The client has orders for a nasogastric (NG) tube insertion. During the procedure, instructions that will assist in the insertion would be:
A. Instruct the client to tilt his head back for insertion in the nostril, then flex his neck for the final insertion.
B. After insertion into the nostril, instruct the client to extend his neck.
C. Introduce the tube with the client’s head tilted back, then instruct him to keep his head upright for final insertion.
D. Instruct the client to hold his chin down, then back for insertion of the tube.
Correct Answer: A. Instruct the client to tilt his head back for insertion in the nostril, then flex his neck for the final insertion.
NG insertion technique is to have the client first tilt his head back for insertion into the nostril, then to flex his neck forward and swallow. A common error when placing the tube is to direct the tube in an upward direction as it enters the nares; this will cause the tube to push against the top of the sinus cavity and cause increased discomfort. The tip should instead be directed parallel to the floor, directly toward the back of the patient’s throat.
Option B: Extension of the neck will impede NG tube insertion. The patient can be given a cup of water with a straw in it to sip from to help ease the passage of the tube. The tube should be advanced with firm, constant pressure while the patient is sipping. If there is a great deal of difficulty in passing the tube, a helpful maneuver is to withdraw the tube and attempt again after a short break in the contralateral nares as the tube may have become coiled in the oropharynx or nasal sinus.
Option C: In intubated patients, the use of reverse Sellick’s maneuver (pulling the thyroid cartilage up rather than pushing it down during intubation) and freezing the NG tube may help facilitate placement of the tube. Once the tube has been inserted an appropriate length, typically around 55 cm as previously noted, it should be secured to the patient’s nose with tape.
Option D: Nasogastric tubes are, as one might surmise from their name, tubes that are inserted through the nares to pass through the posterior oropharynx, down the esophagus, and into the stomach. The most common complications related to the placement of nasogastric tubes are discomfort, sinusitis, or epistaxis, all of which typically resolve spontaneously with the removal of the nasogastric tube.
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