A nasogastric tube is inserted in the intensive care unit (ICU)
for a variety of reasons including gastric emptying, drainage, and
- ▪ Nasogastric tube (NG): A tube passing through the
nose, pharynx, and esophagus, with the distal tip in the stomach.
- ▪ Indications:
- —Nasogastric drainage in various setting:
- • Ileus
- • Following abdominal surgery
- • To prevent regurgitation
- —Administration of certain drugs directly into
- • Activated charcoal in the event of a drug
- —Diagnosis of ingested substance (ie, when
it is unclear what patient has ingested).
- —Enteral feeding:
- • In a patient with an endotracheal tube.
- • In a patient who is unable to protect airway.
- ▪ Contraindications:
- —Head trauma
- —Esophageal surgery or stricture
- —Deviated septum
- ▪ Technique:
- —When possible identify more patent nasal passage
by having patient sniff through each nasal passage.
- —Position patient:
- • If awake, the patient should be placed in
a head-up position.
- • If unconscious, the patient should be placed
in a supine position.
- —Lubricate NG tube and advance into nose, aiming
for the ear.
- —As tip of tube passes into nasopharynx, encourage
awake patient to swallow to facilitate passage of tube into esophagus—it
may be appropriate to have patient drink through straw during the procedure.
- —Advance tube to premeasured depth corresponding
to mid gastric position of the tip (Figure 42-1).
- —Verify tube position by aspiration of gastric contents,
audible bubbling on auscultation over stomach when air injected
into tube, and/or abdominal flat plate x-ray (Figure 42-2).
- —Secure NG tube to nose with tape.
- ▪ Complications
- —Perforation of cribriform plate
- —Esophageal perforation
- —Tracheal intubation with NG tube (Figure 42-3)
Graphic showing NG tube position in stomach.
Abdominal flat plat showing NG tube coiled in stomach.
Chest x-ray showing NG tube in right lung.
Clinical Pearls and Pitfalls
- ▪ NG tube should
be very well lubricated to prevent mucosal abrasion.
- ▪ Patient should
be able to speak following placement—if unable, NG tube
may be between vocal cords.
- ▪ In unconscious
patients, tube insertion may be guided with fingers, laryngoscopy,
or laryngeal manipulation.
- ▪ Do not tape
tube too tightly to nose to prevent alar injury.
Thomsen TW, Shaffer RW, Setnik G. Videos in clinical medicine.
Nasogastric intubation. N Engl J Med. 2006;354:e16.