Nasogastric Tube Insertion

Preliminary Steps

• Hand Hygiene & Privacy: Perform hand hygiene before starting and ensure patient privacy as the procedure can be uncomfortable.
• Patient Positioning: Raise the bed and position the patient upright between 45 to 90 degrees to ease the insertion process.
• Patient Communication: Clearly explain the procedure to the patient, noting that it may be uncomfortable.
• Patient Assessment: Assess gastrointestinal (GI) status and nasal cavity for any facial trauma or deviated septum.

Equipment Needed

• Nasogastric (NG) tube (e.g., Salem Sump)
• Absorbent pad or towel
• Securement device
• Water-soluble lubricant
• Clean piston syringe
• Cup of water (if not contraindicated)

Procedure

1. Preparation:

   • Perform hand hygiene and wear gloves.
   • Assess nasal cavity using a penlight and determine the best nare for insertion.
   • Measure the NG tube length from the nose tip to the earlobe, then to the xiphoid process.
   • Go a few centimeters past the xiphoid process to ensure proper length.

2. Drape & Lubricate:

   • Drape a towel over the patient's chest.
   • Lubricate the NG tube tip to facilitate smooth insertion.

3. Insertion:

   • Position the patient’s head straight and insert the tube into the nostril.
   • Instruct the patient to tuck their chin to their chest to help the tube pass into the esophagus and avoid the trachea.
   • Encourage swallowing using air or water to aid tube advancement.

4. Securing the Tube:

   • Secure the tube with a securement device once the predetermined length is reached.
   • Confirm tube placement by aspirating gastric contents.
   • Obtain an x-ray to verify the tube’s exact placement.

Tips & Precautions

• Non-Sterile Procedure: The GI tract is not sterile—keep this in mind during preparation.
• Tube Measurement: Mark the tube with a permanent marker or tape to know where to stop during insertion.
• Patient Reactions: If the patient coughs or the tube coils at the throat, stop the procedure and assess.
• Helper Advantage: Having a helper can ease the process, especially when assessing for coiling in the throat.
• Resistance Handling: If resistance is met, try the other nostril or stop if necessary.

Technical Details

• Salem Sump Tube: The smaller blue lumen acts as an air vent. Never connect it to suction or use it for flushing liquids.
• Air Vent Positioning: Keep the blue pigtail (air vent) above the stomach to avoid backflow.
• Securement Importance: Do not release the tube until it's secured to prevent displacement.

Conclusion

• Always ensure patient comfort and safety by following proper procedures and assessing for any complications during the insertion process. Regularly check the tube position and watch for any signs of discomfort or incorrect placement.