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Nasogastric tube insertion


  • Wash hands;Β Introduce self;Β Patient’s name, DOB and wrist band;Β Explain procedure and obtain consent
    • Risks: sores around nose/tape, tube misplacement (into lungs), aspiration/pneumonia, discomfort/irritation
    • Contraindications: oesophageal varices, base of skull fracture, recent epistaxis, maxillofacial disorders
  • Warn patient it will be uncomfortable and ask them to raise their hand if they want to stop
  • Advise the patient they must swallow when asked


  • Wash hands and put on apron
  • Clean tray inside and out
  • Gather equipment around tray (think through what you need in order)

Equipment list

  • Gloves
  • Vomit bowl
  • Cup of water with a straw (if patient is able/safe to swallow)
  • Nasogastric tube
    • Fine-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 jelly
  • 50ml syringe (to aspirate)
  • 10ml syringe filled with normal saline (to flush)
  • pH paper strip
  • Tape (to stick down)

  • Wash hands
  • Open packets and place neatly in tray, keeping items in plastic parts of packets (without touching the instruments themselves)
  • Return to patient     



  • Wash hands 
  • Sit patient straight upright (head in normal position)
  • Ask patient to blow their nose
  • Measure from the patient’s tip of nose β†’ ear lobe β†’ 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


  • Wash hands
  • Put on gloves
  • Lubricate the tip of the tube
  • Gently push the tube into the nostril aiming posteriorly as close to horizontal as possible
  • The patient will gag when the tube reaches the back of their throat
  • Ask 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 reached
  • Confirm 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 carina
      • Cross the diaphragm in the midline
      • Tip visible at least 10cm beyond the gastro-oesophageal junction below the left hemidiaphragm
  • Remove tube guidewire β€“ present in fine-bore feeding tubes only. NB: never try to replace guidewire after removing. 
  • Tape tube down at nose and over ear
  • Flush with saline

Other points

  • Check the pH is ≀5.5 and flush the tube before every feed
  • Daily care: check skin around tubing, clean around nose, flush tube
  • Drugs are put down separately – you cannot give enteric coated/slow release drugs via NG
  • To remove: Inject 10ml air down tube and gently remove

To complete

  • Thank patient and restore clothing
  • Discard waste and clean tray
  • Discard gloves and apron
  • Wash hands
  • Document procedure and pH of aspirate 

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