Page 67 - PJ MED OPS Handbook 8th Ed

Nasogastric Tube
Indications:
1. Gastric decompression for ileus (bowels not moving due to any cause), spinal injury, abdominal
trauma, acute abdomen, burn cases with PFC, GI bleeding, electrocution, intractable vomiting,
intubated patient, aeromedical evacuation for severe trauma.
2. Feeding and hydration in extended care setting if patient is unable to swallow and IV/IO not
available or preferred.
WARNING NG tube placement is contraindicated in patients with suspected fractures of the
cribiform plate, basilar skull, or open skull fractures. If an NG tube is needed it may be
passed orally.

NOTE: NG tube will most likely be used in a prolonged field care setting. For intubated casu-
alties, orogastric tube is recommended.

Equipment:
1. NG Tube and water-soluble lubricant (viscous lidocaine preferred)
2. 5cc syringe and tape
3. 60cc syringe (for aspiration)

Procedure (NG Tube):
1. Using the NG tube: Measure the distance from the bottom of the xiphoid process, to the ear
lobe, to the tip of the nose. This will determine length of NG to be inserted.
2. If conscious, lidocaine jelly can be used as a lubricant or topical anesthetic for the nasal cavity
(applied via cotton-tip applicator). Once anesthetized, have the patient breathe through his/
her mouth. Insert lubricated NG tube through the larger nostril with angle of tube horizontal
(STRAIGHT BACK). NOT UP and SUPERIOR into the open portion of the nose.
3. Once distal end reaches posterior pharynx, slightly flex patient’s neck (if C-spine precautions
allow) and instruct to swallow quickly, tell them they will feel a tickle and keep swallowing. As
patient is swallowing, continue to insert tube until predetermined length is reached.
4. After insertion, verify placement by injecting air into the NG tube with the 60cc syringe while lis-
tening over the epigastrium with a stethoscope. If bubbling is heard, aspirate stomach contents
to verify placement and secure the NG tube with tape.
5. Clamp tube and use gentle suction intermittently with 60cc syringe, or leave it draining in a bag
to gravity in which case the tube and bag must be kept lower than the stomach. Clamp and inter-
mittent suction are probably the best operational option.
6. If using for hydration and feeding, reconfirm placement every time by listening with stethoscope
over epigastrium.

Chapter 6. Surgical and Medical Procedures n 65