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Nasogastric tube insertion

Please note content is for educational purposes only and procedures should not conducted based on this information. OSCEstop and authors take no responsibility for errors or for the use of any content.


  • Wash hands; Introduce self; Patient’s name, DOB and wrist band; 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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