The Ultimate Guide to Nasogastric Tubes: Placement, Uses, and Safety Tips

Nasogastric tubes are flexible, thin tubes used in medical processes where liquid nutrition or medication is administered directly to a patient’s stomach through their nose and esophagus. They can also help remove air and fluids from the stomach to treat certain medical conditions requiring that. 

The medical term “nasogastric” basically means “nose to stomach.” If a medical professional cannot administer medication or nutrition to a patient orally, they will usually use a nasogastric tube to do so. This happens often with unconscious, sick, or injured patients who are unable to eat, drink, or swallow normally. 

Nasogastric tubes come in different lengths and sizes. They are meant for short-term use to help patients recover from illnesses, injuries, or surgeries. It is generally safe to insert a nasogastric tube into a patient’s nose to reach their stomach, but the proper technique must be used to avoid hurting the patient. Any misplacement or forced entry of the tube could cause nasal trauma or some other internal damage. 

The Steps of Inserting a Nasogastric Tube into a Patient

Nasogastric tube placement is a serious procedure requiring complete focus, skill, and care. Any doctor, nurse, medical professional, or student performing this procedure must know all the steps involved in the tube insertion process to avoid harming the patient.

Here is an overview of the steps involved in the placement process:

1) Assess the Patient

You must review the patient’s medical history and factor in their current health status to determine the level of risk involved in inserting a nasogastric tube into them. If they suffer from facial trauma or any esophageal or nasal conditions or complications, they could suffer further damage or discomfort from a nasogastric tube. All these potential factors must be considered before proceeding.

2) Gather Equipment

Choose a nasogastric tube with a size appropriate to accommodate the patient’s condition and age. A medical standardized nasogastric insertion kit will come with an assortment of tubes that are usually suitable for most patients. That will make it easier for beginners and students with little experience choosing the appropriate tube sizes.  Other equipment and accessories needed include a syringe, adhesive medical tape, water-soluble lubricant, pH indicator strips, gloves, eye protection, and a gown. 

3) Discuss the Procedure with the Patient

Discuss the placement procedure with your patient to inform them about what will happen during the procedure. Patients who understand the procedure better will feel less anxiety and stress. They will also be told to give a signal if they experience any severe pain or discomfort as the tube is inserted into them. 

4) Position the Patient

Position your patient’s head at the proper angle as they sit in an elevated position on the bed. Their head should be elevated anywhere from 60 to 90 degrees. Most modern hospital beds or medical-grade beds can be automatically elevated with the push of a button and without causing distress to the patient.

5) Measure the Tube

Please avoid inserting too much of the nasogastric tube too deeply into the patient, as this could injure them. Measure the appropriate tube length to ensure that it reaches the stomach perfectly. 

The measurement formula is to measure the length between the tip of the nose and the earlobe. Next, measure the length between the earlobe and the lower sternum. Add both measurements together, and that is the precise amount of tube to insert into the nasal cavity to reach the stomach. Mark the length on the tube as a reminder of when to stop inserting it. 

6) Lubricate the Tube

Use the water-soluble lubricant to thoroughly lubricate the first four inches at the end of the nasogastric tube, starting from the tip. The lubricant will reduce the patient's discomfort as you pass the tube inside them by reducing the amount of internal friction along the way. 

7) Insert the Tube

Now comes the actual insertion of the nasogastric tube. Lightly insert the tip of the tube into the most open nostril of the nose. Aim the tip toward the back of the patient’s head as you pass the tube inside of them and downwards. The patient may cough a little bit as the tube enters the esophagus. They should take small sips of water for further lubrication to relax and calm their esophageal muscles.

Continue inserting the tube until you reach the marked spot on it. Never apply force or pressure to the tube because that will increase the risk of injuring the patient. If necessary, gently remove the tube, apply more lubricant, and try again. Once you insert the tube far enough to reach the marking, the tip of the tube should be in the patient’s stomach. 

8) Secure the Tube

Use the adhesive tape to secure the nasogastric tube to the patient’s nose. It must be anchored and secured well to prevent accidental movement during the treatment process. Ensure you don’t make the tube too tight, as this could cause internal or external ulcers.  

9) Proceed with the Treatment

Now you are ready to proceed with the treatment. Insert the syringe at the other end of the nasogastric tube to administer medicinal fluids to the stomach or extract contents from the stomach. Monitor the patient’s response during treatment to ensure they are not suffering any medical episodes or complications. 

10) Tube Removal

Use sterile water to flush out the remaining contents of the tube. Remove the adhesive tape and gently pull out the tube to avoid inflicting too much discomfort on the patient. Once the tube has been removed, allow the patient to blow their nose to clean the nasal passages. 

Clinical Uses of Nasogastric Tubes

Nasogastric tubes are used in emergency rooms, hospitals, long-term care facilities, and other clinical settings to treat gastrointestinal-related health conditions. Here is a breakdown of the top uses of nasogastric tubes in clinical settings:

1) Gastric Decompression

Gastric decompression is a medical procedure in which fluid and gas are removed from the stomach to reduce pressure and alleviate the symptoms of a particular condition, such as bowel obstruction. If the intestines are blocked for some reason, a nasogastric tube must be inserted into the patient to extract the stomach contents and reduce vomiting and pain. 

