How a Nasogastric Feeding Tube Is Inserted
I wrote this article for relatives of patients, so that they would have a general understanding of what this procedure involves.
Preparation for the Procedure
Before insertion, you need to:
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Make a decision about the need for tube placement — i.e., confirm that the patient really has a swallowing disorder. Sometimes swallowing is not impaired, but the patient refuses food for other reasons (e.g., anorexia nervosa or other psychiatric conditions). Recently, I had such a case in my practice. I was examining an elderly patient before tube insertion and discovered that she had a dislocated lower jaw. With that dislocation, swallowing was impaired. I reduced the dislocation, and her swallowing returned to normal. Unfortunately, such happy endings are extremely rare.
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Assess the patient’s condition before the procedure. If the blood pressure is below 70 mmHg, there is no point in placing the tube — nutrition and fluids will not pass from the stomach into the intestines. This is a dying, terminally ill patient. If the blood pressure is above 150, it should be lowered first. Also, make sure the patient is breathing adequately — oxygen saturation should be at least 80%.
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If the patient is conscious, explain the procedure to them and reassure them. Tell them that the doctor will not make any sudden or unexpected movements.
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The patient can be sitting or lying down — on the back or on the side. Position is not critical. The only important thing is that the head should not be tilted backward.
Step-by-Step Technique for Inserting a Nasogastric Feeding Tube
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Measuring the length.
The doctor measures the distance from the upper part of the abdomen (the epigastric region) to the earlobe — this is usually about 45–50 cm. A mark is made on the tube (if not already printed). I usually place a piece of adhesive tape at this point. -
Lubrication.
The distal (far) end of the tube is lubricated with any oil to ease sliding. I usually use sunflower oil. -
Insertion through the nose.
The tube is gently advanced into the nasal passage. If the patient is conscious, I say: «Swallow, swallow.» If the patient is unconscious, the doctor slowly advances the tube while watching for coughing or cyanosis (which would indicate entry into the trachea). -
Advancing to the mark.
Gradually the tube reaches the desired mark. At this point, it is most likely in the stomach. However, keep in mind that during advancement the tube may bend, coil into a loop, or enter the trachea — and in severely ill patients, coughing may not occur even if it goes into the airway. -
Checking the position (the most critical step).
You must confirm that the tube is in the stomach, not in the respiratory tract. To do this:-
Auscultation: Inject 20–30 mL of air through the tube while listening with a stethoscope over the stomach area. A characteristic «splashing» sound confirms correct placement.
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After hearing the right sound, inject about 50 mL of water and again listen over the stomach. During water injection, there should be no coughing and no water appearing in the mouth.
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Then inject another 50 mL of air and listen once more.
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Fixation.
The tube is securely taped to the nose wing and cheek with adhesive tape (avoiding tension). Personally, I prefer to secure the tube with a bandage wrapped around the head.
Feeding.
How and what to feed the patient through the tube — I have written about that here .
Dr S.Pobedinskiy