Procedure

Purpose and Duration

  • NG tubes are used for feeding, medication delivery, or stomach decompression (e.g., in bowel obstruction).
    • Fine-bore tubes: For feeding, medications, and mild decompression.
    • Wide-bore tubes: Primarily for relieving stomach pressure.
  • They can remain in place for 2–6 weeks but may dislodge earlier, especially if tugged or caught.

Preparation

  • Contraindications: Basal skull fractures, facial trauma, or patient refusal.
  • Equipment Needed: NG tube (correct size), gloves, lubricating gel, water with a straw, fabric tape, drainage bag, vomit bowl, pH strips, and large syringe.
  • Obtaining Consent: Explain the procedure, benefits, and risks (discomfort, irritation, misplacement, rare injuries).

Insertion Procedure

  1. Positioning: Have the patient sit upright with their head supported by a pillow.
  2. Measure the Tube: Measure from the tip of the nose to the earlobe, then to the xiphisternum.
  3. Lubricate and Insert:
    • Lubricate the tube, inspect the nostrils for blockages, and insert through one nostril, directing it horizontally.
    • Ask the patient to sip water and swallow as the tube reaches the throat.
    • Gently advance the tube to the marked length. If resistance is encountered, try the other nostril or adjust the angle.
  4. Securing the Tube: Tape the tube securely to the patient’s nose and attach the drainage bag if required.

Confirming Tube Placement

  • Aspirate fluid and check its pH (should be ≤5.5).
  • If no aspirate or unclear results, confirm placement with a chest X-ray.
  • The “whoosh test” (injecting air and auscultating) is not considered a reliable method.

Potential Complications

  • Common: Nasal discomfort, throat irritation, and tube displacement.
  • Serious: If the tube is misplaced in the lungs, it can cause life-threatening complications.
  • Rare: Nasal septum or esophageal injury, or perforation of the basal skull.

Maintaining the NG Tube

  • Displacement: NG tubes can often become displaced, so reassure patients and families. Preventive measures include:
    • Bridles: These use magnetic probes to secure the tube and are helpful in patients with difficulty maintaining tube placement.
    • Mittens: Soft mittens can prevent agitated or confused patients from pulling out the tube. These should be used with caution, and patients must consent when possible.
  • Confirm Position Regularly: Always check the tube’s position before feeding or administering medications.

Feeding and Long-Term Considerations

  • If the patient is not absorbing feed properly (e.g., high-volume aspirates or vomiting), consider adjusting the feeding rate or adding motility agents.
  • For long-term feeding, alternatives like nasojejunal (NJ) or percutaneous endoscopic gastrostomy (PEG) tubes may be considered.

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