Nasogastric intubation

• NG tubes should only be passed by those staff who have received the correct training and have been deemed competent

• Verification of the nasogastric tube is essential if care is to be safe

• Nurses are responsible to ensure they are confident and competent in the knowledge and skills of practice aligned to local guidelines, procedures and policies

• It is essential to ensure accurate documentation relating to NG tube insertion and the subsequent care of the person

The nasogastric tube is a narrow-bore or wide-bore tube passed into the stomach via the nose; this is a common procedure, carried out in a number of healthcare settings for a number of reasons. This article concentrates on the passage of nasogastric tubes that are inserted through the nose and rest in the stomach, as opposed to those tubes that are inserted through the nose and rest in the duodenum or further (nasoduodenal or nasojejunal).

Upper gastrointestinal tract

The upper gastrointestinal tract can be described as extending from the mouth to the ileum.

Mouth

The mouth leads to the oral cavity, within which are the lips, the cheeks and gingivae (gums) and the teeth. The main oral cavity also lies between the hard and soft palate above, the tongue below and the teeth. The oral cavity leads to the pharynx, which contains adenoids (pharyngeal tonsils) and palatine tonsils. Salivary glands (parotid, submandibular and sublingual) open into the oral cavity.

The pharynx has 3 parts

• Nasopharynx (from the base of the skull above to the soft palate below)

• Oropharynx (from the soft palate above to the hyoid bone below)

• Laryngopharynx (from the hyoid bone above to the cricoid cartilage below)

The nasal cavity, oral cavity and larynx open into the nasopharynx, oropharynx and laryngopharynx, respectively.

Oesophagus

The oesophagus (sometimes referred to as the gullet) crosses 3

Indications for insertion of NG tube

There are several benefits associated with the insertion of a NG tube. However, this also comes with a range of risks associated with their use (see Box 1).

Box 1. Risks and potential complications

• The tube may enter the lung
• The tube may coil up in throat
• Sinusitis
• The tube could perforate the base of the skull and may enter the brain
• There may be perforation of the oesophagus
• Formation of retropharyngeal abscess
• Reflux of stomach contents into the oesophagus and risk of aspiration
• Death as a result of feeding into the lung
• Parotitis (inflammation of the parotid glands) (Durai et al, 2009b)

Durai et al (2009a) suggest that there are only two main indications for the insertion of an nasogastric tube:

1. To empty the upper gastrointestinal tract
2. For feeding

The majority of medications are not licensed for administration through a nasogastric tube. A

The equipment needed for the insertion of a nasogastric tube is detailed in Box 2. This equipment should be placed on a trolley at the bedside. The nurse should ensure all of the equipment required is there prior to the procedure beginning.

Explain to the person what each piece of the equipment is, its purpose and how it is intended to be used. Prior to preparing the equipment, wash hands.

Box 2. Equipment to be used for the passage of a nasogastric tube

• Fine-bore nasogastric tube (with wire as introducer)
• Receiver
• Sterile water
• 50 mL enteral syringe
• Hypo allergenic tape
• Glass of water
• Water soluble lubricant
• Paper indicator strips
• Tissues