Procedural videos

Nasogastric tube insertion animated demonstration

Equipment needed

The equipment required for this procedure includes:

  • Nasogastric tube of appropriate size and type (fine bore or Ryle’s type)

  • Lubrication jelly or water

  • Gloves and plastic apron

  • Adhesive tape/purpose-made nose adhesive

  • 30 mL enteric (feeding) syringe

  • Drainage bag or connection tubing

  • Universal pH paper.

Contraindications

  • Basal skull fracture: you should not use a nasogastric tube in patients with a basal skull fracture as it may lead to intracranial placement.

  • Facial trauma.

  • Previous trans-ethmoidal/trans-sphenoidal neurosurgery.

  • Oesophageal anastomosis and gastric surgery in postoperative patients (unless a specialist performs insertion with direct endoscopic insertion).

  • Patient refusal.

Indications

  • Enteric feeding.

  • Drug administration.

  • Small and large bowel obstruction.

  • Gastric outlet obstruction.

  • Acute gastric dilation.

  • Paralytic ileus.

  • To prevent aspiration from gastro-oesophageal reflux distal to an oesophageal anastomosis (placed under direct vision intra-operatively).

  • Postoperative gastrointestinal surgery (placed intra-operatively). These can also be naso-jejunal tubes, where the end lies more distally in the jejunum.

Complications

  • It is common for the tube to be dislodged or removed in a confused or agitated patient.

  • Epistaxis may occur.

  • Malposition followed by aspiration of fluid into the bronchial tree may result in aspiration pneumonia and severe respiratory compromise.

  • Feeding tubes may become blocked with the feed substrate requiring repositioning if the blockage cannot be cleared with clear fluids or effervescent fluids.

  • If malposition occurs in a patient with a base of skull fracture, then intracranial positioning may occur. For this reason, you should not use nasogastric tubes in patients with a suspected or confirmed basal skull fracture.

  • You can avoid most complications by ensuring correct positioning of the nasogastric tube.

Aftercare

Check the position of the nasogastric tube. You should follow your organisation’s local guidelines as to which method you should use. Methods include:

  • Aspiration - aspirate gastric fluid and test on pH paper. Gastric fluid should be acidic, with a pH between 1 and 5.5. The National Patient Safety Agency in England advise that you should test aspirate on CE marked pH indicator paper for use on human gastric aspirate.[42]

  • Chụp x-quang ngực nếu pH trên 5,5, hoặc bạn không thể hút dịch dạ dày, thì yêu cầu chụp x quang ngực. Chụp x-quang cần hiển thị ống thông mũi dạ dày cản quang nằm dọc theo thực quản (và tránh các đường cong phế quản), tách đôi ngã ba khí phế quản, và cắt ngang cơ hoành ở đường giữa, cũng như đầu ống có thể nhìn thấy dưới nửa cơ hoành. Điều quan trọng cần lưu ý rằng do cơ hoành có dạng vòm, có khả năng đầu ống thông mũi dạ dày nằm dưới cơ hoành nhưng thực ra vẫn ở trong phổi. Do đó, điều quan trọng là không sử dụng tiêu chí này để đánh giá vị trí chính xác của ống thông.