Nasogastric tube placement

Question 1

What is a nasogastric tube?

Answer 1

The technique in which a nasogastric tube is passed via the nose into the stomach. This allows delivery of nutritionally complete feed or removal of stomach contents.

Question 2

What are the indications for an NG tube?

Answer 2

Decompression of stimach e.g. ileus
- use a tube with 4x big drainage holes for thick bile

for feeding= one with 2x ports, smaller pars and self lubricating- guide wire for insertion

depends on trust you are in and their guidelines though

Question 3

What are the absolute and relative contraindications for NG tube insertion?

Answer 3

do not put in an NG tube blindly if pt has:
basal skull fracture, oesop tumour, platelets <50 (norm >150), GI or varicocele bleed (could knock off the bands Tx with)
use endoscopy, interventional radiology etc

Question 4

What are the potential complications of NG tube placement?

Answer 4

go into the lungs
–> pneumothorax
so if there is resistance at the back of the nasopharynx, dont push!
get them to put their head back to open airway (not chin on chest) - insert back 90 degrees and twist down nasopharynx
remember at the nasopharynx point - gagging
if they have safe swallow they could drink while you put it in (or swallow)
- get aspirate to check if in stomach or not. If pH is over 6 need a chest x ray if its <5.5 - safe to feed
clear the 5mls liquid that is in the tube before taking another 0.1 ml to check from…

Question 5

What preparation do you need for inserting an NG tube?

Answer 5

wash and dry hands/use alc gel
assemble equip: NG tube, cup of water with straw, tape/dressing, pH testing strips, gloves and apron, emesis basin, lubricant and gauze, syringe
move to patient bedside, check patient identity, verify need for NG insertion and obtain informed consent
position patient sitting upright with neck straight
put on gloves and wear

Question 6

How do you insert an NG tube?

Answer 6

examine both nostrils for septum deviation - use more patent nostril for insertion, ask patient to occlude each nostril in turn and listen to them breathing with each. Measure the NG tube from pt nose BRIDGE to EAR LOBE to xiphisternum
lube tip of NG tube
arrange a signal for them to communicate if they want to stop
insert tube –> more patent nostril advancing along base of nasal canal directly horizontal towards nasopharynx
when resistance it met at the back of nasal canal e.g. approx 10-20cm. Advance the tube gently as it curves downwards to the pharynx; rotating the tube can help with any resistance but NEVER force the tube
ask the patient to take sips of water (if safe to swallow) to facilitate the NG tube down the oesophagus

stop whenever the distance marker is reached on the NG tube
secure NG tube to nose with a dressing
aspirate from the NG tube and check for gastric pH
if aspiration is unsuccsessful or pH is >5.5 then need a CXR!
once NG tube is deemed safe for feeding, remove guide wire (if not safe put label over end to stop people using it)
discard gloves and clean hands
doc the procedure including consent, size and length of tube inserted, volume and pH of any fluid aspirated, any complications and whether or not a chest radiograph is required in patients notes. Use the trust NG insertion sticker.(can be left for up to 6 weeks)

Question 7

When should an NG insertion be stopped?

Answer 7

stop whenever the distance marker is reached on the NG tube OR:
tube emerges in the oral cavity
pt experiences resp distress or unable to speak (tube is going the wrong way)
nasal haemorrhage
significant resistance of the tube met