1. Nasogastric tube placement

2. Indications
Aspiration of gastric contents for therapeutic or diagnostic purposes
Delivery of medication
Assessment of upper gastrointestinal hemorrhage

3. Contraindications
Patients who have suffered recent fractures of the base of the skull
Patients who have had recent esophageal trauma or strictures

4. Complications
Misplacement: cranial cavity after severe faciomaxillary trama or basal skull fractures
Inadvertent insertion of nasogastric tubes into the trachea and distal airways is reported to range from 0.3% to 15% of insertions

5. Complications
Trauma: epistaxis, pharyngeal or esophageal perforation, mediastinitis, gastric perforation
Displacement
Esophageal inflammation, strictures
Aspiration. This may lead to bronchial infections and aspiration pneumonia.

6. Supplies Nasogastric feeding tube of appropriate size.
Water soluble lubricant
Tape
Glass of water with a straw
Stethoscope
Emesis basin
Towel
Catheter tip syring
Gloves
Clamp, when appropriate
Equipment for instilling liquids when appropriate

7. Procedure Explain procedure and purpose to patient and/or caregiver.
You many have the patient should remove dental appliances before the nasogastric tube is inserted
Answer the patient or family members’ questions about the procedure
Wash hands.
Gather supplies on a clean, dry surface.
Apply gloves and other protective equipment.

8. Procedure
Select the most patent nostril by having the patient alternately close each nostril and breathe
Place the patient in a high or semi-fowlers position. Cover chest with a towel. Have an emesis basin available in case insertion stimulates vomiting.

9. Procedure
Determine the appropriate length of tube to be inserted by measuring the distance from the tip of the nose to the lower edge of the ear lobe and the distance from the ear to the bottom of the xiphoid process ('NEX" - nose, ear, xiphoid). Mark the distance with a piece of tape.

10. Procedure
Lubricate the tip of the tube with a water-soluble jelly if the tip is not pre-lubricated, about inches.
Hyperextend the head and neck slightly. Insert the tube into the nostril holding the nose to anchor the tube, aiming the tube downward into the posterior nasopharynx.
Ask the patient to breath through his mouth

11. Procedure
If not contraindicated, may flex the head and neck slightly as the tube reaches the oropharynx to facilitate esophageal passage.
Allow patient to take sips of water through a straw and continue to pass tube firmly but gently until the tape mark reaches the nostril. Tube should advance approximately inches each time patient swallows.

12. Procedure Do not force the tube if obstruction appears.
Rotating the tube may assist in advancing.
If persistent obstruction continues, stop intubation attempt.

13. Check placement of tube in stomach
Aspirate for gastric contents with syringe.
Place the stethoscope over the epigastric area. Inject 10 cc of air through the tubing.
A "whooshing" or rumbling sound should be heard.

14. Other means of testing placement

15. Secure tube Cut a piece of tape about 3 inches long.
Cut tape lengthwise, three quarters of the way down the middle.
Place the uncut end of the tape along the bridge of the patient’s nose.
Wrap remainder of the tape around the tube.
Place an extra piece of tape across patient’s nose, over first piece of tape.

16. Securing tube
Place tape tab on the tube where attachment of tube to clothing will avoid tension on tube. Pin the tab to garment

17. Document procedure Date and time of tube placement
Description of tube and size
The patient's response to the procedure
The amount and characteristics of gastric contents
Instructions given to patient/caregiver

18. Removing the NG Tube Explain the procedure to the patient
Remove tube from suction
Clamp tube
Untape tube from nose
Utilizing a smooth quick movement, remove tube.
Assure patient’s nostril is cleaned.
Dispose of equipment.
After the tube is removed, no special care is needed. The patient's throat may feel irritated from the presence of the tube.