NG Tube (Nasogastric Tube) - Indications, Size, Color, Insertion, Care, and Responsibilities

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Introduction

  • In nursing practice, the use of a nasogastric (NG) tube plays a vital role in both acute and long-term patient care.
  • This tube acts as a bridge between the external environment and the gastrointestinal tract, particularly the stomach.
  • Whether it’s for feeding, medication, or decompression, this intervention can be life-saving.
  • The NG tube is commonly used in hospitals, ICUs, emergency units, and even in some home-care settings.
  •  As such, having a comprehensive understanding of its indications, precautions, insertion technique, post-insertion care, and nursing responsibilities is essential for every nurse.
Ryles Tube Insertion Procedure | Types Of Rules Tube
Nasogastric Tube Insertion Procedure 

What is a Nasogastric Tube?

A Nasogastric (NG) tube is a flexible, hollow plastic tube that is inserted through the nostril, passes through the nasopharynx and esophagus, and ends in the stomach. It provides a direct access point to the stomach for various clinical interventions such as:

  • Removing gastric secretions (decompression)
  • Delivering nutrition and medications
  • Sampling gastric contents for diagnosis
  • Performing gastric lavage in poisoning cases

It is an essential clinical tool for both diagnostic and therapeutic purposes, especially in patients who cannot use their gastrointestinal system in the usual way.

Indications (Why is NG Tube Used?)

  1. Enteral Nutrition: For patients who cannot swallow due to stroke, trauma, coma, or surgery.
  2. Gastric Decompression: In cases of bowel obstruction, paralytic ileus, or post-abdominal surgery.
  3. Gastric Lavage: In emergency poisoning or drug overdose situations.
  4. Medication Administration: In patients unable to swallow but with functional GI tract.
  5. Aspiration of Gastric Contents: For diagnostic analysis such as assessing upper GI bleeding.
  6. Preventing Vomiting and Aspiration: Especially in postoperative patients or those with impaired gag reflex.
  7. Bowel Rest: In pancreatitis or perforated ulcer to allow healing without GI stimulation.
  8. Pre-anesthesia Gastric Emptying: To reduce risk of aspiration during surgery.

Contraindications

  1. Severe facial trauma: Risk of incorrect placement into the other site.
  2. Skull base fractures: Danger of intracranial insertion.
  3. Esophageal strictures or varices: Risk of trauma and bleeding.
  4. Nasal obstruction: Deviated septum, polyps, or tumors.
  5. Coagulopathy or bleeding disorders: Increases risk of epistaxis.
  6. History of esophageal surgery or perforation: Delicate tissues may not withstand tube insertion.

Types of NG Tubes

  1. Levin Tube: Single-lumen; used for feeding or simple drainage.
  2. Salem Sump Tube: Double-lumen; used for continuous suction with air vent to prevent gastric mucosa damage.
  3. Dobhoff Tube: Small bore, weighted tip; used for long-term feeding, comfortable for conscious patients.
  4. Ryles Tube: Multipurpose; usually used for gastric lavage and feeding.
  5. Sengstaken-Blakemore Tube: Specialized tube with balloons for controlling esophageal variceal bleeding.

NG Tube Sizes and Color Codes


• Note: Always verify manufacturer’s color coding system as there may be slight variations.

Equipment Required

  • Appropriate NG tube size based on patient age and purpose
  • Sterile gloves and hand sanitizer
  • Water-soluble lubricant
  • Glass of water with straw (for cooperative patients)
  • 60 ml syringe (for aspiration and flushing)
  • pH paper or pH meter
  • Adhesive tape or fixation device
  • Stethoscope
  • Towel or disposable drape
  • Suction apparatus (if decompression is needed)
  • Kidney tray
  • Penlight and nasal patency checker

