04.01 Inserting an NG (Nasogastric) Tube

In this video we’re going to show you the correct technique for insertion of an NG tube. We’ll also give you a few tips and tricks we use.

Of course, before you get started, make sure you’ve determine which nare is more patent and that the patient doesn’t have a deviated septum.

Before you start, lay a towel across the patient’s chest - I’m telling you I’ve had patients throw up on me - this step is WORTH IT!!

Now you need to take your NG tube and measure the length you need for insertion. Measure from the tip of the nose to the earlobe, down to the xiphoid process. Then mark that spot with a piece of tape or a marker.

You also want to go ahead and prep your tape or securing device. Rip off about a 3 inch piece of tape, then cut a slit in it about ⅔ of the way up. They should look like a little pair of pants!

Go ahead and hand the patient a cup of water so they can sip and swallow while you insert the tube. Of course, our big oversized Ken doll can’t hold the cup, so just use your imagination here!

Now you want to lubricate the end of the NG tube and slowly begin inserting the tube. You should aim back and down - NOT up. UP goes to the brain, that’s not where we’re headed. Aim straight back and down.

When you feel a little bit of resistance, have the patient sip and swallow from their cup of water. You can also twist a little as you push and that should help. Don’t ever force it past firm resistance.

Once you reach your measurement, you want to secure the tube while you check placement. Apply the tape you cut to the bridge of the nose and wrap the two pieces around the tube.

Now to check placement, you’ll use the 60 mL syringe to aspirate gastric contents. They should be greenish or brownish and may have undigested food, which is normal.

Then you’re going to drop the aspirate on a pH strip. The pH should be less than 4 to confirm placement. If it’s more than that, or if at any point the patient starts choking or coughing, pull the tube out.

Now you can clamp the tube and secure it to the patient’s gown with a piece of tape. And you will wait for an abdominal x-ray. You CANNOT put anything down this tube until the x-ray confirms placement.

Make sure the client is in a comfortable position while you clean up your supplies - just make sure you keep the 60 mL syringe at bedside.

I want to point out here that for the longest time we used an air bolus to confirm placement. That practice is NO LONGER recommended because it’s not reliable. The gold standard is the abdominal x-ray.

This is a skill you don’t get to see often unless you’re in the ER, so I hope this was helpful. Now, go out and be your best self today. And, as always, happy nursing!