NASOGASTRIC TUBE (NGT)
Ryles Tube • Insertion Procedure • Placement Verification • Nursing Care
Nursing Practical + NORCET High-Yield Notes
A nasogastric (NG) tube is an important clinical device used to provide access to the stomach through the nose. It is commonly used in medical, surgical, emergency and critical-care settings.
Depending on the type of tube and the patient's condition, an NG tube may be used for enteral feeding, medication administration, gastric decompression, aspiration of gastric contents or selected gastrointestinal procedures.
A nasogastric tube is a flexible hollow tube inserted through the nostril, passed through the nasopharynx and esophagus, and advanced toward the stomach.
It provides temporary access to the upper gastrointestinal tract for diagnostic or therapeutic purposes.
- Enteral nutrition.
- Medication administration.
- Gastric decompression.
- Aspiration of gastric contents.
- Collection of gastric specimens.
- Selected gastric lavage procedures when clinically indicated.
NG feeding may be considered when oral intake is unsafe or inadequate but the gastrointestinal tract is functional.
- Stroke with dysphagia.
- Reduced level of consciousness.
- Neurological disorders affecting swallowing.
- Selected postoperative patients.
- Patients unable to meet nutritional requirements orally.
- Intestinal obstruction.
- Paralytic ileus.
- Gastric distension.
- Selected postoperative gastrointestinal conditions.
- Collection of gastric contents for selected diagnostic purposes.
- Removal of gastric contents when clinically indicated.
Selected medications may be administered through an appropriately placed enteral tube when oral swallowing is not possible and the medication is suitable for tube administration.
NG tube insertion requires careful assessment when there is a risk of traumatic passage or esophageal perforation.
| Condition | Concern |
|---|---|
| Severe maxillofacial trauma | Risk of traumatic tube passage and associated complications. |
| Suspected basilar skull fracture | Nasally inserted devices may pose serious risk when skull-base anatomy is disrupted. |
| Nasopharyngeal obstruction | May prevent safe passage. |
| Esophageal obstruction or significant stricture | Increased risk of trauma or perforation. |
| Recent esophageal procedure | Requires specialist assessment and consideration of tissue injury risk. |
| Uncorrected coagulation abnormality | Increased bleeding risk. |
| Tube | Main Feature | Common Use |
|---|---|---|
| Levin Tube | Single-lumen tube | Gastric aspiration, decompression or selected short-term uses |
| Salem Sump Tube | Double-lumen tube with an air vent | Gastric decompression with suction |
| Dobhoff / Small-bore Feeding Tube | Small-bore feeding tube, often with a weighted tip | Enteral feeding |
| Ryles Tube | Commonly used nasogastric tube in nursing practice | Feeding, aspiration and gastric drainage depending on tube type |
| Sengstaken-Blakemore Tube | Specialized balloon tube | Selected emergency control of variceal bleeding |
Nasogastric tubes are commonly described using the French (Fr) scale. The French size refers to the external circumference of the tube.
1 French (Fr) ≈ 0.33 mm external diameter.
The appropriate size depends on the patient's age, clinical indication, feeding requirements and the type of tube being used.
Color coding may vary between manufacturers, therefore nurses should not rely on color alone when identifying tube size.
- Appropriate NG tube.
- Clean gloves according to procedure and local policy.
- Water-soluble lubricant.
- Appropriate syringe for aspiration/irrigation.
- pH indicator paper intended for gastric aspirate.
- Adhesive tape or commercial tube fixation device.
- Protective towel or disposable drape.
- Emesis basin or kidney tray.
- Water and straw if swallowing is safe and the patient is allowed to drink.
- Suction apparatus when gastric decompression is required.
- Appropriate PPE.
- Verify the clinical order/indication according to institutional policy.
- Identify the patient using appropriate identifiers.
- Explain the procedure and expected sensations such as gagging or discomfort.
- Assess nasal passages and select the more suitable nostril.
- Assess the patient's level of consciousness and ability to follow instructions.
- Assess aspiration risk and airway protection needs.
- Position the patient upright, usually in a high-Fowler or appropriately elevated position when clinically feasible.
- Place a towel or protective sheet over the chest.
- Prepare the required equipment before beginning.
A commonly taught bedside method is the NEX method:
- Place the tip of the tube at the patient's nose.
- Measure from the nose to the earlobe.
