Nasogastric Tube Procedure Overview

Nasogastric Tube (NGT)

• Definition: A medical procedure involving inserting a thin, flexible plastic tube through the nose, esophagus, and into the stomach.
• Alternative: Orogastric Tube (OG) is similar, but the tube enters through the mouth.
• Purpose: Used for drainage, diagnostics, therapeutics, and feeding.
• Indications for use:
  • Unable to take oral feedings.
  • Oral surgery (e.g., cleft lip/palate, jaw fracture).
  • Difficulty swallowing.
  • Malnutrition.
  • Premature babies.
  • Vomiting/anorexia nervosa.
  • Aspiration of gastric contents (e.g., poisoning).
  • Medication administration.
  • Unconsciousness.
  • Endotracheal intubation.

Equipment

• Kidney tray: For collecting waste.
• Cotton-tipped applicators: For cleaning nostrils.
• Ryle's tube: Used for feeding or drainage.
• Lubricant (water-soluble jelly or glycerin): To prevent friction.
• Scissors: For cutting.
• Adhesive plaster or tape: For securing.
• Measuring cup/glass: For measuring feed amounts.
• Sterile syringe (10-20 mL): For aspirating contents or administering medications.
• Paper bag: For collecting waste.
• Glass of warm water: To warm feed to body temperature.
• Tongue blade: Used for examination.
• Suction apparatus: To clear airways as needed.
• Bowel with water: To check NG tube placement.
• Clamp: To prevent leakage of gastric contents.

Pediatric Positioning

• Supine: Lying flat.
• Head elevated: Bed head elevated 30-40°. Options are sitting upright for older children.
• Infant/younger child holding: Requires parental consent.

Procedure

• Identify the child.
• Explain the procedure.
• Make the patient comfortable.
• Position a face towel: Across the chest and under the chin.
• Keep a kidney tray ready: For vomit.
• Clean the nostrils.
• Assemble supplies properly.
• Proper hand washing.
• Check tube patency.
• Measure placement: From nose tip to xiphoid process.
• Lubricate the tube.
• Insert slowly: Give sips of water and guide with swallows (adjust amount to child's age)
• Check placement: Aspirate stomach contents and check pH. X-ray is an option.
• Monitor input/output.
• Remove the tube: If blockage occurs or if no longer needed.

Oral Hygiene

• Frequency: Every 4-6 hours.
• Purpose: Prevents infection.

Non-Radiological Verification of Placement

• pH test: Aspirate 2 mL of stomach contents, and test using pH paper.
  • pH ≤5.5 indicates correct placement
  • pH >5.5 requires radiology confirmation
• Gastric auscultation: Using a syringe, inject 3mL of air, while listening with a stethoscope.
  • If you hear whooshing, gurgling, or popping sounds, the tube is correctly positioned.

Contraindications

• Gastric surgery.
• Ulcers.
• Tracheo-esophageal fistula.
• Esophageal surgery
• Recent nasal/facial surgery
• Polyps in nose
• Deviated nasal septum
• Patient on anticoagulant therapy.