Nasogastric tube insertion

Contraindications

Collect equipment, including lubricant gel, NG tube, 60 mL slip-tip syringe, free water for flushing, tape, and PPE (gloves and gown)

Preparation
- Estimate length of tubing to get to 5 cm below carina.
  - Measure tip of nose to ear to xyphoid process and subtract 10 cm.
  - This should be around 10 cm more than the ETT, if they have one.
  - Typically around 30 to 35 cm.
- Dip NG tip in water, flush tube with water, then flush out water with air.
- Lubricate tip of NG tube.
- Sit patient upright with head of bed around 45 degrees.
Step 1
- Cap the medication port at the Y connector, and firmly attach an empty syringe to the guidewire end.
- Insert to predetermined length.
  - Ask patient to swallow sips of water during insertion to ensure esophageal rather than tracheal placement.
  - If resistance, gently twist or turn the tube and try again, then try on other nare.
- Attempt to aspirate. If resistance is felt, then likely in esophagus; if easily aspirates air, the likely in trachea.
- Use chest x-ray to rule out airway placement.
- If not yet 5 cm below carina, then advance tube and reimage.
- Document the distance inserted.
Step 2
- Advance the tube to predetermined marking, usually another 20 cm.
- Use abdominal x-ray to confirm placement in the stomach