nasogastric tube insertion

 Ryle's Tube Insertion 

Ryle's tube provide access to nasogastric tract for introduction of nutrition, medication and aspiration of stomach content.

A clean tray containing;

1 Ryle's Tube 

1 pair gloves

1 50 cc Syringe

Lubricant jelly; Lidocaine (Xylocaine)

Tape; to secure NG tube

Stethoscope

Glass of water for patient 

1. Position the patient sitting upright with their head with support pillow.

2. Estimate the NG tube will be inserted; measure from the bridge of the nose to the ear lobe and then down to 5cm below xiphisternum.

3. Lubricate the end of the nasogastric tube lubricants jelly. Gently insert the tip of the tube into the nose and slide along the floor of the nasal cavity.

4. When NG tube enters the oropharynx and glides down the posterior pharyngeal wall, patient may gag; if patent is awake, asked to mimic swallowing or given sip of water through a straw (if swallow is deemed safe) and tube continues to be inserted as the patient swallows. 

5. Once the tube down to  pharynx and enters the esophagus, it is easily inserted down into the stomach. After desired nasogastric tube insertion length, fix the NG tube to the nose with a dressing. The NG tube must be secured in place to prevent it from moving. 

6. Confirm the Ryle's tube placement.

7. Documenting the patient's file.

NG Tube Placement

Confirm Ryle's tube insertion by following methods;

1. Place a stethoscope over the patient’s epigastrum and auscultate while instilling a 50 cc air bolus using an irrigation syringe (air enters the stomach when a whooshing sound is heard).

2. Use an irrigation syringe and aspirate gastric contents

3. Place the lower the open end of the NG tube into a cup of water (bubbles indicate that the tube is in place)

4. Chest X-ray; to confirm placement 

5. Ask the patient to hum or talk (coughing or choking; indicates tube is properly placed)

NG tube Removal

Instruct to patient sit up.

Clear the NG tube by 20ml of air in tube for prevent risk of aspiration of tube feed falling out of tube.

Cape the tube.

Untape tube from nose.

Gently, smoothly pull tube out.