Nasogastric tube insertion steps


Nasogastric Intubation:



1.        Removing stomach contents

           A. Diagnostic

         GI bleeding

         Penetrating or blunt trauma

B. Therapeutic

         Paralytic ileus

         Gastric dilatation

         Intestinal obstruction Persistent vomiting

                                            Removal of toxins and pill fragments

                                            Heating or cooling for temperature abnormalities

                              C. Prophylactic

                                            Decompression prior to abdominal surgery or peritoneal lavage

                                            Prevention of aspiration in multiple trauma

                2. Instillation of materials

                                            Medications, feedings, contrast, charcoal


  • Loss of integrity of cribriform plate (midface fracture)                                                                
  • Esophageal stricture                                                                                           
  • Comatose patients without airway protection                               
  • Penetrating neck trauma

(Note: varices are not a contraindication)                                                                       


1.        Salem sump tube of appropriate size                                                       

2.        Suction apparatus

3.        Cup of water with straw (for cooperative patients)

4.        2% Lidocaine gel, small syringe

5.        Lubricant

                6.     Tape, benzoin

                7.     Nasal decongestant (optional)


                1. Position patient: fully sitting if awake; supine wlneck flexion if comatose

                2. Inspect nares for obstruction; apply nasal decongestant and anesthetic to nasal mucosa, pharynx

3.  Estimate tube insertion length: ear-nose-xiphoid, mark wltape (Fig. 1)

4.  Pass lubricated tube along floor of nose (Fig. 2)

                5. Ask patient to sip water, advance tube quickly with swallowing

                6. Confirm placement by auscultation over stomach, aspiration of gastric contents,            

                or by x-ray in comatose patients. 

Nasogastric tube insertion step-by-step:

  1. patient in high fowlers
  2. towel on patient’s chest and emesis basin within reach
  3. wipe nasal bridge with alcohol swab
  4. stand on pts right side if right handed
  5. Select nostril with greatest air flow
  6. Measure tube distance – tip of nose to earlobe, then to xiphoid process
  7. mark length on tube with tape prior to insertion to prevent inserting greater length than needed
  8. lubricate 7.5-10cm of tube
  9. instruct pt to initially extend neck back against pillow
  10. insert tube gently and slowly through nares
  11. aim down to patient’s ear
  12. if resistance is felt do not force tube
  13. if resistance is felt try to rotate tube to advance
  14. if resistance still met, withdraw tube, allow pt to rest, then lubricate again and attempt in other nare
  15. when tube reaches just above oropharynx, instruct pt to flex head forward, take a small sip of water and swallow
  16. advance tube 2.5-5cm with each swallow
  17. if pt begins to cough, gag or choke withdraw tube slightly and stop advancement, instruct pt to breath and take sips of water
  18. Check placement
  • instruct pt to talk
  • inspect posterior pharynx for coiled tube
  • attach catheter tip syringe to end of tube and aspirate contents – check colour and pH
  • order X ray to check tube placement

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