What is Nasogastric tube (NG Tube/ Ryle’s tube)?
It is a specific tube used for carrying the food and medicines directly through the nose to the stomach in difficult conditions like feeding to unconscious patients or patients with paralytic ileus or during laparotomy, etc.
Nasogastric tube sizes and color
It comes in different sizes for different age groups and different structures of the nose.
It comes in a size range from 6 to 18 French (where, 3 french= 1 mm). Its total length is 125cm or 30inches
A nasogastric tube has mainly 3 parts
- Tip: radiopaque, heavier, blunt
- Body: markings, 4 small holes above the tip
- 1st marking (single line) = 40cm from tip of tube – gastro esophageal junction/ lower end of esophagus
- 2nd marking (double line) = 50cm from tip of tube – body of stomach
- 3rd marking (3 lines) = 60cm from tip of tube – pylorus of the stomach
- 4th marking (4 lines) = 70cm from the tip of tube – duodenum
Indication of Nasogastric tube
- Feeding in case of an unconscious patien
- Feeding in dysphagia or bulbar palsy
- Feeding in severe odynophagia
- Intestinal decompression in case of paralytic ileus
- Intestinal obstruction
- During laparotomy
- After abdominal surgery
- In gastric lavage
- In gastric content analysis
Procedure of Nasogastric tube insertion
- NG tube
- Sterile gloves
- Bowel with water
- Lubricant 2% xylocaine jelly
- 50cc disposable syringe
- Adhesive tape/ easy fix
- Collecting bag
- Explain the procedure, indication, complication to the patient or patient’s party.
- Place the patient in the supine position and head elevated 450 and wear the sterile gloves
- Length measurement is done by the tip of tube from the ear lobe to nose then xiphoid process
- After the measurement is completed, lubricate the tip of the tube from 2% xylocaine jelly
- Examine the nose, watch for Deviated Nasal Septum (DNS), and among the both nostrils, the wider one is selected
- If there is any discharge in the nose, clean or suction the nose.
- Insert the tube into nostril and advance it backward towards the ear and down towards the nasopharynx.
- Tell the patient to keep on swallowing until the tube reached to stomach.
- After making sure that the tube is in stomach, fix it with adhesive tape in the nose and collecting bag is connected if needed.
Methods of conformation of the tube in the stomach
- Aspiration of gastric contents with syringe.
- Place the open end of the tube under water in bowel
- Detection by auscultation of hissing sound over the epigastrium after pushing of 30-50 ml of air into the tube from is open end.
- X-ray chest and abdomen
Complications that can be seen while NG Tube insertion
- Nasal bleeding
- Sore throat
- Esophageal perforation
- Pulmonary aspiration
- Erosion of nose
- Collapsed lung
- Intracranial placement of tube
Contraindications for NG tube insertion
- Base of skull fracture
- Severe facial fracture especially to the nose
- Obstructed esophagus and obstructed airways
How do you remove a nasogastric tube?
1: Firstly stop the patients feeding through the NG tube about 1 hour before the removal of the tube if possible.
2: Wash your hand properly with soap and water or use alcohol-based hand rub or use sterile gloves
3: Flush the NG tube with a prescribed amount of water, it helps to prevent the stomach content from entering into the lungs, when we pull up the tube
4: Remove the adhesive tape or whatever you have used to fix and hold the NG tube
5: Bend the one end of the tube completely and slowly pull out the tube until its fully out and then throw the tube into the trash
Which type of tube is used in nasogastric feeding?
The tube used as Nasogastric tubes is nowadays made up of plastic and rubber which are of polyvinyl chloride. The tube used is disposable in nature. This tube is about 125cm long and the main role of feeding is played by the 4 holes present at the base of the NG tube.