Makindo Medical Notes

About the Procedure

• Preparation: Begin by explaining the procedure to the patient and obtaining verbal consent. Ensure the patient understands the process and what to expect.
• Lubrication and Anesthesia: Apply a water-soluble lubricant to the tip of the nasogastric (NG) tube and use a local anesthetic spray on the back of the throat to reduce discomfort.
• Insertion:
  • Introduce the NG tube gently through the selected nostril, informing the patient before advancing it.
  • Carefully advance the tube through the nasopharynx; this step is often the most uncomfortable, so progress steadily without rushing.
  • If resistance is encountered, a slight rotation of the tube may help, but never force the tube as this could cause injury.
  • Should the patient become distressed or start gagging, pause to allow them to relax before continuing.
  • Periodically check the patient’s mouth to ensure the tube is not coiling there.
  • Continue advancing the tube into the esophagus. If the patient is having difficulty, ask them to take small sips of water and swallow, as this can facilitate smooth passage.

Checking Placement

• Aspiration and pH Testing:
  • Attempt to aspirate gastric contents through the NG tube.
  • Test the pH of the aspirate; a pH less than 4 generally indicates correct gastric placement.
• Radiographic Confirmation:
  • If no gastric contents can be aspirated or if the pH is greater than 4, a chest X-ray (CXR) is required to confirm proper tube placement.
  • Note that some institutions mandate a CXR regardless of pH results, so always adhere to local guidelines.
  • Acceptable pH ranges may vary between hospitals; ensure you consult and follow your facility’s protocols.

Conclusion

Nasogastric tube insertion is a common procedure that requires clear communication, careful preparation, and meticulous technique to ensure patient safety and comfort. By following the proper steps—from obtaining informed consent and applying adequate lubrication and anesthesia, to gentle insertion and vigilant placement confirmation—clinicians can reduce complications and improve outcomes. Adhering to local protocols for verifying tube placement, whether by pH testing or radiographic confirmation, is essential for safe and effective patient care.