Nasogastric Tube Insertion

Nasogastric tube insertion is a medical procedure that involves the insertion of a tube through the nose and into the stomach. It is commonly used for various purposes such as administering medications, feeding, decompressing the stomach, or obtaining gastric samples.

The following is a general note outlining the procedure for nasogastric tube insertion based on guidelines from the National Institute for Health and Care Excellence (NICE):

• Preparation:
Suprapubic catheterization may be indicated in various situations, including but not limited to:
1. Gather the necessary equipment, including a nasogastric tube, water-soluble lubricant, tape, a syringe, and a stethoscope.
2. Explain the procedure to the patient and obtain informed consent.
3. Position the patient in an upright or semi-upright position, if possible.
4. Wear appropriate personal protective equipment (e.g., gloves, apron) to maintain infection control.
• Nasogastric Tube Selection:
1. Choose the appropriate size and type of nasogastric tube based on the patient's age, condition, and purpose of insertion.
2. Ensure that the tube is of sufficient length to reach the stomach comfortably.
• Lubrication and Insertion:
1. Lubricate the distal end of the nasogastric tube with a water-soluble lubricant to facilitate insertion.
2. Gently insert the tube through the patient's nostril, aiming downward and toward the back of the throat.
3. Ask the patient to swallow or sip water to aid the passage of the tube into the esophagus and stomach.
4. Advance the tube slowly and carefully, encouraging the patient to breathe through their mouth if necessary.
5. Assess the tube's placement by checking for bilateral breath sounds and aspiration of stomach contents (aspirate stomach contents using a syringe).
• Securing the Tube:
1. Once the tube is in the correct position, secure it to the patient's nose using adhesive tape or a tube holder.
2. Ensure that the tube is not pulled excessively tight, allowing for movement but preventing accidental dislodgement.
• Confirmation of Placement:
1. Crude/Unreilable method:
   Use a stethoscope to auscultate for the presence of air in the stomach while injecting a small amount of air through the tube.
2. Reliable Method:
   Check pH of the gastric aspirate on the bedside, a pH of between 1 and 5.5 is usually confirmatory for correct NG placement.
3. Do not hesitate doing this:
   Consider obtaining an abdominal X-ray to confirm the tube's placement if there are concerns or uncertainties in the above methods.
• Tube Position Verification:
1. Mark the external length of the inserted tube at the nostril or lip level for reference and monitoring.
• Documentation:
1. Type and size of tube
2. External length of tube or cm marking at nostril
3. pH of aspirate
• Post-insertion Care:
1. Flush the nasogastric tube with the appropriate amount of water to ensure patency and verify placement.
2. Secure the tube to prevent accidental displacement during patient movement.
3. Provide the patient with appropriate education and instructions regarding tube maintenance, feeding, and any necessary precautions.

It is essential to note that the specific steps and techniques for nasogastric tube insertion may vary based on institutional protocols, patient condition, and healthcare provider preferences. Adherence to aseptic techniques, proper positioning, and patient comfort are vital aspects of the procedure. Healthcare professionals performing nasogastric tube insertion should have adequate training, knowledge, and experience to ensure patient safety and minimize the risk of complications.

Regular monitoring, repositioning, and care of the nasogastric tube are essential to prevent complications such as tube dislodgement, blockage, or irritation of the nasal passages. Healthcare professionals should follow institutional guidelines and consult specific manufacturer instructions for the equipment used in the procedure.