The Massachusetts General Hospital Handbook of Neurology

Authors: Flaherty, Alice W.; Rost, Natalia S.

Title: Massachusetts General Hospital Handbook of Neurology, The, 2nd Edition

Copyright 2007 Lippincott Williams & Wilkins

> Table of Contents > Procedures > Nasogastric Tube

Nasogastric Tube

A. Indications

Feeding (small tube, e.g., Enteroflex), to rule out GI bleed or protect lungs from vomiting (large tube, e.g., Salem sump).

B. Contraindications

Esophageal varices.

C. Need

tube (NG tube or Enteroflex), large syringe with correct tip (Luer for Enteroflex, catheter tip for Salem sump), lubricating jelly, cup of water + straw, stethoscope, sterile saline if lavage, basin for aspirated contents, tape, benzoin, safety pin.

D. Insertion

• Measure distance between pts. nose and stomach to get idea of how far to advance it. Lubricate tip.

• Position pt.: Have pt. sit completely upright, head bent forward. If pt. cooperative, give a straw and water.

• Push tube straight back while pt. swallows water.

• To rule out GI bleed, aspirate contents and guaiac them (acidity of stomach contents sometimes causes false-positive result), then lavage with ice-cold saline.

E. Checking placement

• Feel back of mouth with finger: Tube may curl. Watch for biters.

• Listen to belly: Cover extra holes in tube with your fingers. Blow air into gut and listen with stethoscope for bubbles. Check aspirates.

• Secure the tube: Tape tube to pts. nose and pin it to pt's. garment. Consider soft restraints in confused pts.

• Get a CXR: This checks tube position and rules out PTX. If tube is an Enteroflex, check the CXR before pulling the wire.

F. Med orders

If drugs must now go down NG tube, stop extended-release drugs, since they cannot be ground. Write order to flush tube after all drugs. Sucralfate can clog tubes.