NG Tube Insertion 🤧
Step-by-step guide for nasogastric tube insertion. Technique, position confirmation, complications, and troubleshooting for NCHDs.
🧠 Indications
- Enteral feeding when oral intake is not possible (e.g. dysphagia, stroke)
- Gastric decompression (e.g. small bowel obstruction, ileus)
- Administration of medications when oral route unavailable
⚠️ Contraindications
- Suspected or confirmed base of skull fracture
- Facial trauma or nasal obstruction
- Recent nasal or oesophageal surgery
- Severe coagulopathy (relative)
📞 What to Ask / Prep
- Reason for insertion: feeding, decompression, meds?
- Is patient alert or confused (aspiration risk)?
- Check for contraindications (see above)
- Check for recent facial trauma or surgery
- Ensure informed consent where possible
- Gather equipment (NG tube, syringe, lube, tape, pH strips, gloves)
📝 Procedure Steps
- Explain procedure and gain consent
- Sit patient upright (ideally 45–90°)
- Measure from nose → ear → xiphisternum and mark the tube
- Lubricate tip and gently insert through nostril
- Ask patient to sip water (if safe) as you advance tube
- Advance to pre-measured mark
- Temporarily secure and check position (see below)
📌 Confirmation of Placement
- Check aspirate pH <5.5 = gastric placement
- If pH not obtainable or >5.5 → CXR to confirm placement
- Document confirmation method in notes
- Do NOT use tube until placement confirmed
🛠️ Troubleshooting
- No aspirate: try repositioning head, injecting 10ml air then retry
- Unable to pass: try other nostril, ask senior if still unsuccessful
- Coughing / distress: withdraw tube, check airway
- If malposition suspected → remove and start again
📄 Documentation
- Indication for NG tube
- Method of placement and confirmation
- Size and length of tube inserted
- Any complications
- Plan for feeding/medications