NASOGASTRIC TUBE INSERTION

(A SELF-INSTRUCTIONAL PACKAGE)

By
Arianne L. Garcia, RN
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 Nasogastric Tube Insertion
Overview Post Test Actual Video

Definition Complications

Comprehension
Indications
Check 2

Contraindication Procedure
s

Comprehension Preparation/
Check 1 Equipments
 Overview
An alternative feeding method to ensure adequate
nutrition includes enteral (through the
gastrointestinal system) methods. Enteral
Nutrition (EN), also referred to as total enteral
nutrition (TEN), is provided when the client is
unable to ingest foods or the upper
gastrointestinal tract is impaired and the transport
of food to the small intestine is interrupted.
 Overview
Enteral feedings are administered
through nasogastric and small-
bore feeding tubes or through
gastrostomy or jejunostomy
tubes.
 Definition
Nasogastric tube is a tube that is passed
through the nose and down through the
nasopharynx and esophagus into the
stomach, abbreviated as NGT. It is a
flexible tube made of rubber or plastic,
and it has bidirectional potential.
 Definition

The word “nasogastric" is a hybrid of the

Latin “naso" from "nasus" for nose or
snout and the Greek “gastric" from
"gaster" meaning the paunch or belly. The
term "nasogastric" was coined in 1942.
A commonly used NGT is the Levin tube
 Indications
A person may need a stomach tube
inserted to:
•empty the stomach after a drug overdose
or accidental poisoning
•drain the stomach after major trauma, so
the person can't inhale stomach contents
into the lungs
 Indications
•treat malnutrition by giving feedings through
the tube. Tube feeding is also used when a
person is unable to eat normally, such as after a
stroke
•keep the stomach relaxed after major surgery
to the abdomen, such as an abdominal
exploration
•prevent distension of the stomach when the
person has a bowel obstruction
 Contraindications
•Patients with sustained head trauma, maxillofacial
•Patients with sustained head trauma, maxillofacial injury, or anterior fossa
injury, or anterior
skull fracture. Inserting afossa skullthrough
NGT blindly fracture. Inserting
the nose has potentiala ofNGT
blindly
passing through the nose
through the criboform has
plate, thuspotential of passing
causing intracranial penetration of
the brain.
through the acriboform
•Patients with plate,stricture,
history of esophageal thus causing intracranial
esophageal varices, alkali
penetration
ingestion at riskofforthe brain.
esophageal penetration.
•Comatose patients have the potential of vomiting during a NG insertion
•Patients
procedure, with a history
thus require protectionofof esophageal stricture,
the airway prior to placing a NGT.
esophageal varices, alkali ingestion at risk for
Caution should be utilized when passing a NGT in a patient with suspected
esophageal penetration.
cervical spine injury.
•Comatose patientsorhave
•Excessive manipulation movement thebypotential of vomiting
the patient during placement
including coughing or gagging may potentiate cervical injury.
during
•Manuala stabilization
NG insertion procedure,
of the head thustherequire
is required during procedure.
protection of the airway prior to placing a NGT.
 Contraindications
Caution should be utilized when passing a
NGT in a patient with suspected cervical
spine injury.
•Excessive manipulation or movement by
the patient during placement including
coughing or gagging may potentiate cervical
injury.
•Manual stabilization of the head is
required during the procedure.
 Comprehensive Test 1

Answer the following Multiple Choice Questions. Read each

question carefully then just click on the letter you think would be
the right answer.

Question # Question # Question #

1 2 3
 Comprehensive Test 1

Question #1

It is provided when the client is unable to ingest

foods or the upper gastrointestinal tract is impaired
and the transport of food to the small intestine is
interrupted.

f. TEN
g. Nine
 Comprehensive Test 1

Question #2

The commonly used NGT is called ____________?

f. Levis Tube
g. Levin Tube
 Comprehensive Test 1

Question #3

NGT treat _________ by giving feedings through

the tube.

 Obesity
 Malnutrition
Equipments
Nasogastric tube
Viscous lidocaine 2%
Oral analgesic spray (Benzocaine)
Oral syringe, 12 mL
Glass of water with a straw
Water-based lubricant
Toomey syringe, 60 mL
Tape
Emesis basin or plastic bag
Wall suction, set to low intermittent
suction
Suction tubing and container
Safety pin
Gloves
Stethoscope
Protective pad or towel
Procedure
Explain the procedure,
benefits, risks,
complications, and
alternatives to the patient
or the patient's
representative.
Examine the patient’s
nostril for septal deviation.
To determine which nostril
is more patent, ask the
patient to occlude each
nostril and breathe through
the other.
 Instill 10 mL of viscous lidocaine 2% (for oral
use) down the more patent nostril with the
head tilted backwards, and ask the patient to
sniff and swallow to anesthetize the nasal and
oropharyngeal mucosa. In pediatric patients, do
not exceed 4 mg/kg of lidocaine. Wait 5-10
minutes to ensure adequate anesthetic effect.

