Table of Contents
Introduction
- 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
Preparation
- 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
Procedure
Preparation
- Wash hands
- Sit patient straight upright (head in normal position)
- Ask patient to blow their nose
- Measure 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 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 – 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