Nasogastric tubes


A nasogastric tube is a narrow-bore tube passed into the stomach via the nose. It Insert non-formatted text here It is used for nutritional support, and also for aspiration of stomach contents.

Feeding tubes of gauge less than 9 mm cause less discomfort and less risk of rhinitis, pharyngitis or esophageal erosion than wide-bore tubes.

The use of a nasogastric tube for enteral feeding is adequate for up to six weeks.

Polyurethane or silicone feeding tubes are unaffected by gastric acid and can therefore remain in the stomach for a longer period than PVC tubes,

PVC NG tubes can only be used for up to two weeks.

For long-term enteral feeding, the use of percutaneous endoscopic gastrostomy (PEG) is associated with improved survival, better tolerance by the patient and lower incidence of aspiration.

Feeding by nasogastric tubes can be employed by:

Bolus: by gravity, requiring minimal equipment but is associated with an increased risk of gastrointestinal symptoms.

Intermittently: by gravity or use of a pump, which gives time free of feeding. It is associated with increased the risk of gastrointestinal symptoms.

Continuously: by pump system. It reduces the rate of gastrointestinal symptoms but the patient is connected to the system most of the time and this may limit mobility.

Bu utilizing a semi-recumbent positioning of the patient, the risk of airway aspiration can be reduced.

The nasogastric feeding route is not appropriate for patients with:

High risk of aspiration.

Gastric stasis.

Gastro-esophageal reflux.

Upper gastrointestinal stricture.

Nasal injuries.

Base of skull fractures.

Placement of a nasogastric tube:

A measurement is made from the bridge of the nose to the earlobe, then to the point halfway between the lower end of the sternum and the navel.

The tube is lubricated in its first 2-4 inches, and then passed via the nostril, past the pharynx, into the esophagus and then into the stomach, while the patient swallows with advancement of the tube.

It is essential to confirm the position of the tube in the stomach.

Testing pH of aspirate

X-rays can confirm position.

Introducing a small quantity of air into the stomach and checking for a bubbling sound over the epigastrium is no longer recommended, as it is unreliable and can give false reassurance.

Nasogastric tubes should be taped securely at the nose to avoid displacement.

The position of the nasogastric tube should be monitored by recording the length of the tube at the point of exit from the nostril, regularly checking the pH of the aspirate, checking the nasal fixation tapes daily and checking for signs of respiratory discomfort or regurgitation.

The tube position must be checked:

On initial placement.

At least once daily during continuous feeds, or before the administration of feed following a break or if bolus feeding.

Before the administration of drugs if the tube is not used for any other purpose.

After episodes of coughing, retching or vomiting.

After oropharyngeal suction.

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