Nasogastric Intubation

Dr.Efman.E.U.Manawan Mkes.,SpB-KBD

GI Tract

Oral cavity
Pharynx
Esophagus
Stomach

Small Intestine
Large Intestine
Accessory
Structures

Medical NCO Course

The Gastrointestinal System

The Oral Cavity
Chemical digestion
Mechanical digestion
Esophagus
Peristaltic waves

Esophagus:
Muscular canal
About 24 cm
long
Extends from
pharynx to
stomach

Stomach
Structure
Layered muscular
tube
Lined with mucous
membranes
Contains gastric
glands

Small Intestine
Begins at pyloric
sphincter
Coils through
abdominal
cavity
Opens into large
intestine

Gallbladder

Secretes and
stores bile
produced by the
liver

Pancreas
Gland
12-15 cm (5-6 in)
long
2.2 cm (1 in) thick
Posterior to the
stomach
Connected to
duodenum by 2
ducts

Pancreas
Exocrine gland
Secretes pancreatic juice

Endocrine gland
Secretes hormones (insulin) into blood
Cells need insulin to process glucose

Pancreas
Pancreatic juice
Most important digestive juice
Contains digestive enzymes,
sodium bicarbonate and alkaline
substances
Neutralizes HCl in juices entering
small intestine

Nasogastric Intubation

NG Tube Indications
Aspirate stomach
contents
Diagnostic or
therapeutic

Assessment of GI
bleeding
Determine gastric
acid content

NG Tube Indications
Treat paralytic ileus
Treat intestinal obstruction
Recurrent vomiting likely
Trauma
Overdose

NG Tube Contraindications
Esophageal strictures
Alkali ingestion, caustic ingestions,
esophageal burns
Comatose patients

NG Tube Contraindications
Trauma patients with:
Cervical or intracranial bleeding
Increased intracranial pressure

Recent surgery of the following

types:
Oropharyngeal
Nasal
Gastric

Inserting NG Tube
Explain procedure
Position patient
High Fowler if alert
Drape
Emesis basin
Water and straw

Inserting NG Tube
Unconscious patient
Left lateral position
Head turned to downward side
Gag and cough reflexes absent or
suppressed
NG tube easily misplaced (lung)
Inability to swallow

Inserting NG Tube
Check nares for
patency
Select appropriate
tube size
Determine length
of insertion
Tip of nose, to ear,
to xiphoid process
Mark tube

S C10077/EC10077/E-3

1010-98

Inserting NG Tube
Lubricate tube
Lubricant must be water-soluble
May use topical anesthetic if available
(ie, lidocaine)

Coil tube to shape it into curve

Have patient hold water and straw
to mouth

Inserting NG Tube
Insert tube
Along floor of nose
Straight back
Advance until
resistance felt
(nasopharynx)

Inserting NG Tube
Ask patient to
swallow sips of
water and flex
neck slightly.
As patient
swallows,
advance tube
into and down
esophagus.

S C10077/EC10077/E-6

10--98
10

Inserting NG Tube
When tube is in the esophagus:
Advance rapidly to the pre-marked
distance

Excessive choking, gagging, coughing,

change in voice or condensation inside
the tube indicates possibility of
placement in trachea. The tube should
be withdrawn.

Confirm NG Tube
Placement
X-ray
Most reliable if tube is radiopaque
Requires order from physician

Injecting air
60 cc catheter syringe
Place stethoscope over LUQ of abdomen
Inject air into lumen of tube, NOT blue
pigtail
Listen for swoosh sound

Confirm NG Tube
Placement

Aspirate stomach contents

60 cc catheter tip syringe
Pull back to check for gastric
aspirate
Possibility for fluid to be from
lungs or pleural space

Confirm NG Tube
Placement
Test pH of gastric aspirate

60 cc catheter-tip syringe and pH

paper
pH < 4 = 95% chance that tip is in
stomach
pH > 6 = may be in lung or pleural
space; could be in stomach if
patient takes antacids or some
medications

Confirm NG Tube
Placement
Non-radiopaque methods
Possibility of error
Use more than one method
Passage into lungs frequent; especially
in comatose or demented patients
Aspiration of gastric contents more
reliable
Especially if tested with pH paper

Securing the Tube

Secure to
patients nose
Tape to nose and coil
around tube
Avoid pressure to
nares
Secure to patients
clothing near
shoulder area
Blue pigtail must be
above level of
patients stomach

Complications
Excessive coughing, motion, gagging
may aggravate the following:

Neck injuries
Increased risk for C-spine injuries

Penetrating neck wounds

May increase hemorrhage

Tube misplacement
Pulmonary
Intracranial

Removing NG Tube
Disconnect from drainage container
and suction (if applicable)
Attach syringe-tip catheter to lumen
of tube
Flush tube with 20cc of air
Empties contents from tube to prevent
aspiration into lungs

Removing NG Tube
Remove tape from patients nose
Unpin tube from gown
Have patient take deep breath and
hold while tube is removed
Pull tube with quick and steady motion
Discard appropriately
Provide or instruct patient on oral and
nasal care