Nasogastric and Orogastric Tube Insertion

Protocol #103P Indications: To decompress the stomach. To lavage the stomach. Contraindications: - Absolute: Suspected fractures of the basilar skull. Facial trauma with suspected fractures. Known or suspected esophageal varices. - Relative: Ingestion of caustic poisons (tracheal intubation recommended prior). Adverse Effects: Passage of the tube into the trachea. Coiling of the tube in the posterior pharynx. Equipment: - Nasogastric sizes-5 French to 18 French, Orogastric sizes-24 French to 42 French - Water soluble lubricant - Tape or tube holder - Irrigation syringe with catheter tip - Stethoscope - Suction Procedure: 1. Determine the need for a NG or OG tube. Infants < 6 OG is preferred. 2. Determine correct size: Pediatrics: Use Resuscitation tape. Nasogastric tubes can be used as Orogastric tubes in the pediatric patient. 8 French feeding tube may be substituted for nasogastric tube sizes 5/6 to 8 French. Adults: Nasogastric: Largest tube that can pass through nare Orogastric: Largest tube needed to aspirate out substance or toxin from stomach. 3. Position patient: Conscious patient: high fowlers with head tilted forward ("chin on chest"). Unconscious patient: left lateral recumbent position with slight Trendelenburg. Airway must be protected by endotracheal intubation prior to NG or OG placement. 4. Measure length of NG tube from the nose to the earlobe and then to a point midway between xyphoid process and umbilicus. Mark the length of tube with a piece of tape. 5. Lubricate tip of tube with water soluble lubricant if inserting nasally. 6. Nasal insertion: Direct tube along the floor of nostril to the posterior pharyngeal than direct the tube downward through the nasopharynx. Oral insertion: Direct tube to the back of the tongue and then direct tube downwards through the oropharynx. If patient is conscious or old enough to follow instructions, instruct the patient to swallow to facilitate the placement of the tube in the stomach. 7. Continue advancing tube until tape mark is at the nostril or the lip. If tube meets resistance or the patient has respiratory distress, remove the tube. Fogging of the tube accompanied by cough or respiratory distress indicates tracheal intubation. March 1, 2010

8. If patient begins to vomit, suction around tube and leave in place as long as confirmation has of correct placement has been made. If at any time the patient airway is compromised remove NG/OG tube immediately and maintain airway. 9. Confirm placement of tube by: Aspirating gastric contents with a syringe. Injecting 5 to 20 cc of air while auscultating over the stomach for a "swoosh indicating gastric placement. 10. Auscultate lung sounds. 11. If tube is not placed properly: Remove immediately. Reinsert following the same procedure. Do not attempt insertion more than three (3) times. If tube is properly placed: Tape in place or apply a tube holder securing ETT and NG. 12. For stomach decompression: Attach tube to continuous low suction.

Eric Chun, MD Medical Director Date Reviewed _______________ _______________ _______________ Medical Director Signatures __________________________ __________________________ __________________________