› Nasogastric Tube Insertion

Nasogastric Tube Placement

As with most things the more you do it the better you get. While it does require some finesse, just a few things need to be adhered to in order to be successful.

First picking the correct tube is necessary, based on the reason for the nasogastric tube.

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Salem Sump Nasogastric Tube

This tube is used for suction, and ranges in size from 10 Fr (French) to 18 Fr. It has two lumens  . The first lumen is obviously to suction out gastric contents and the smaller lumen, or “pigtail”  is to allow air from the environment to enter into the stomach. This prevents a vacuum or having the tube adhere to the stomach lining.

Levin NG tube

This nasogastric tube has only one lumen with multiple holes at the tip and side, and is used for decompression, lavage, or feeding.

Tips for Easier Insertion

  • Wrap the tube around your hand before inserting into the patient in order to get it curved for easier passage.
  • Use a pen light to check the nares for the optimal one. Also, use it to  verify when the tube is in the nasopharynx. 
  • The patient will always begin to tear. It’s just a reflex reaction.
  • The tube is pointed towards the opposite ear and advanced a few inches each time the patient swallows. In the beginning, the head is held upright. Very soon you hit some resistance and the head needs to be tucked towards the chest to allow passage of the tube. At that point the patient also begins to swallow regularly.
  • If you were to enter the trachea, the patient would be having difficulty breathing and would be coughing considerably. Passing down the esophagus, while mildly uncomfortable would not cause these types of problems.
  • Listening to air being injected into the stomach is the traditional way to verify if the tube is in the stomach, however, it is being replace by testing the gastric contents with pH test strips. Gastric contents are about 5.5 pH, if it is a higher number, it is from the lungs instead.

Instructive Video Using a Mannequin

Watching NG Tube Placement with a Real Person

A Student Inserting an NG Tube

Terminology

Lumen: (how to pronounce) an open tube. so a single lumen is only one tube from beginning to end, two lumens would have two open tubes wrapped together in a single covering.

Lavage: (use the second pronunciation) washing a hollow organ, such as the stomach with repeated flushes of water.

Sample of Nursing Documentation

Inserted 12 Fr Salem sump tube L (for “left”) nares. 10 mls yellow gastric contents obtained via syringe. Verified placement of NG tube with pH test of gastric contents which was. 5.5 pH. Tube secured at 70 cm mark and secured with tape to nares and pinned to hospital gown. Set at intermittent low suction. Patient tolerated procedure well.  

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