A nasogastric tube, or NG tube, is a flexible plastic tube that is inserted through the nose, down the back of the throat and into the stomach. Large bore nasogastric tubes are used to drain stomach contents, for example in patients who have bowel obstruction; and fine bore nasogastric tubes are used to deliver nutrition or medications directly into the stomach. In this film, we will focus on the insertion of a fine bore feeding nasogastric tube. Nasogastric feeding should be considered in patients who require nutritional support, for example those who have difficulty swallowing or eating, or are at risk of malnutrition. This includes patients who have had minimal oral intake for 5 days or longer, have problems with absorption, have a high metabolic state, or high nutrient loss. Nutritional assessment is covered in another film in the Tomorrow\u2019s Clinicians series. Nasogastric tube insertion should be avoided in patients with base of skull fractures, facial trauma, those undergoing maxillo-facial surgery, patients with oesophageal tumours, or those undergoing oesophageal surgery.<\/p>\r\n\r\n\r\n\r\n
Once you have watched this video, why not attempt the multiple choice quiz to test your knowledge?<\/p>\r\n","protected":false},"excerpt":{"rendered":"
A nasogastric tube, or NG tube, is a flexible plastic tube that is inserted through the nose, down the back of the throat and into the stomach. Large bore nasogastric tubes are used to drain stomach contents, for example in patients who have bowel obstruction; and fine bore nasogastric tubes are used to deliver nutrition […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,1],"tags":[],"class_list":["post-427","post","type-post","status-publish","format-standard","hentry","category-tomorrows-clinicians","category-uncategorized","entry"],"youtubeVideo":"510247786\/bd4dbe3f4c","question1":"Which of the following is NOT a potential indication for nasogastric tube insertion?","answers1":"Swallowing difficulties | Malnutrition or risk of malnutrition | Increased metabolic state | Poor dietary intake for up to 48 hours","correctAnswer1":"3","correctAnswerText1":"Other indications include absorption problems and poor dietary intake, but usually after 5 days and trialling other methods.","question2":"Which of the following is NOT a potential contraindication for nasogastric tube insertion?","answers2":"Base of skull fracture\r\n| Facial trauma\r\n| Oesophageal cancer or surgery\r\n| Pneumothorax","correctAnswer2":"3","correctAnswerText2":"Another contraindication includes some types of maxillofacial surgery. It is often helpful to review the patient's notes or operation note.","question3":"In preparation for insertion of the nasogastric tube:","answers3":"Clean the external opening of the nose with an alcohol-based cleansing wipe. Ensure the guide wire is inserted in the tube opening before measuring between the nose, earlobe and xiphisternum to approximate the length of tube insertion that will be necessary.\r\n| Clean the bridge of the nose with an alcohol-based cleansing wipe. Ensure the guide wire is inserted in the tube opening before measuring between the nose, earlobe and xiphisternum to approximate the length of tube insertion that will be necessary.\r\n| Clean the bridge of the nose with an alcohol-based cleansing wipe. Ensure the guide wire is inserted in the tube opening before measuring between the nose, earlobe and umbilicus to approximate the length of tube insertion that will be necessary.\r\n| Clean the bridge of the nose with an alcohol-based cleansing wipe. Ensure the guide wire is inserted in the tube opening before measuring between the nose, laryngeal prominence and xiphisternum to approximate the length of tube insertion that will be necessary.","correctAnswerText3":"After taking this guideline measurement you will know how far the tube will need to be passed, as a minimum, to reach the stomach.","correctAnswer3":"1","question4":"Regarding the insertion of a nasogastric tube:","answers4":"The tube should be inserted into the right nostril as it is closest to the side of the person performing the procedure.\r\n| The tube should be inserted into the nostril which appears clearest and away from any deviating nasal septum, in an upwards direction.\r\n| The tube should be inserted into the left nostril as there is more control with this approach.