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 nose tip → earlobe → 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: pH ≤5.5 confirms gastric placement.
• Chest X-ray: If uncertain, use for confirmation.
• Whoosh Test (injecting air and auscultating): Not reliable; avoid for confirmation.

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 Prevention: Use bridles or mittens for patients prone to pulling out the tube.

• 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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