Nasogastric/Orogastric Insertion

Position: Position patient sitting upright, with head extended and neck flexed

Measure: Measure the depth of insertion needed to insert into gastric contents. Estimate the distance by starting from the tip of the NGT at tip of the nares, to the ear auricle, to the epigastrium (see reference picture below). Keep in mind the distance measured by using the black notches on the NGT.

Prepare: Prepare the NGT by lubricating the tip with lubricating jelly. Open the 50 cc syringe, and pull back on the plunger all the way to allow air into the syringe. Then screw the syringe onto the blue vent of the NGT.

Insert: Aim the lubricated tip medially and posteriorly into the nasal cavity of the patient. If inserting into the oral cavity, insert posteriorly. The patient may gag, and you may feel resistance at the larynx. As you come to the larynx, have the patient swallow (can dry swallow or give a cup of water to facilitate swallowing). This will allow the epiglottis to cover the trachea and facilitate insertion into the esophagus. Once the tube is past the larynx, insert NGT to the predetermined depth measured initially. If you feel resistance at any point, stop. Tip: do not insert NGT slowly as this is more uncomfortable for the patient and leads to more gagging thus more resistance, try to insert more rapidly, but again stop with any resistance. Upon insertion, if the patient starts coughing, this is an indication it is inserted into the trachea.

Confirm: Place your stethoscope at the epigastrium. Use the 50 cc syringe secured onto the bottom of the NGT. As you inject air into the NG using the syringe, listen for borborygmus (rumbling or gurgling noise). Tip: NGT will spontaneously come out on its own, keep an eye out as you are confirming. If you need additional assistance, ask someone to hold it in place as you confirm.

Secure: Grab a 3-4 inch long piece of taper. Tear it halfway down its vertical length. Apply the wide end to the patient’s nose, and wrap the two “tails” around the tube. Ensure the nares are not covered. Place a second piece of tape horizontally over the nose across the first piece of tape.

Post NGT orders: order a CXR to confirm NG tip position. The NGT must be seen going through the esophagus with the tip below the level of the diaphragm. Some NG/OG's have a side port located a few cm above the tip which will appear as a break in the NGT/OGT on CXR. Ensure the side port is also below the level of the diaphragm.