How does a nurse or doctor insert an nasogastric NGT tube?

The insertion of a nasogastric (NGT) tube is a procedure commonly performed by healthcare professionals such as nurses and doctors to administer liquid nutrition, medications, or to drain stomach contents. Here are the general steps involved in inserting an NGT tube:

1. Obtain necessary supplies:

- NGT tube (appropriate size and length for the patient)

- Water-soluble lubricant or jelly

- Stethoscope

- Syringe with normal saline or water

- Emesis basin or container

- Adhesive tape

- Gloves

2. Assess the patient:

- Explain the procedure and obtain consent from the patient if possible.

- Assess the patient's level of consciousness, gag reflex, and any nasal obstructions.

3. Hand hygiene:

- Perform hand hygiene according to facility guidelines.

4. Position the patient:

- Place the patient in a semi-upright or high Fowler's position to reduce the risk of aspiration.

5. Prepare the NGT tube:

- Open the NGT tube package and attach a syringe filled with normal saline or water to the tube's distal end.

6. Lubricate the tube:

- Apply water-soluble lubricant to the tip and first 10-15 cm of the tube.

7. Measure and mark the tube:

- Measure the distance from the tip of the patient's nose to the earlobe and then to the xiphoid process (tip of the sternum). Mark this length on the tube using tape.

8. Insert the tube:

- Gently insert the lubricated tube through the nostril, aiming towards the back of the throat. Ask the patient to swallow sips of water or perform swallowing motions as the tube advances to help guide it into the esophagus.

9. Check tube placement:

- As you insert the tube, listen with a stethoscope placed on the abdomen for a "whooshing" sound that indicates the tube has reached the stomach (air insufflation technique).

- Alternatively, you can inject a small amount of air (5-10 mL) into the tube and listen for the sound of air entering the stomach.

- You can also check for the presence of gastric contents in the tube.

10. Secure the tube:

- Once the tube is in the correct position, gently tape it to the patient's nose and cheek to secure it in place.

11. Confirm placement:

- After securing the tube, aspirate a small amount of gastric contents and test the pH using pH paper to ensure the tube is in the stomach.

12. Provide aftercare:

- Provide proper patient education about tube care, feeding, and any precautions.

- Document the procedure, including the tube size, insertion depth, and any observations.

Remember that the procedure may vary based on the specific healthcare institution's protocols and the patient's condition. It is important to follow the recommended guidelines and consult with a healthcare professional if you are not familiar with inserting NGT tubes.