The Set Up
1
Patient Positioning
Position the patient with the head of the bed elevated at least 30 degrees. If this position is contraindicated, consider the reverse Trendelenburg position.
2
Nares Assessment
Assess the patient's nares to determine the best choice for NG tube insertion. Use a penlight to ease visualization, as needed.
3
Tube Length Determination
Determine the insertion length of the tube to help ensure gastric placement. Place the tube's distal end at the tip of the patient's nose and then extend the tube to the earlobe, down to the xiphoid process (~35-40cm), and then midway to the umbilicus (>65cm – goal is post pyloric).
Insertion Part 1
1
Initial Insertion
Grasp the tube with the distal end pointing down and insert it carefully into the patient's nostril. Instruct the patient to flex the head forward (if not contraindicated) and tuck the chin to close the trachea and open the esophagus.
2
Guiding the Tube
Guide the NG tube through the nose at an angle parallel to the floor of the nasal canal. Then guide it gently down as the tube advances through the nasal passage toward the distal pharynx. If you meet resistance, try to rotate the tip of the tube gently until it advances past the nasal passage.
Note: If you continue to meet resistance, don't force the tube. Instead, withdraw the tube and let the patient rest, relubricate the tube, and retry or insert the tube in the other naris.
3
Facilitating Passage
Unless contraindicated, have the patient sip water through a straw as you slowly advance the tube to facilitate tube passage into the esophagus.
4
Monitoring for Complications
As you advance the NG tube, monitor the patient for cues such as coughing that may indicate that the tube entered the respiratory tract or is kinked or coiled in the oral cavity. Stop the procedure immediately and remove the tube if you suspect respiratory intubation.
Insertion Part 2
1
Initial Placement Check
Stop NG at measured length, around 35-40cm and perform chest x-ray. Have a provider assess chest x-ray to ensure NG is in the esophagus. If NG is in the respiratory tract, remove and start again. If NG is in the esophagus, continue to drop to second measured length (>65).
2
Final Placement Confirmation
Perform KUB to ensure NG is in the stomach. Provider to write an okay to use order when NG tube is visualized in the stomach. Never instill via any NG/OG device until there is x-ray confirmation of gastric or duodenal placement confirmed by Provider.
3
Securing and Finalizing
Secure NG tube to nose with tape, NG securement device or nasal bridle if indicated. Remove guide wire. If wire is stuck, instill water down tube and try again. Add NG tube as LDA in chart.
