Procedure

- The procedure for NG tube insertion may vary depending on the type of tube and the purpose of insertion. However, some common steps are:

• Explain the procedure to the patient and obtain informed consent. Assess the patient’s condition, anatomy, and ability to cooperate. Check for any contraindications or cautions. Gather the necessary equipment and supplies.
• Choose the side for tube insertion and spray topical anesthetic in this nostril and the pharynx at least 5 minutes before tube insertion. If time permits, give 4 mL of 10% lidocaine via a nebulizer or insert 5 mL of 2% lidocaine gel into the nares.
• Measure the insertion distance by placing the tip of the tube at the tip of the nose, then extending it to the earlobe and then to the xiphoid process. Mark this distance with a marker or tape.
• Lubricate the tip of the tube with water-soluble lubricant. Position the patient in a high-Fowler’s position with the head tilted forward. If the patient is unconscious or intubated, position them in a supine position with the head of the bed elevated to 30 degrees.
• Insert the tube through the nostril with gentle pressure and a slight twisting motion. Ask the patient to swallow water or saliva as the tube advances. If resistance is felt, withdraw the tube slightly and try another direction. Do not force the tube or insert it deeper than the marked distance.
• Verify the placement of the tube by using one or more of the following methods:
  • Aspirate gastric contents with a syringe and check the pH. A pH of 5.5 or less indicates gastric placement.
  • Inject air through the tube while auscultating over the stomach. A whooshing sound indicates gastric placement. However, this method is not reliable and should be used with caution.
  • Obtain a chest x-ray and confirm that the tip of the tube is below the diaphragm and in the stomach. This is the most accurate method and should be used for small-bore tubes or when other methods are inconclusive.
  • Secure the tube to the nose with tape or a commercial device. Make sure there is no tension on the tube and that it does not interfere with breathing or swallowing. Label the tube with the date, time, type, and length of insertion.
  • Connect the tube to a feeding bag, syringe, or suction device as ordered. Adjust the flow rate, volume, and frequency of feeding or suctioning as prescribed. Monitor for any signs of complications such as aspiration, bleeding, infection, or displacement.
  • Document the procedure, including:
    • The type, size, and length of the tube.
    • The method and result of placement verification.
    • The patient’s tolerance and response to the procedure.
    • The type, rate, volume, and frequency of feeding or suctioning.
    • The appearance, amount, and pH of gastric aspirate.
    • The condition of the nose, mouth, and skin around the tube.
    • Any teaching done or referrals made.