Page 207 - 2026 SMOG

NASOGASTRIC AND OROGASTRIC TUBE INSERTION
Clinical Indications
• Enabling gastric decompression, decreasing the risk of vomiting and aspiration, and obtaining a
sample of gastric contents
• Allows for gastric lavage in drug overdose or poisoning
Contraindications
• Nasogastric tubes are contraindicated in the presence of massive facial trauma or suspicion of
basilar skull fracture (CSF otorrhea, Battle’s sign, raccoon eyes, mechanism). May insert an
orogastric tube instead
Procedure
• If possible, sit the patient upright for optimal neck and stomach alignment.
• Measure tubing from the bridge of the nose to the earlobe, then to the point halfway between
the end of the sternum and the navel. Mark the measured tube with a marker
• Select the most patent nare (or the throat) and pass a lubricated tube in a posterior—NOT
SUPERIOR—direction. If resistance is met, attempt to corkscrew slightly or remove and
attempt in the other nare.
• Withdraw the tube immediately if changes occur in the patient’s respiratory status, if the tube
coils in the mouth, if the patient begins to cough, or if the patient becomes cyanotic.
• Advance the tube until the mark is reached.
Confirmation
1. Position the stethoscope over the patient’s stomach (about 2 inches below the sternum)
2. Inject air into the tube and check for gastric sounds (confirm with 2nd provider if needed).
a. 10mL of air for Nasogastric
b. 30–60mL of air for Orogastric
3. Visual assessment of aspirate color and volume.
a. Gastric aspirate appears cloudy, green, tan, off-white, or brown
b. Lung aspirate is usually clear and in a small volume
4. Check the pH of the aspirate if possible
5. X-ray confirmation

2026 Standard Medical Operating Guidelines (SMOG) • 199