\r\n| The tube should be inserted into the nostril which appears clearest and away from any deviating nasal septum, in a backwards direction.","correctAnswer4":"3","correctAnswerText4":"Any significant resistance encountered should prompt the procedure to be stopped and the direction of insertion to be adjusted.","question5":"The patient should be asked to swallow a sip of water when:","answers5":"The tube reaches the nares (nostrils)\r\n| The tube reaches the lateral wall of the nose\r\n| The tube reaches the nasopharynx\r\n| The tube reaches the gastro-oesophageal junction","correctAnswer5":"2","correctAnswerText5":"Flexion of the neck by gently prompting the patient's chin towards their chest may help at this stage of insertion.","question6":"Regarding insertion of the nasogastric tube:","answers6":"A fine bore tube should be inserted to 25 cm\r\n| A wide bore tube should be inserted to 25 cm\r\n| A nasogastric tube should be inserted to the hilt and then the position checked\r\n| A nasogastric tube should be inserted to the estimated distance and then the position should be checked","correctAnswer6":"3","correctAnswerText6":"","question7":"Regarding insertion of a nasogastic tube:","answers7":"Position should be confirmed using a 60ml enteral syringe to aspirate. A pH of between 1-5 indicates the tube is correctly positioned.\r\n| Position should be confirmed using a 60ml enteral syringe to aspirate. A pH of between 5-7 indicates the tube is correctly positioned.\r\n| Position should be confirmed using a 5ml enteral syringe to aspirate. A pH of between 1-5 indicates the tube is correctly positioned.\r\n| Position should be confirmed using a 10ml enteral syringe to aspirate. A pH of between 1-5 indicates the tube is correctly positioned.","correctAnswer7":"0","correctAnswerText7":"A small syringe may result in only the empty tube being aspirated. Indicator paper should be used to confirm a pH consistent with gastric secretions.","question8":"In the event that no aspirate is achieved after passing the nasogastric tube without difficulty:","answers8":"As long as no resistance is felt, you safely assume that the tube is correctly located within the stomach.\r\n| You insert a bolus of air into the tube and auscultate over the air of the stomach. If air is heard you safely assume that the tube is correctly located within the stomach.\r\n| You request a chest x-ray before the guide wire is removed to confirm the position.\r\n| You request a chest x-ray after the guide wire is removed to confirm the position.","correctAnswer8":"2","correctAnswerText8":"","question9":"After you have confirmed that the tip of the nasogastric tube is within the stomach...","answers9":"The tube should be flushed with 30ml of sterile water and the guide wire should be removed and placed into the sharps bin before the end of the tube is capped off.\r\n| The tube should be flushed with 30ml of heparinised saline and the guide wire should be removed and placed into the sharps bin before the end of the tube is capped off.\r\n| The tube should be flushed with 30ml of sterile water and the guide wire should be removed and placed into the clinical waste bin before the end of the tube is capped off.\r\n| The tube should be flushed with 30ml of 5% dextrose and the guide wire should be removed and placed into the clinical waste bin before the end of the tube is capped off.","correctAnswer9":"0","correctAnswerText9":"","question10":"Regarding documentation following nasogastric tube insertion:","answers10":"This is not a sterile procedure so documentation is not required. A nurse should be informed verbally.\r\n| Reposition the patient comfortably. Document the length of the tube inserted, the pH of the aspirate and the x-ray result (if requested).\r\n| Reposition the patient comfortably. Document on the patient's observation chart the length of the tube inserted, the pH of the aspirate and the x-ray result (if requested).\r\n| As long as the procedure is fully documented there is no added benefit in explaining to the patient or the nurse as to why the procedure has been performed.","correctAnswer10":"1","correctAnswerText10":"It is always sensible to ensure that both the patient and relevant clinical staff are aware of any clinical procedure which is carried out. You should also document that the nasogastric tube is safe to use.","question11":"","answers11":"","correctAnswer11":"","correctAnswerText11":"","question12":"","answers12":"","correctAnswer12":"","correctAnswerText12":"","question13":"","answers13":"","correctAnswer13":"","correctAnswerText13":"","question14":"","answers14":"","correctAnswer14":"","correctAnswerText14":"","question15":"","answers15":"","correctAnswer15":"","correctAnswerText15":"","icon":"nosogastric-tube-insertion","parentId":"","recapId":"424","_links":{"self":[{"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=\/wp\/v2\/posts\/427"}],"collection":[{"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=427"}],"version-history":[{"count":2,"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=\/wp\/v2\/posts\/427\/revisions"}],"predecessor-version":[{"id":429,"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=\/wp\/v2\/posts\/427\/revisions\/429"}],"wp:attachment":[{"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=427"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=427"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=427"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}