- Continue the measurement toward the xiphoid area.
- Mark the estimated insertion length according to local policy and the tube manufacturer's guidance.
- Perform hand hygiene and prepare appropriate PPE.
- Explain the procedure to the patient.
- Position the patient upright when possible.
- Assess the nostril and select the more patent side.
- Lubricate the tube tip with an appropriate water-soluble lubricant.
- Direct the tube gently along the floor of the nasal cavity rather than upward.
- Advance slowly until the tube reaches the nasopharynx.
- Ask a cooperative patient to swallow, if safe, while gently advancing the tube.
- Encourage calm breathing and provide reassurance.
- Stop immediately if severe respiratory distress, cyanosis or significant resistance occurs.
- Continue advancement only according to the planned insertion length and clinical protocol.
- Secure the tube appropriately after placement has been confirmed.
Correct placement is one of the most important safety steps before using an NG tube for feeding, medication or fluids.
Gastric aspirate can be tested using appropriate pH indicator paper designed for gastric aspirate. A sufficiently acidic result may support gastric placement according to the institution's protocol.
X-ray may be required when gastric aspirate cannot be obtained, pH testing does not confirm safe placement, or when clinical circumstances require radiographic confirmation.
The external tube length should be documented after placement and monitored for changes. A change in the visible length can suggest tube migration.
Tube position should be reassessed according to institutional policy, especially when there is concern that the tube may have migrated.
- After initial insertion.
- When the tube becomes loose or visibly displaced.
- After significant vomiting or retching.
- After episodes of severe coughing.
- When new respiratory symptoms develop.
- When oxygen saturation unexpectedly decreases.
- Before feeding or medication when placement has not been appropriately confirmed.
Gastric decompression may be used to remove accumulated gastric contents and reduce gastric distension in selected patients.
- Intestinal obstruction.
- Paralytic ileus.
- Severe gastric distension.
- Selected postoperative gastrointestinal conditions.
When suction is prescribed, use the prescribed pressure and mode. Excessive or inappropriate continuous suction can contribute to mucosal injury.
- Confirm tube placement according to institutional protocol before use.
- Keep the head of the bed appropriately elevated during feeding and afterward according to clinical policy.
- Check the feeding prescription and formula.
- Administer the feed at the prescribed rate.
- Observe for coughing, respiratory distress, abdominal distension, vomiting or other intolerance.
- Flush according to the feeding protocol and tube manufacturer's instructions.
- Maintain accurate intake and output records.
- Confirm tube placement before administration.
- Review whether the medication is appropriate for enteral administration.
- Do not crush modified-release or enteric-coated medications unless specifically approved.
- Administer medications separately when appropriate.
- Flush according to institutional protocol and medication compatibility requirements.
- Document medication administration and relevant tube-care details.
| Complication | Possible Cause / Concern |
|---|---|
| Epistaxis | Nasal mucosal trauma during insertion. |
| Gagging / vomiting | Tube stimulation of the pharynx. |
| Misplacement into respiratory tract | Incorrect tube pathway; may result in aspiration if used. |
| Aspiration | Incorrect tube placement, reflux or impaired airway protection. |
| Esophageal injury/perforation | Traumatic insertion or underlying esophageal pathology. |
| Nasal pressure injury | Prolonged pressure from tube or fixation device. |
| Sinus discomfort/sinusitis | Prolonged nasal tube presence. |
| Tube blockage | Medication residue, thick feed or inadequate flushing. |
| Gastric mucosal injury | Improper or excessive suction. |
- Verify the indication and patient identity.
- Explain the procedure and provide reassurance.
- Assess nasal patency and relevant risk factors.
- Select an appropriate tube according to the clinical purpose.
- Use appropriate infection-control precautions.
- Monitor the patient continuously during insertion.
- Recognize signs of respiratory distress immediately.
- Confirm tube placement before use according to policy.
- Document external tube length and placement verification.
- Maintain tube patency using the correct flushing procedure.
- Provide oral hygiene regularly.
- Inspect the nostril and surrounding skin for pressure injury.
- Monitor feeding tolerance when used for enteral nutrition.
- Monitor gastric drainage when used for decompression.
