Nasogastric NG Tube Insertion OSCE Guide
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punam todkarNasogastric (NG) Tube Insertion – OSCE Guide
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Dr Lewis Potter
This nasogastric (NG) tube insertion guide provides a step-by-step approach to
performing NG tube insertion in an OSCE setting with an included video demonstration.
Download the NG tube insertion PDF OSCE checklist, or use our interactive OSCE
checklist. To learn more about confirming NG tube placement, check out our guide.
Gather equipment
Gather the relevant pieces of equipment and place into a tray:
Nasogastric tube (fine bore)
Disposable gloves
Lubricant and gauze: to lubricate the tip of the NG tube.
Disposable bowl: to be used in the event of vomiting.
Paper towels: to allow the patient to wipe around their mouth if needed.
Large syringe: to obtain an aspirate from the NG tube.
pH testing strips: to assess the pH of the aspirate.
Dressing: to secure the NG tube.
A glass of water for the patient (if swallow is deemed safe).
Local anaesthetic spray: to numb the oropharynx.
Gather equipment
Introduction
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Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Confirm the patient’s name and date of birth.
Briefly explain what the procedure will involve using patient-friendly language: “At the
moment you’re having trouble swallowing food in the normal way. Because of this, we
need to place a fine tube through your nose going into your stomach to allow us to
provide you with nutrition. The procedure will be uncomfortable, but it shouldn’t be painful
or take very long. If at any point it becomes too uncomfortable and you want me to stop,
just tap on my arm.”
Gain consent to proceed with NG tube insertion.
Check if the patient has any allergies (e.g. latex).
Ask the patient if they have any pain before continuing with the clinical procedure.
Position the patient sitting comfortably on a chair or bed.
If a patient has suffered head trauma and a base of skull fracture has not been ruled
out, NG tube insertion should be avoided due to the potential risk of entering the
cranial vault.
You might also be interested in our OSCE Flashcard Collection which contains over
2000 flashcards that cover clinical examination, procedures, communication skills
and data interpretation.
Measurement of the insertion length
1. Position the patient sitting upright with their head in a neutral position.
2. Don a pair of non-sterile gloves.
3. Estimate how far the NG tube will need to be inserted: measure from the bridge of the
nose to the ear lobe and then down to 5cm below the xiphisternum.
Position the patient sitting upright
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Don gloves
Measure the NG tube from the bridge of the nose -> to the ear lobe -> to 5cm below
the xiphisternum
Measure the NG tube from the bridge of the nose -> to the ear lobe -> to 5cm below
the xiphisternum
Note the insertion length
Insertion of the NG tube
1. Lubricate the tip of the NG tube.
2. If available, a local anaesthetic should be sprayed towards the back of the patient’s
throat.
3. Warn the patient you are about to insert the NG tube.
4. Insert the NG tube through one of the patient’s nostrils.
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5. Gently advance the NG tube through the nasopharynx:
This is often the most uncomfortable part for the patient.
If resistance is met, rotating the NG tube can aid insertion. Avoid forcing the NG
tube if significant resistance is encountered.
If the patient becomes distressed, pause to give them some time to recover.
Intermittently inspect the patient’s mouth to ensure the NG tube isn’t coiling within
the oral cavity.
6. Continue to advance the NG tube down the oesophagus: ask the patient to take some
sips of water and then swallow as this can facilitate the advancement of the NG tube.
Avoid giving patients a drink if their swallow is deemed unsafe, due to the risk of
aspiration.
7. Once you reach the desired nasogastric tube insertion length, fix the NG tube to the
nose with a dressing.
Lubricate the tip of the NG tube
Gently insert the NG tube into the nostril
Advance the NG tube to the desired length
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Inspect patient's mouth for evidence of coiling
Secure the NG tube
Aspiration of the NG tube
1. Attempt to aspirate gastric contents:
If aspiration is successful, test the pH: a value of <4 suggests correct placement.
If aspiration is unsuccessful or the pH is >4 the patient will require a chest x-ray
(CXR).
Some hospitals require a CXR regardless of pH, so check your local guidelines.
Acceptable pH ranges also vary between hospitals, so always check your local
guidelines.
2. Once the NG tube is deemed safe for use, the radiopaque guidewire can be removed.
Attempt to aspirate gastric contents and assess pH
Close the NG tube port
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Dispose of the used equipment
Wash your hands
To complete the procedure…
Explain to the patient that the procedure is now complete and reassure them that the
NG tube will become more comfortable over the next few hours.
Thank the patient for their time.
Offer the patient paper towels to clean their face and nose.
Dispose of used equipment, including PPE, into a clinical waste bin.
Wash your hands.
Let the nursing staff know if the NG tube is currently safe to use.
Document the details of the procedure in the patient’s notes:
Your personal details including your name, job role and GMC number.
The date and time the procedure was performed.
Confirmation that verbal consent was obtained.
The indication for NG tube insertion.
The insertion length of the NG tube.
The pH of the aspirate or the failure to obtain an aspirate.
CXR interpretation (if performed): “NG tube visible dissecting the carina and sitting
below the left hemidiaphragm”.
Any complications experienced during the procedure.
Whether the NG tube is currently safe to use.
Reviewer
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Dr Ally Speight
Consultant Gastroenterologist
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