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11/13/24, 7\:24 PM Guide | Nasogastric (NG) tube insertion

Nasogastric (NG) tube insertion

Table of contents
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Gather equipment

Gather the relevant pieces of equipment and place into a tray\:
Nasogastric tube (
Disposable gloves
Lubricant and gauze\: to lubricate the tip of the NG tube.
Disposable bowl\: to be used in the event of vomiting.
Paper towels\: to allow the patient to wipe around their mouth if needed.
Large syringe\: to obtain an aspirate from the NG tube.
pH testing strips\: to assess the pH of the aspirate.
Dressing\: to secure the NG tube.
A glass of water for the patient (if swallow is deemed safe).
Local anaesthetic spray\: to numb the oropharynx.
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Gather equipment

Introduction

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Brie
s w a l l o w i n g f o o d i n t h e n o r m a l w a y . B e c a u s e o f t h i s , w e n e e d t o p l a c e a
a l l o w u s t o p r o v i d e y o u w i t h n u t r i t i o n . T h e p r o c e d u r e w i l l b e u n c o m f o r t a b l e , b u t i t s h o u l d n' t b e p a i n f u l o r t a k e v e r y l o n g. I f a t
a n y p o i n t i t b e c o m e s t o o u n c o m f o r t a b l e a n d y o u w a n t m e t o s t o p , j u s t t a p o n m y a r m .
"
Gain consent to proceed with NG tube insertion.
Check if the patient has any allergies (e.g. latex).
Ask the patient if they have any pain before continuing with the clinical procedure.
Position the patient sitting comfortably on a chair or bed.
If a patient has su
avoided due to the potential risk of entering the cranial vault.

Measurement of the insertion length

1. Position the patient sitting upright with their head in a neutral position.
2. Don a pair of non-sterile gloves.
3. Estimate how far the NG tube will need to be inserted\: measure from the bridge of the nose to the ear lobe and then down to
5cm below the xiphisternum.
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Position the patient sitting upright

Insertion of the NG tube

1. Lubricate the tip of the NG tube.
2. If available, a local anaesthetic should be sprayed towards the back of the patient's throat.
3. Warn the patient you are about to insert the NG tube.
4. Insert the NG tube through one of the patient's nostrils.
5. Gently advance the NG tube through the nasopharynx\:
This is often the most uncomfortable part for the patient.
If resistance is met, rotating the NG tube can aid insertion. Avoid forcing the NG tube if signi
If the patient becomes distressed, pause to give them some time to recover.
Intermittently inspect the patient's mouth to ensure the NG tube isn't coiling within the oral cavity.
6. Continue to advance the NG tube down the oesophagus\: ask the patient to take some sips of water and then swallow as this
can facilitate the advancement of the NG tube. Avoid giving patients a drink if their swallow is deemed unsafe, due to the risk of
aspiration.
7. Once you reach the desired nasogastric tube insertion length,
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Lubricate the tip of the NG tube

Aspiration of the NG tube

1. Attempt to aspirate gastric contents\:
If aspiration is successful, test the pH\: a value of \<4 suggests correct placement.
If aspiration is unsuccessful or the pH is >4 the patient will require a chest x-ray (CXR).
Some hospitals require a CXR regardless of pH, so check your local guidelines.
Acceptable pH ranges also vary between hospitals, so always check your local guidelines.
2. Once the NG tube is deemed safe for use, the radiopaque guidewire can be removed.
Attempt to aspirate gastric contents and assess pH
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To complete the procedure...

Explain to the patient that the procedure is now complete and reassure them that the NG tube will become more comfortable
over the next few hours.
Thank the patient for their time.
O
Dispose of used equipment, including PPE, into a clinical waste bin.
W h h d
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