Nasogastric Intubation by Tom Raflik

Introduction

It may be necessary to place a nasogastric (NG) tube if your patient has gastric distention. Gastric distention can be caused by artificial ventilations or air swallowing. Placing an NG tube is also useful to remove blood and/or other substances from the stomach.

Indications for NG Tube

• Inability to achieve adequate tidal volumes during ventilations due to gastric distention.
• Presence of gastric distention in an unresponsive patient.

Contraindication for NG Tube

• Patients with head or facial trauma because the tube may go into the cranial sinuses.
• Soft-Tissue damage in the nose.
• Inducement of vomiting.

Whenever a NG Tube is contraindicated consider an orogastric tube instead. Some experts believe a NG Tube should only be used with an Endotracheal Tube in place, which would prevent the NG Tube from going into the trachea. Check with your local protocols on the use of NG Tubes.

Equipment Needed To Place NG Tube

• Age - appropriate NG tubes
• 20 ml syringe
• Water - soluble lubricant
• Emesis Basin
• Tape
• Suctioning Equipment
• Stethoscope

Sizing Guidelines for NG Tubes

• Newborn/Infant - 8.0 French
• Toddler/Preschooler - 10 French
• School Age - 12 French
• Adolescent - 14-16 French

To determine the correct length, measure the tube from the tip of the nose, over the ear, to the tip of the Xiphoid Process.

To Place NG Tube

• Oxygenate and continue ventilations if possible.
• Select proper diameter and measure length.
• Lube distal end.
• Pass gently downward along nasal floor to the stomach.
• Ausculate over the epigastrium to confirm correct placement.
• Listen for bubbling while injecting 10-20 cc of air into the tube.
• Use suction to aspirate stomach contents
• Secure tube in place.

Sources

1. Paramedic Care Volume 5 pgs 80-82