Patient Preparation

1. Verify physician’s order and patient identity.

2. Educate the patient and obtain verbal consent.

3. Assess nasal patency using penlight.

4. Place patient in High Fowler’s position (90 degrees).

5. Drape towel across chest and provide tissues or emesis basin.

6. Measure NG tube: Nose → Earlobe → Xiphoid process. Mark tube with tape or marker.

7. Pre-assess gag reflex and ability to follow instructions (especially for conscious patients).

NG Tube Insertion Procedure: Step-by-Step

1. Perform hand hygiene and wear gloves.

2. Lubricate 2-4 inches of the tube.

3. Ask patient to slightly tilt head back; insert tube into nostril.

4. As tube passes nasopharynx, instruct patient to lower the chin and swallow as sips of water.

5. Continue inserting until pre-measured length is reached.

6. Confirm placement:

  • Aspirate and test pH (<5 indicates gastric placement)
  • Inject 10–20 ml air and auscultate stomach (less reliable)
  • Use X-ray if required (gold standard)

7. Secure tube to nose with adhesive and position tube over ear.

8. Connect to suction, clamp, or feeding set.

Verification of Placement

Must be performed before any feed, medication, or aspiration:

1. Gastric aspirate pH: 1.0–5.0 confirms gastric location

2. Visual characteristics: Gastric content appears greenish/yellow

3. X-ray confirmation: Especially in ICU or sedated patients

4. Mark and monitor tube length: Dislodgement may change position

Complications

1. Misplacement into trachea or lungs → aspiration pneumonia

2. Epistaxis (nasal bleeding) during or after insertion

3. Esophageal perforation

4. Sore throat, hoarseness, or sinusitis

5. Pressure ulcer at nares from prolonged use

6. Blockage of tube due to medication improper flushing and residue

7. Gastric erosion if suction is continuous without protection

Nurse’s Responsibilities

1. Explain the procedure to reduce anxiety

2. Choose appropriate size and type of tube

3. Maintain aseptic technique during insertion

4. Monitor for signs of distress like coughing, gagging, cyanosis

5. Confirm and reconfirm placement before every use

6. Flush tube before and after feeding/medications

7. Maintain records of intake and output

8. Provide mouth care and inspect nasal area regularly

9. Educate patient/family if care is to be continued at home

10. Follow hospital policies and infection control guidelines

Do's and Don'ts

Do's:

  • Pre-lubricate the tube to reduce friction
  • Use gentle but firm technique
  • Reassure and talk to patient throughout
  • Label the tube and feeding line clearly

Don'ts:

  • Do not use force if resistance is felt
  • Never start feeding without confirming position
  • Avoid using oil-based lubricants (aspiration risk)
  • Don’t leave unsecured tube hanging (risk of displacement)

Documentation

1. Date and time of insertion

2. Size and type of NG tube used

3. Side of insertion (left or right nostril)

4. Total length inserted

5. Placement verification method

6. Patient’s tolerance to the procedure

7. Any adverse events observed

8. Ongoing maintenance or flushing details

NG Tube vs OG Tube


Clinical Case Example

Scenario: A 75-year-old female with ischemic stroke is unable to swallow. Action: NG tube inserted for enteral feeding. Used 12 Fr Dobhoff. X-ray confirmed placement. Tube secured and feeds started after 4 hours. Outcome: Tolerated well. No complications noted. Family educated for home care post-discharge.

Student Tips for Practicals

1. Always carry two sizes of NG tubes for practicals

2. Practice measuring length on peers for confidence

3. Understand difference in adult vs pediatric tubes

4. Use clear tape and label properly

5. Be calm and gentle while inserting; patient may gag

6. Learn to troubleshoot blockage and dislodgement

FAQs

Q1: Can we reuse an NG tube?

No. NG tubes are single-use and should not be reused due to infection risks.

Q2: What if patient keeps pulling the tube out?

Use mittens/restraints if prescribed, and educate the patient/family.

Q3: How often should the tube be flushed?

Before and after feeding, after medication administration, and every 4–6 hours in continuous use.

Q4: Is air auscultation still used?

Not recommended as sole method. Always pair with pH or X-ray.

Conclusion

NG tube insertion is not just a technical skill — it's a critical nursing responsibility. Done properly, it can provide life-saving nutrition and treatment access. Nurses must be confident, compassionate, and competent in this essential procedure. Always prioritize safety, hygiene, and patient comfort.

Suggested Next Topic:

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