How to Insert a Nasogastric Tube

As with any other procedure performed as a paramedic, doctor, nurse or any other health care professional you need to ask yourself
the important question of – do I have to do this procedure? Before you start practicing your skills on them.

So, what are some reasons why you would want to consider inserting a nasogastric tube?

Gastric distension with air or fluid after near drowning or poor EAR is the most common need for inserting a nasograstric tube in an emergency setting, especially when the patient has:

An increased risk of regurgitation;

Continuous vomiting unresponsive to antiemetics;

Intubated patients who are receiving IPPV (especially
children).

How to insert a nasograstric tube:
Choose the right size tube;

Measure from the tip of the nose to the ear lobe down to just below the xiphoid process (this gives you an approximation of the length
required to reach the stomach, but it may vary, all humans seem to  be anatomically different);

In the unconscious patient, insert the ETT first and then pass the tube through the widest nostril and then down the oesophagus using a
laryngoscope to confirm that this tube went into the oesophagus.
In the conscious patient, the tube should be lubricated first and then passed through the widest nostril while encouraging the patient
to swallow. Little sips of water may assist this process.

To check for adequate placement of the NG Tube:

Aspirate with a 50 ml syringe and assess for gastric contents;

Inject 50ml of air down the tube and auscultate the epigastrium for the sound of bubbles in the stomach.

 

Secure the NG tube well.

 

Other variances of this procedure include orogastric insertion where the tube is inserted through the mouth, down the oesophagus and then into the stomach.