There are several reasons why a patient might need a nasogastric (aka NG) tube that nurses should be aware of. Let’s go over these indications as well as the process of NG insertion.
What is a NG Tube?
A NG tube is a flexible tube inserted via the nares that goes all the way down into the stomach. It can be inserted for a variety of reasons.
Why Insert a NG Tube?
Indications for nasogastric tubes include feeding, decompression, compression, and lavage.
Feedings
If for some reason a patient is not able to swallow or hold down food, then a nasogastric tube for feeding might be ordered. In this case, enteral feedings are given via NG tube and are delivered straight into the stomach for easier absorption.
Decompression
If a patient comes in complaining of severe nausea, vomiting, or abdominal distention, then a nasogastric tube for decompression might be ordered. In this case, the NG tube is hooked up to suction to remove all gastric contents, including gas, stomach acid, or undigested food to help ease the pain.
Compression
If a patient comes in with an injury to their stomach or bleeding in their stomach, a nasogastric tube for compression might be ordered. In this care, the NG tube will have a balloon at the end that is inserted into the stomach and inflated. This helps to apply internal pressure to the area that is bleeding to stop the bleed.
Lavage
If a patient accidentally ingests something poisonous, a nasogastric tube might be ordered for lavage. In this case, the NG tube is used to wash the stomach to help with the poisoning.
How to Insert a NG Tube?
Inserting a nasogastric tube is fairly easy in theory, but typically, whatever reason you’re inserting the NG tube makes the situation a bit more complicated. For example, if your patient is nauseous, sticking a tube down their throats isn’t going to be the most enjoyable thing. So keep this in mind when preforming a NG insertion.
Get an Order
Before you can insert a NG tube, you must have a doctors’ order.
If you’re going to call the doctor for a new order, visit Tips for New Nurses on Calling the Doctor.
Speak with your Patient
After you have an order, speak with you patient. Are they coherent? Do they understand the procedure and why it was ordered? Have they ever had a NG tube inserted before? Are they going to be able to swallow on command? Have they had any trauma to the nares that would make one side better than the other?
Gather Supplies
The use of the nasogastric tube (feedings, decompression, compression, or lavage) will determine what supplies you’ll need. For example, if your patient is going to be getting enteral feedings, then you’re going to need an IV pole and a pump to hang and administer the enteral feedings. If your patient is getting a NG tube for decompression, then you’re going to need a suction canister and the proper tubing.
Otherwise, the insertion of the NG tube is pretty much the same. This is what you’re going to need…
- The proper NG tube (Salem Sump, Blakemore, Dobhoff, etc.)
- Pen light
- Tape or dressing to secure it to the nose
- Lubricant
- Cup of water with a straw
- Kidney basin
- Towel
- Piston pump syringe (60cc syringe)
- Stethoscope
- Gloves
Insertion
After gathering supplies and making sure the patient is on board with the procedure, it’s time to set up and insert the NG tube. Lay out your supplies on the bedside table and keep the patient calm. Raise the bed until the patient is sitting up. Use your pen light to assess both the nares and determine which side is best for easy insertion.
Next, you’re going to want to measure the appropriate length on the nasogastric tube. Start with the tip of the NG tube at the patients’ nares, then go back to their earlobe and then down to their xiphoid process. This measurement will tell you when the NG tube is positioned in the stomach. Be sure to place tape around the length you measured off so that you know when to stop further advancement.
After measuring, it’s time to lubricate the tip of the NG tube and set up towels on your patient like a bib. Give your patient the kidney basin, in case the insertion triggers their gag reflex, and the cup of water with a straw. By this point, the patient should already have been educated on the insertion. During the insertion process it is fine to wear clean gloves rather than sterile gloves since the NG tube is going in the mouth and down to the stomach, which isn’t a sterile area.
Next have your patient take some deep breaths and begin insertion through the nares. Once the NG tube passes from the nares into the throat, instruct your patient to drink some water with the straw. This will help the tube pass through the throat more easily as the patient swallows.
Check Placement
Once you have inserted the nasogastric tube all the way to where you taped the tube off according to your measurement, go ahead and secure the tube onto the nose with tape or a securing device. Take your 60cc syringe (aka piston pump) and your stethoscope to listen for the ‘whoosh’ of air in the stomach. To do this, place your stethoscope on the patients’ stomach, hook your air-filled piston pump up to the NG tube, and inject the air into the tube while listening. You should hear a ’whoosh’ sound as the air travels through the NG tube and out into the stomach, indicating that the tube is in the right place.
Even if you hear the ‘whoosh’, you may not use the NG tube for any reason until proper placement of the NG tube is verified with an X-ray. It is the gold standard.
Use
After you get your placement verified by X-ray, you may now use your NG tube. If it’s ordered for decompression, then hook it up to suction at the prescribed rate. If it’s going to be used for feedings, get your IV pole and pump and check the order for the times and rate the enteral feed should be given. Set your pump up accordingly.
And that’s it! You now know what a NG tube is and how to properly place one!
Be sure to check out the entire Nursing Fundamentals Series:
Have any good NG tube insertion stories? Comment below!