Other reasons to decompress the gastrointestinal tract with a nasogastric tube include preventing nausea after abdominal surgery and reducing fluid and gas buildup due to weak intestinal muscles. 

2) Enteral Feeding

Some patients are unable to eat food normally because of recent surgeries, neurological disorders, or injuries to their head or neck. A short-term feeding solution during their recovery period is to administer enteral feeding through a nasogastric tube. The tube could remain in the patient for no more than 4 to 6 weeks, which should be enough time for them to recover. 

A liquid nutrient solution is inserted through the nasogastric tube and into the patient’s stomach. These nutrients include all the essential macronutrients and micronutrients, such as carbohydrates, proteins, vitamins, fats, and minerals. They will ensure the patient stays healthy and heals as fast as possible.  

3) Administer Medication

An injured, ill, or unconscious patient unable to swallow will usually need medication to help them recover and treat their condition. Medical professionals will administer the proper dose of medication through the nasogastric tube and into the patient’s stomach. These medications could be pain relievers, antibiotics, or other therapeutic drugs easily absorbed in the gut. 

All medications are dissolved into water to liquify them. It ensures all the medication goes into the patient without any setbacks or clutter in the tube. 

4) Gastric Lavage

Gastric lavage is a life-saving medical procedure known as “pumping out the stomach.” Doctors and nurses will often perform this procedure with a nasogastric tube to remove toxic substances from a patient after they have experienced a drug overdose or certain types of poisoning.

Emergency rooms are the most common medical setting where gastric lavages are performed. Medical professionals use saline or water to flush out the patient’s stomach through the nasogastric tube and remove toxic substances. 

5) Conducting Diagnostic Procedures

Doctors and medical diagnostic professionals sometimes need to collect samples of stomach content to diagnose a potential gastrointestinal-related condition. They access the stomach using nasogastric tubes and collect the samples for further testing. These diagnostics can determine the cause of conditions like elevated pH levels, unusual bacteria, and gastrointestinal bleeding. 

Based on the diagnostic results, the doctor will recommend the best treatment for the patient. This treatment may or may not involve further use of the nasogastric tube. It all depends on the recommended treatment method. 

6) Prevent Gastric Aspiration

Patients suffering from gastroesophageal reflux, stroke, neurological disorders, unconsciousness, or brain injuries have a high risk of gastric aspiration. Someone has gastric aspiration when they accidentally inhale vomit, food, or liquid contents from their stomach into their lungs. When this happens, it can cause serious health complications like chemical pneumonitis and pneumonia. 

Nasogastric tubes can help drain the gastric contents to reduce or eliminate the adverse symptoms. They can also administer controlled and safe feeding to the patient without any risk of the nutritional content entering their lungs. Patients in intensive care settings are the most likely to need this kind of treatment. 

Safety Tips When Inserting Nasogastric Tubes

Let’s review the critical safety tips when inserting nasogastric tubes into patients. These tips could prevent or reduce the risk of infection, injury, or discomfort for the patient. 

1) Verify the Correct Tube Placement

Never begin administering treatment through the nasogastric tube until you have verified that it was placed into the patient correctly. 

There are two ways to verify the correct tube placement. First, ask the patient to give you a signal as to whether they are in pain or not. If they are not in pain, ensure the tube is inserted by checking the external tube markings to verify. 

2) Maintain Hand Hygiene

You must take hygiene seriously when working with nasogastric tubes because it will prevent your patient from getting infected. Practicing good hygiene means cleaning the external areas of your tube with warm water and mild soap. You should also keep the cap on the feeding port when you are not using it to prevent contaminants from getting inside. 

Never reuse tubes, syringes, or other related accessories when treating patients. Always use new tubes and syringes to prevent infecting or transmitting diseases to patients.  

3) Crush Medications into Fine Particles

Liquid medications don’t always come in premade packages. You will often have to produce them by crushing hard medications into tiny, fine particles so that they can dissolve in water.

 It is important to verify that all the particles are as fine as dust to make them easier to dissolve in water. Otherwise, thicker particles could clog the nasogastric tube and prevent the patient from receiving their entire dose of medication. 

4) Regularly Monitor the Patient

You or another medical worker must regularly monitor the patient’s condition as the nasogastric tube remains inside them. There is always at least a slight risk of a medical complication, such as respiratory distress, vomiting, nausea, abdominal discomfort, or nasal irritation. You need to notice the signs of these conditions and respond to them quickly and appropriately. 

Conclusion

You should clearly understand the importance of nasogastric tubes and how they are inserted and used in clinical settings. These tubes can deliver life-saving treatment to patients who are incapacitated and unable to swallow. Only well-trained medical professionals should ever attempt to insert a nasogastric tube into a person because it could cause internal injuries if inserted incorrectly.

Do you need nasogastric tubes to help train your medical students? Pristine Medical offers a comprehensive nasogastric insert kit with all the essential tools to practice performing this procedure on patients, including an irrigation tray, PVC tubes, and lubricating jelly.