# Nasogastric Tube (NGT) Insertion

## Overview

This module describes how to insert a nasogastric or orogastric tube.

## Indications

Diagnostic:

Therapeutic:

## Contraindications

## Patient information and consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“I am going to put a tube through your nose into your stomach so that we can …”

### What can my patient expect?

“Placing the tube is uncomfortable and sometimes painful. You may want to vomit, but once it is in place it is not painful.”

### What is my patient’s role?

“Please tell me if you have had any surgery on your face, throat or stomach, or a bleeding tendency. Stay very still while I put in the tube, and swallow when I tell you to.”

## Preparation

Prepare a trolley with equipment.

### Documentation

### Equipment

## Site & Positioning

Sit the patient up at a 45° angle, with their neck flexed forward, so that the tube follows the curvature of the nasopharynx.

To determine the insertion depth of the NG tube, measure along the tube from the tip of the patient’s nose to the earlobe and down to the xiphoid process. Take note of the insertion depth.

## Procedure

Follow medical asepsis with non-sterile gloves.

## Troubleshooting

My patient is now struggling to breathe.

Ask the patient to speak. If the patient cannot speak, you have probably gone down the trachea through the vocal cords. Retract the tube and try again.

I feel resistance while I try to insert the tube.

It is normal to feel some resistance as the tube approaches the pharyngeal curvature, but if you cannot gently push past, you may be entering the trachea or coiling the tube in the pharynx. Retract the tube and try again.

The tube is too floppy to insert.

Cool the tube in the fridge before using it. You can bend it into a slight curve to help you slide down into the oesophagus.

My patient gags and panics.

Pause, retract the tube a little, ask the patient to take deep breaths, and continue once they have calmed down, while the patient sips water. Try to time the tube insertion with the sips.

I am unable to advance the tube in a neonate.

The baby might have a congenital abnormality of the nose and oesophagus such as choanal atresia or a tracheo-oesophageal fistula. Abandon the procedure and call a senior.

I’m unsure when to insert an NGT in a neonate.

I’m unsure how to insert an NGT in a neonate.

## Risks

## References