Nasogastric tube insertion

Dr. P. Sandya
Consultant pediatrician
KIMS hospital

LEARNING OBJECTIVES:

To understand the basics of

nasogastric tube insertion
To understand Indications &
Contraindications of it
To learn scientific procedure of
nasogastric tube insertion.
To understand the possible
complications and how to avoid that.

Introduction :

Nasogastric tube is passed for either aspiration of gastric

contents or for administration of feeds or therapeutic
substances in neonates.
The insertion of a nasogastric tube facilitates feeding,
stomach decompression, administration of medications and is
a frequent procedure in the neonatal intensive care unit.
Although it is usually a very safe procedure, there is a very
small risk that the tube may inadvertently be misplaced with
the risk of milk or medication being instilled or aspirated into
the lungs.
Orogastric tubes are used predominantly in babies in
respiratory distress or with structural abnormality of nasal
cavity where full bottle feeds are contraindicated.

Indications:
Diagnostic
o Diagnosis of trachea esophageal fistula. (with x
ray).
o To get stomach aspirates for shake test for lung
maturity in preterm babies.
o Assessment of upper GI bleeding
o Gastric aspirate test for diagnosis of neonatal
septicaemia
o Measurement of gastric volume
o Determination of gastric content

 Therapeutic and feeding

o All Infants < 34weeks gestation
o Infants unable to oral feed due to poor suck
or swallow reflexes
o Infants with respiratory problems
o Patients on C-PAP therapy
o To facilitate aspiration and deflation of the
stomach
o Paralytic ileus, acute gastric dilation,
intestinal obstruction.

Contraindications

Nasal fracture
Unilateral choanal atresia or
stenosis
Head and neck injury preventing
passage
Oesophageal stricture

Equipments
Appropriate size nasogastric tube.
use tubes with markings to enable accurate
measurement of depth and length
2 ml, 5 ml & 10 ml syringe
Adhesive tape
Gloves


Wt. Based criteria
Size 4-5 for weight <1Kg
Size 5 for weight 1K 1.5Kg and
Size 6 for weight >1.5Kg
For babies > 3.5Kg you may consider
using a size 8 tube

 Age based criteria

5Fg feeding tube for all infants 34 weeks
gestation or < 1750gms.
6Fg feeding tube may be used if infant >
35 weeks.
8Fg tube on free drainage is generally used
to aid gastric decompression in infants with
abdominal distension or following surgery

PROCEDURE
Preparation
explain procedure to parents.
Wash hands and prepare equipment.
Wrap baby securely in a sheet.
To prevent risk of aspiration, pass nasogastric tube before a
feed.
Determine length of tube to be inserted keeping tube in its
packet, extend tip of tube fromnose to outer aspect of ear lobe
and then from earlobe down to xiphisternum, aiming for the
space in the middle below the ribs; note the mark on the tube or
keep your fingers on the
point measured.

Method of insertion
More patent nostril is selected for passing the tube.
In neonates, lubrication of terminal part is done with
water to prevent aspiration of oily substance.
With clean hands, wear gloves and pass tube slowly
and steadily into the nostril, curve directed
downward. It is passed along the floor of the nose. In
case of difficulty it is tried in another nostril.
Resistance is felt when it reaches the naso
-pharynx, a slight twisting of the tube puts it into the
nasopharynx.

 If the baby gags or the tube coils up in the mouth,

the tube is withdrawn partly and again it is passed.
It should be passed up to the measured length.
It should be fixed after conformation of its proper
placement in a butterfly fashion or with vertical
Taping.
Observe baby throughout procedure for colour
change, vomiting, respiratory distress or resistance.
If it is observed, that means It indicates that the tube
is in trachea.
if any distress occurs, stop and remove tube.

 Conformation of proper placement

Aspiration of stomach contents on applying suction
by attaching a syringe on the outer end of the tube.
Air is injected in the tube, while the epigastric area
is auscultated. A sound is heard if the tube is in
stomach. (Whoosh test)
By Radiography. (see image below)

 COMPLICATIONS

Failed passage
Insertion in trachea & pulmonary aspiration
Oesophageal perforation
Gastric perforation
Nasal necrosis
Oesophageal stricture

 Never use a gastric tube without

first verifying the position

 Frequency of checking tube placement

when there are concerns raised regarding
correct tube placement.
Prior to each bolus feed.
Prior to each syringe change for continuous
feeds.
When there is a discrepancy in tube length.
Prior to administration of drugs via the
naso or orogastric tube.

 Thank you