- Educate patient and family about tube safety.
| DO | DON'T |
|---|---|
| Explain the procedure to the patient. | Do not force the tube against significant resistance. |
| Use appropriate water-soluble lubricant. | Do not use oil-based substances as routine tube lubricant. |
| Keep the patient appropriately positioned. | Do not administer feed when placement is uncertain. |
| Confirm placement using an approved method. | Do not rely on auscultation/"whoosh" alone. |
| Document tube length and verification. | Do not ignore a change in external tube length. |
| Monitor the nose and skin regularly. | Do not allow prolonged pressure without assessment. |
Document the following according to institutional policy:
- Date and time of insertion.
- Indication for tube insertion.
- Tube type and size.
- Nostril used.
- External tube length after securing.
- Method used to verify placement.
- pH result when applicable.
- X-ray confirmation when performed.
- Patient's tolerance.
- Any complications or adverse events.
- Feeding, medication or suction details as applicable.
| Feature | NG Tube | OG Tube |
|---|---|---|
| Route | Nose → Esophagus → Stomach | Mouth → Esophagus → Stomach |
| Route name | Nasogastric | Orogastric |
| Common advantage | Can be used when oral route is unsuitable | Avoids nasal passage |
| Important consideration | Nasal trauma or obstruction may complicate insertion | Requires appropriate oral access and fixation |
Clinical Approach: The healthcare team assesses the indication for enteral feeding. An appropriate feeding tube is inserted by trained staff. Placement is confirmed using the approved method before feeding is started. The tube is secured, external length is documented, and the patient is monitored for feeding intolerance and aspiration risk.
The key nursing priority is not simply inserting the tube—it is ensuring safe placement, preventing complications and providing appropriate ongoing care.
- Know the indications and contraindications before starting the procedure.
- Remember the NEX measurement concept.
- Understand the difference between Levin and Salem Sump tubes.
- Know why a Salem Sump has a second air-vent lumen.
- Practice patient positioning and communication.
- Never force the tube.
- Learn the correct placement-verification method used in your institution.
- Do not use the "whoosh" test as the sole confirmation method.
- Know the complications and immediate warning signs.
- Practice accurate documentation.
- NG = Nasogastric.
- OG = Orogastric.
- NEX = Nose → Earlobe → Xiphoid.
- NG tubes can be used for feeding, medication, aspiration and decompression depending on the tube and indication.
- Salem Sump is a double-lumen tube.
- The second lumen of a Salem Sump functions as an air vent.
- Do not use a tube for feeding until appropriate placement confirmation has been obtained.
- Air auscultation/"whoosh" is not a reliable sole confirmation method.
- pH testing of gastric aspirate is used as a first-line confirmation method in some protocols.
- X-ray may be required when bedside confirmation is not satisfactory or when clinically indicated.
- Observe for respiratory distress during insertion.
- Epistaxis is a common insertion-related complication.
- Do not force a tube against resistance.
- Monitor the external tube length for possible migration.
- Document placement verification and tube length.
| Question | Answer |
|---|---|
| NG stands for? | Nasogastric |
| NG tube ends in? | Stomach |
| NEX stands for? | Nose → Earlobe → Xiphoid |
| Salem Sump? | Double-lumen tube |
| Main purpose of air vent? | Helps prevent excessive gastric mucosal suction |
| Common insertion complication? | Epistaxis |
| Can the tube be forced against resistance? | No |
| Can air auscultation alone confirm placement? | No |
| Important bedside confirmation method? | Appropriate gastric aspirate pH testing according to protocol |
| When may X-ray be required? | When bedside confirmation is unsuccessful/uncertain or clinically indicated |
📝 NGT / RYLES TUBE — NORCET MCQ TEST
Student Name
Follow the specific manufacturer's instructions and institutional policy. Many enteral tubes are intended for single-patient use and may have defined replacement schedules.
Do not force the tube. Stop, reassess and seek appropriate clinical assistance according to the patient's condition and institutional protocol.
No. Auscultation after injecting air should not be used as the sole method of confirming tube placement.
NEX refers to Nose → Earlobe → Xiphoid, a commonly taught method for estimating insertion length.
Pulmonary administration of feed can result in serious aspiration-related complications.
Nasogastric tube insertion is an important nursing skill that combines technical competence, patient communication, clinical assessment and patient-safety principles.
A nurse must understand the indication, select the appropriate tube, insert it gently, recognize complications, verify placement correctly and provide safe ongoing care.
Correct indication → Appropriate tube → Gentle insertion → Confirm placement → Secure tube → Monitor patient → Document care
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