Nasogastric Tube Insertion
Category: Gastrointestinal
Overview
Insertion of a flexible tube through the nose into the stomach for feeding, medication administration, or gastric decompression.
Indications
Gastric decompression, nutritional support, medication administration, gastric lavage, prevention of aspiration in unconscious patients.
Contraindications
Nasal obstruction, recent nasal surgery, severe facial trauma, suspected esophageal obstruction, severe coagulopathy.
Equipment Needed
Nasogastric tube (appropriate size), water-soluble lubricant, syringe for testing, stethoscope, tape, pH strips, cup of water with straw, suction equipment if needed.
Procedure Steps
1. Explain procedure and obtain consent
2. Position patient in high Fowler's position
3. Assess nasal passages for patency
4. Measure tube length (nose to earlobe to xiphoid process)
5. Lubricate tube tip with water-soluble lubricant
6. Insert tube through nostril, directing posteriorly
7. When tube reaches pharynx, have patient swallow water
8. Advance tube with each swallow until marked length reached
9. Verify placement using multiple methods (pH testing, X-ray)
10. Secure tube with tape to prevent displacement
11. Connect to appropriate drainage or feeding system
12. Document insertion and verification of placement
Safety Considerations
Verify correct placement before use. Stop insertion if patient experiences severe discomfort or difficulty breathing. Use water-soluble lubricant only. Never force tube insertion.
Potential Complications
Aspiration, esophageal perforation, pneumothorax, epistaxis, sinusitis, tube displacement, gastric ulceration with prolonged use.
Documentation
Record tube type and size, insertion method, placement verification methods used, patient tolerance, and initial aspirate characteristics.
References
American Association of Critical-Care Nurses. (2016). AACN Practice Alert: Verification of Feeding Tube Placement. Critical Care Nurse, 36(3), e8-e13.