Indications
- • Gastric decompression (bowel obstruction, ileus)
- • Enteral feeding
- • Gastric lavage / medication administration
Contraindications
- ⚠ Basal skull fracture (use orogastric)
- ⚠ Oesophageal stricture / varices (relative)
- ⚠ Recent upper GI surgery (discuss with team)
Equipment
- • Fine-bore feeding tube (10–12 Fr) or wide-bore Ryles (14–18 Fr)
- • Lubricant, glass of water with straw
- • pH paper
- • Catheter-tip syringe
- • Tape / fixation device
Technique
- • Measure NEX distance (nose-earlobe-xiphisternum)
- • Lubricate tip; patient sitting, head slightly flexed
- • Insert horizontally into nostril, advance along floor of nasal cavity
- • Ask patient to swallow water as tube reaches oropharynx
- • Advance to measured length
- • Aspirate gastric contents → pH ≤5.5 confirms gastric position
- • If unable to confirm, CXR with tip below diaphragm and bisecting carina
Complications
- ⚠ Misplacement into airway (pneumothorax if fed)
- ⚠ Epistaxis
- ⚠ Discomfort, sinusitis
- ⚠ Ulceration with long-term use
Aftercare
- • NEVER FEED without confirmed safe position (pH or CXR)
- • Document insertion length and confirmation method
- • Re-check position before each feed / 4 hourly
Clinical pearls
- • NPSA never event: feeding into lung from misplaced NG
- • CXR criteria: tube in midline below diaphragm, tip 10 cm beyond GOJ
Perform under supervision until competent. Follow local SOPs and consent policy.
