5

LIST THE LATE COMPLICATIONS OF AN NGT

Answer 5

II. Late (during use)
(i) Aspiration pneumonia
(ii) Gastro- irritations
(iii) Pharyngitis/esophagitis
(iv) Vocal cord paralysis
(v) Stenosis or stricture of esophagus
(vi) Ca esophagus
(vii) Infection
(viii) Loss of electrolytes due to vomiting
(ix) Necrosis: - retro- or nasopharyngeal