NASOGASTRIC TUBE INSERTIONPractical Procedures 487TECHNIQUE
1 Explain to the patient exactly what you are about to do, and why.
2 Assess the patient’s ability to swallow and the patency of either nostril and sit
the patient upright with neck slightly f lexed.
3 Measure the required length of tube: from nose to earlobe, then earlobe to
xiphoid process and add 15 cm.
4 Cover the tip of the nasogastric tube with lubricating jelly and insert into the
largest patent nostril horizontally and backwards, at a right angle to the
face (under the inferior turbinate). Do not pass upwards towards the nasal
bridge.
5 Gently advance the tube past the naso- and oropharynx to the pre-selected
distance. Ask the patient to swallow when the tube is felt at the back of the
mouth and, as the patient swallows, carefully push the tube down further.
(i) A sip of water may assist the patient in swallowing.
6 Check that the tube is positioned correctly:
(i) Aspirate slowly on the tube using a 50 mL syringe. Then test
syringe contents with blue litmus paper (as gastric contents are
acid they will turn blue litmus paper red).
(ii) Rapidly inject 20 mL of air into the tube while auscultating over
the left hypochondrium. Listen for ‘bubbling’ over the stomach
(correct position).
(iii) Request a CXR. Look for the path of the tube and trace its course
below the diaphragm, and deviation to the left into the gastric
area. Make sure it is not entering the chest or coiled up in the
oesophagus.
7 Attach the drainage bag and secure the nasogastric tube to the tip of the nose
with non-allergenic tape, taking care to avoid pressure on the medial or
lateral nares.
COMPLICATIONS1 Failure to pass – can be distressing for patient who may not wish to continue.
2 Misplacement, such as inadvertent tracheal placement, or curled back on
itself in the oesophagus or hypopharynx.
3 Epistaxis (turbinate trauma).
4 Oesophageal trauma or penetration.
5 Intracranial penetration – should never happen if the procedure is avoided
in midface or basal skull trauma.