Table of Contents IntroductionPreparation ProcedurePreparationInsertionOther pointsTo complete Introduction Wash hands; Introduce self; Patient’s name, DOB and wrist band; Explain procedure and obtain consentRisks: sores around nose/tape, tube misplacement (into lungs), aspiration/pneumonia, discomfort/irritationContraindications: oesophageal varices, base of skull fracture, recent epistaxis, maxillofacial disordersWarn patient it will be uncomfortable and ask them to raise their hand if they want to stopAdvise the patient they must swallow when asked Preparation Wash hands and put on apronClean tray inside and outGather equipment around tray (think through what you need in order) Equipment list Gloves Vomit bowlCup of water with a straw (if patient is able/safe to swallow)Nasogastric tubeFine-bore feeding tube (usually 6-8 French gauge): made of polyurethane (lasts 6-8 weeks), used for feeding Wide-bore Ryle’s tube (usually 14-16 French gauge): made of polyvinyl chloride (lasts 7-10 days), used for drainage Lubrication jelly50ml syringe (to aspirate)10ml syringe filled with normal saline (to flush)pH paper stripTape (to stick down) Wash handsOpen packets and place neatly in tray, keeping items in plastic parts of packets (without touching the instruments themselves)Return to patient     Procedure Preparation Wash hands Sit patient straight upright (head in normal position)Ask patient to blow their noseMeasure from the patient’s tip of nose → ear lobe → xiphisternum in centimetres with the nasogastric tube (it has measurements on it). Then add 10cm and remember the total.Give patient cup of water with a straw Insertion Wash handsPut on glovesLubricate the tip of the tubeGently push the tube into the nostril aiming posteriorly as close to horizontal as possibleThe patient will gag when the tube reaches the back of their throatAsk them to swallow and then keep swallowing. Push the tube down fast when they are swallowing.Continue advancing the tube until the memorised measurement is reachedConfirm correct placement (i.e. in the stomach, not the lungs) by one of two possible methods (in order of preference):Aspirate gastric contents and drop onto pH paper (pH should be ≤5.5)Order a chest x-ray, on which the NG tube must meet all four criteria to ensure it is safe to use:Pass vertically down the oesophagus (must not follow the course of either of the main bronchi)Clearly bisect the carinaCross the diaphragm in the midlineTip visible at least 10cm beyond the gastro-oesophageal junction below the left hemidiaphragmRemove tube guidewire – present in fine-bore feeding tubes only. NB: never try to replace guidewire after removing. Tape tube down at nose and over earFlush with saline Other points Check the pH is ≤5.5 and flush the tube before every feedDaily care: check skin around tubing, clean around nose, flush tubeDrugs are put down separately – you cannot give enteric coated/slow release drugs via NGTo remove: Inject 10ml air down tube and gently remove To complete Thank patient and restore clothingDiscard waste and clean trayDiscard gloves and apronWash handsDocument procedure and pH of aspirateÂ