Aspiration of viscous Instillation of viscous

lidocaine into an oral syringe. lidocaine 2%.
 Estimate the length of insertion by measuring
the distance from the tip of the nose, around
the ear, and down to just below the left costal
margin. This point can be marked with a piece
of tape on the tube. When using the Salem
sump nasogastric tube (Kendall, Mansfield,
Mass) in adults, the estimated length usually
falls between the second and third preprinted
black lines on the tube.
Position the patient sitting upright with
the neck partially flexed. Ask the patient to
hold the cup of water in his or her hand
and put the straw in his or her mouth.
Lubricate the distal tip of the nasogastric
tube.

Nasogastric tube lubrication with water-based lubricant.

 Gently insert the nasogastric tube along the
floor of the nose and advance it parallel to the
nasal floor (ie, directly perpendicular to the
patient's head, not angled up into the nose)
until it reaches the back of the nasopharynx,
where resistance will be met (10-20 cm). At
this time, ask the patient to sip on the water
through the straw and start to swallow.
Continue to advance the nasogastric tube until
the distance of the previously estimated length
is reached.
Patient flexing his neck and drinking water
while a nasogastric tube is inserted.
Stop advancing and completely
withdraw the nasogastric tube if, at
any time, the patient experiences
respiratory distress, is unable to
speak, has significant nasal
hemorrhage, or if the tube meets
significant resistance.
Verify proper placement of the
nasogastric tube by auscultating a rush of
air over the stomach using the 60 mL
Toomey syringe or by aspirating gastric
content. The authors recommend always
obtaining a chest radiograph in order to
verify correct placement, especially if the
nasogastric tube is to be used for
medication or food administration.
Apply Benzoin or another skin
preparation solution to the nose bridge.
Tape the nasogastric tube to the nose to
secure it in place. If clinically indicated,
attach the nasogastric tube to wall suction
after verification of correct placement.
 Comprehensive Test 2

Answer the following true or false questions by just clicking the

answer of your choice.

Question # Question # Question #

1 2 3
 Comprehensive Test 2

Question #1

When inserting a NGT you have to measure first

the distance from the tip of the nose, around the
ear, and down to just below the left costal margin.

f. True
g. False
 Comprehensive Test 2

Question #2

Obtaining a chest x-ray is the most reliable means of

ensuring proper placement of the Nasogastric tube.

f. True
g. False
 Comprehensive Test 2

Question #3

NGT promote distension of the stomach when the

person has a bowel obstruction.

f. True
g. False
 Complications

 The main complications of NGT insertion

include aspiration and tissue trauma. Placement
of the catheter can induce gagging or
vomiting, therefore suction should always be
ready to use in the case of this happening.
More serious complications include esophageal
perforation, aspiration, pneumothorax, and,
rarely, intracranial placement.
 Post Test
1. What is the other name of Enteral Nutrition?___________.
2. What is the normal pH of the stomach that will determine the
3. The commonly use nasogastric tube is called ____________.
4. By inserting this tube, you are gaining access to the stomach an
5. Excessive ____________________ or ___________________ du
potentiate cervical injury.
6. Give me 5 Equipments used in NGT insertion
7. Give me 3 ways on how you could verify the tube placement.
8. Give me 2 serious complications of NGT insertion.

Click on the numbers

to reveal the
answers
 Answers to Post Test.

1. Total enteral nutrition

(TEN)
 Answers to Post Test.

2. pH 5.5 or below
Answers to Post Test.

3. Levin Tube
 Answers to Post Test.

4. Nasogastric Tube
 Answers to Post Test.

5. Manipulation or
movement by the
patient
 6. Equipments during NGT insertion
 Nasogastric tube
 Viscous lidocaine 2%
 Oral analgesic spray (Benzocaine spray or other)
 Oral syringe, 12 mL
 Glass of water with a straw
 Water-based lubricant
 Toomey syringe, 60 mL
 Tape
 Emesis basin or plastic bag
 Wall suction, set to low intermittent suction
 Suction tubing and container
 Safety pin
 Gloves
 Stethoscope
 Protective pad or towel
 7. Verifying Tube Placement
 Chest X-ray
 Aspirating gastric contents with the irrigation syringe
 While listening over the epigastrum with a
stethoscope quickly instill a 30cc air bolus with the
irrigation syringe. Air entering the stomach will
produce a “whooshing” sound.
 Ask the patient to hum or talk. Coughing, cyanosis
or choking may indicate that the NGT has passed
through the larynx.
 Place the open end of the NGT in a cup of water.
Persistent bubbling may indicate that the NGT has
passed through the larynx.
 8. Complications

esophageal perforation,
aspiration,
pneumothorax,
and, rarely, intracranial placement.
I hope you have enjoyed your experience
and have learned some new
information about Nasogastric Tube
Insertion.