NG tube placement
Formal Definition
Nasogastric (NG) tube placement — the bedside procedure of inserting a flexible plastic tube through the nostril, down the nasopharynx and esophagus, into the stomach for gastric decompression, medication administration, enteral feeding (short-term), or gastric sampling/lavage; tube sizes vary by purpose (large-bore Salem sump for decompression, small-bore Dobhoff for feeding/medications); placement verification requires confirmatory radiography (KUB X-ray) before use, with the tube tip ideally positioned in the stomach/just past the GE junction.
How It's Used on the Ward
"NG tube" or "place an NG" — the patient needs a tube from nose to stomach; large-bore (Salem sump) for decompression (suction air/fluid out during bowel obstruction or ileus); small-bore (Dobhoff) for feeding or medications; placement is verified with an X-ray before use to make sure it's in the stomach and not in the lungs.
Example
""Patient with N/V and abdominal distension concerning for bowel obstruction, CT confirms SBO. Surgeon: 'Place a Salem sump NG to low wall suction — we need to decompress the stomach and prevent aspiration while we figure out whether this needs surgery. Verify placement with an abdominal X-ray before hooking it up to suction.' Nurse inserts, confirms pH of return is acidic (often a first-line verification), X-ray confirms tip in stomach, suction started to low intermittent wall suction.""
Clinical Context
Indications for NG: gastric decompression (ileus, bowel obstruction, post-op nausea/vomiting, severe abdominal distension), enteral medication administration (antipsychotics, antibiotics when NPO), short-term enteral nutrition (Dobhoff for medications/small-volume feedings), gastric lavage (active GI bleeding for evacuation), specimen collection. Insertion process: (1) Patient positioning (sitting up, neck flexed forward), (2) Measure length (nose to ear to xiphoid), (3) Lubricate tip, (4) Advance through most patent nostril along the floor of the nasal cavity, (5) Patient sips water through a straw while tube is advanced to facilitate swallowing, (6) Confirm placement: (a) pH of aspirate (<5.5 suggests gastric placement), (b) capnography/capnometer negative for CO2, (c) chest X-ray (KUB) showing tube tip below diaphragm in the stomach. Verification before use: any tube used for medications/feeding must be radiographically confirmed; pH alone isn't sufficient for definitive verification. Risks: nasopharyngeal trauma (epistaxis), malposition (most commonly in the lung — feeding through mispositioned NG is a fatal event), aspiration of tube feedings, sinus infection, longer-term: erosive injury, esophageal stricture. Complications significantly decrease with experienced operators and proper technique.