Nasogastric tubes are plastic or vinyl tubes that are inserted through the nostril into the stomach. They are used primarily to drain or sample gastric secretion or to provide access to the upper gastrointestinal tract.

The NG tube is usually used on a temporary basis. The large size of the NG tube is irritating to the nose, pharynx, and esophagus. Once it has fulfilled its immediate diagnostic or therapeutic purpose, it should be removed.

A. Indication:

1. Gastric Lavage after poising or overdose
2. Gastrointestinal feeding and medication administration.
3. Gastrointestinal decompression, for prolong nausea, ileus, postop state, drainage of SBO
4. Gastrointestinal diagnostic sampling and testing, evaluation of upper GI bleed

1. Nasopharyngeal or upper esophageal obstruction, mass
2. Severe maxillofacial trauma and/or basilar skull fracture.
3. Severe uncontrolled coagulopathy.
4. Known tracheo-esophageal fistula
5. known esophageal stricture, varices or bullous disease
6. nasal stenosis, mass, astresia

1. gastricointestinal tube of choice
2. SurgiLube (water soluble lubricant), or 1% lidocaine jelly
3. glass of water and straw, emesis basin and towel
4. 50cc syringe,
5. tongue bade, flashlight
6. tincture of benzoin, scissors, tape
7. stethoscope

1. nasal/pharyngeal/laryngeal trauma
2. nasotracheal intubation or transbronchial perforation
3. esophageal or gastric trauma or perforation
4. intra-cranial penetration
5. laryngotracheal obstruction
6. mucosal damage
7. entrapment

1. Pulmonary aspiration
2. gastroesophageal reflux
3. mucosal injury and ulceration
4. chronic irritation causing rhinitis, sinusitis, pharyngitis, otitis, media, and rarely, vocal cord paralysis.

1. Give nothing by mouth for several hours.
2. Explain procedure to patient, including route, purpose, and anticipated duration of intubation. Obtain consent.
3. Have the patient sit upright, or raise the head of the bed. If this is not possible, passing the tube with the patient in the left lateral decubitus position has less risk of aspiration than if the patient is supine.
4. Check for nasal obstruction. Have the patient inhale briskly through each nostril and use the more patent nostril for intubation. Find out if they breath easier out of one nostril or the other.
5. Test the gag reflex. Patients unable to gag are at increased risk for pulmonary aspiration. Local anesthesia is indicated only for the most difficult cases.

1. Estimate the length of tube to be inserted. The tip of the tube should enter the stomach at approximately 40 cm;advance to approximately 50 cm.
2. Wet and soften the tip of the NG tube in warm water.
3. Lubricate tube and examine tube for rough edges or blocked holes.
4. lubricate the nasal passage
5. With the patient’s head tilted down, gently push the tube through the nares, aiming it back and then down to conform with the nasopharynx. If pointed too hight the tip will abrade the turbinates.
6. As the tip reaches the posterior pharyngeal wall, have the patient sip small amount of water or initiate dry swallows. This is the most uncomfortable part of the procedure. If resistance is met, retract and try again. Do not force the tube. IF the patient coughs or is unable to speak, the tube may be in the trachea. However, smaller tubes do not always elicit these signs.
7. Pass the tube to the predetermined length, checking that it is not coiled in the patient’s pharynx and mouth. (if duotube, remove sylet with slight jiggling motion to reduce adherence to lumen)
8. Confirm the tube’s placement in the stomach by gently aspirating gastric content with a syringe and checking pH. Fill syringe with 50cc of air and attach to NG tube, listen with your stethoscope over the epigastric area, forcefully insert 50cc of air. Verify tube position by ascultating alone is not as helpful, since the sounds of air in the bronchial tree can be mistaken for gastric insufflation. Radiologic verification is mandatory in anesthetized or comatose patients. If you are using the tube only for aspiration, then the presence of gastric content/bile/blood is evidence that the tube is in the proper position.
9. If the location is correct advance the tube to approximately 60 cm, and after applying tincture of benzoin, tape tube to nose and/or cheek.

1. inform patient
2. turn off any suction devices
3. remove tape
4. patients should be in seated position
5. cover patient’s chest with a blue chuck
6. hold the NG tube with one hand, and with the other hand gently hold the nostril to minimize traction on the nostril/nose as the tube is removed.
7. Ask the patient to breath deeply through an open mouth as you quickly remove the tube in one smooth movement.
8. clean the patient’s nose, and provide tissue.