Share

Topic 6: Introduction to nasogastric tube insertion

Learning Outcomes

  • List the indications and contraindication of nasogastric tube insertion
  • Describe the method for inserting a nasogastric and fine bore enteric tube
  • Apply the tips and tricks to insert a nasogastric tube if you are having difficulty
  • Discuss the methods, and their limitations, that are available to confirm the position of an inserted nasogastric tube
  • Develop a checklist for radiological confirmation of correct nasogastric tube placement
  • Recognise the presence of an endobronchial insertion of a nasogastric tube/feeding tube and the associated potential complications
  • Know how to manage a blocked nasogastric tube

Resources

  • Cross section model of a GI tract
  • Co-phenylcaine spray
  • Toomey syringe
  • Nasogastric tubes
  • Enteral feeding tubes
  • Viscous lignocaine 2%
  • Oral analgesic spray (Benzocaine spray or other)
  • Syringe, 10 ml
  • Glass of water with a straw
  • Water-based lubricant
  • Nasogastric tape
  • Emesis basin or plastic bag
  • Wall suction, set to low intermittent suction
  • Suction tubing and container
  • Checklist for checking the position of a nasogastric tube on CXR (see box 1 BMJ article)
  • CXRs of correctly and incorrectly placed NGT and feeding tubes

Facilitator questions for nasogastric tube insertion

Case 1

  • What are the indication and contra-indications to NGT insertion?
  • What are the complications of NGT insertion?
  • What can you do to increase the chances of successfully inserting a NGT if you are having difficulty?
  • The registrar said to put it on suction. What level of suction?
  • How do you write an order for suction on a NGT?
  • How can you unblock a NGT?

Case 2

  • Can you write up his oral contrast?
  • If the intern asks for a CXR, show them the CXR
  • Discuss the methods for checking position of a NGT and their limitations.
  • Ask each participant to use the laminated radiological checklist for identifying the position of NGT with a number of different CXRs. The CXRs show correct and incorrect positions of nasogastric tubes and ask the pre-interns to comment on the adequacy of the position.

Case 3

  • How is it different to the insertion of a NGT?
  • What are the complications of the insertion of a feeding tube?

Case 1

Mrs Ferdman was admitted to the ward from the Emergency  Department with a small bowel obstruction.  The nurse tried twice to get  the tube in but was unsuccessful and has asked you to insert it

You  finally get the NG tube in.  You get copious amounts of bile-stained  fluid back.

The NGT is now blocked.

Case 2

Mr Rogers has been admitted  to the ward with severe pancreatitis. The surgical registrar suggested a  NGT because of vomiting.  Your colleague inserted the NGT but has gone  home. Radiology has just rung and he is next on the list for CT abdomen.

Case 3

Ms Nash is on the stroke unit with a posterior  circulation stroke and has swallowing difficulties. The speech  pathologist suggested the insertion of a feeding tube.

Lamont T et al. Checking placement of nasogastric feeding tubes in adults (interpretation of x ray images): summary of a safety report from the National Patient Safety Agency. BMJ. 2011; 342:d2586.

Videos in Clinical Medicine: Thomsen T.W, Shaffer R.W, Setnik G. Nasogastric Intubation. N Engl J Med. 2006; 354:e16 http://www.nejm.org/doi/full/10.1056/NEJMvcm050183

Nasogastric tube assessment and X-Ray http://www.health.nsw.gov.au/policies/pd/2009/pdf/PD2009_019.pdf