Remote Primary Health Care Manuals

Putting in nasogastric tube (NGT)

Well lit area.
Wear gloves.
 

Used to

  • Give fluids or medicines 
  • Remove air and fluid from stomach — to stop vomiting

Attention

  • Do not use in traumatic head injury or if any signs of skull fracture

Table 4.1 Tube type and size

Reason for NGT

Age

Tube size

Feeding

any

single lumen (8-10Fr)

Emptying stomach under 5 years single lumen (8-10Fr)
over 5 years double lumen (10-12Fr)
children over 12 years and adults double lumen (12-16Fr)

In hot weather consider cooling tube in fridge/freezer to make it firm and aid with insertion

What you need

If child — helper to wrap and hold them 

  • Wrapping cloth
  • Bandages for mittens in small child
  • Small strip of hydrocolloid dressing
  • Correct size nasogastric tube — see Table 4.1
  • Water-based lubricant
  • 20mL syringe
  • Cloth tape
  • Paper tape
  • Marking pen
  • Pencil torch
  • pH test strips
  • Vomit bowl if person awake
  • Drainage bag — if needed

What you do

  • Stick small strip of hydrocolloid dressing on cheek on same side of nose where tube is going — Figure 4.1
  • Cut cloth tapes long enough to tie around person’s head plus a bit extra
  • Cut strip of paper tape long enough to go around tube and stick to person’s nose and to hydrocolloid dressing on cheek — Figure 4.1

Figure 4.1   

Hydrocolloid dressing is attached beside nose.

Measure length of nasogastric tube needed

Table 4.2 Measure tube and  position person

Adults Infants and children
 
Measure length NGT
  • Hold tube upside down. Measure from bridge of nose, to earlobe, to bottom of sternum  (breastbone)
  • Mark tube with marking pen — Figure 4.2
  • Hold tube upside down. Measure from tip of nose, to earlobe, to halfway between bottom of sternum (breastbone) and umbilicus
  • Mark tube with marking pen — Figure 4.3
Position
  • Keep head straight or tilted back slightly
  • If conscious have person sitting
  • Wrap child as shown — Figure 4.4 to Figure 4.7 
  • If child restless — put bandage mittens on so when you unwrap them they don’t pull tube straight out
  • Bend head forward a little

Figure 4.2   

Measure nasogastric tube for an adult by running the tube from bridge of nose, to earlobe, to sternum.

Figure 4.3   

Measure nasogastric tube for baby by running tube from tip of nose, to earlobe, then to point midway between sternum and umbilicus.

Prepare child

Figure 4.4   

Baby lies on sheet and practitioner prepares to wrap the baby.

Figure 4.5   

Baby lies on sheet and practitioner wraps one side of sheet around and under baby.

Figure 4.6   

Baby lies on sheet and practitioner wraps second side of sheet around baby in opposite direction to the first side.

Figure 4.7   

Infant is firmly wrapped in sheet, and held by a practitioner about to insert a nasogastric tube.

Put in tube
  • Attach 20mL syringe to end of tube
  • Lubricate tip of nasogastric tube or wet under tap
  • Tell person it is normal to feel urge to gag and reassure them
  • Keeping tube in straight line, gently push it back through chosen nostril — Figure 4.8 and Figure 4.9

Figure 4.8   

Nasogastric tube is inserted in line with the nostril.

Figure 4.9   

Nasogastric tube enters through the nose, then curves through the nasal cavity and into the oesophagus.

  • Feed tube down back of throat into oesophagus (food pipe) until pen mark reaches front of nose
    • If person awake — ask them to swallow a few times
  • If person seems to be choking — take tube out straight away. Calm person/carer and try again
  • Look in mouth with pencil torch as you push tube down. If tube coiled in back of mouth — take out and try again
  • If small child — make sure they can't pull tube straight out
    • Put cloth tape around tube and tie behind head
    • OR put piece of tape around tube and stick to cheek or nose temporarily
Check tube in stomach
  • Confirm placement via x-ray. If x-ray not available do pH testing with pH test strip
    • Do not use litmus paper for pH testing
  • Pull back (aspirate) small amount of fluid with 20mL syringe
  • Drop fluid onto pH strip — placement confirmed if pH 1.0–4.0
  • If unable to pull back fluid or if pH greater than 4.0 — advance tube 5cm and retest
  • If pH still greater than 4.0 — either pull tube out and try again or repeat testing in 30 minutes
  • If you can't pull back fluid for testing — pull tube out and start again
  • If unable to confirm placement by pH testing — medical consult
Securing tube
  • If tube in right place — tape properly to hydrocolloid dressing — Figure 4.10

Figure 4.10   

Attach one end of tape to hydrocolloid dressing, split remainder of tape and stick one half over top of nose, other half under nose and across tube.

  • If still not secure — leave cloth tape in place and/or use more paper tape to stick tube to forehead so end hangs over ear and/or pin it onto their clothes — out of sight if child
  • When you unwrap infant be ready to stop them pulling tube straight out
Using nasogastric tube for fluid replacement
Using nasogastric tube for drainage
  • Plug end of nasogastric tube with stopper or attach to drainage bag to allow free drainage