Nasogastric tube insertion: Purpose, Procedure, Benefits and Side Effects

A short, thin tube is inserted through the nose, down the throat, and into the stomach during a surgery called a nasogastric (NG) tube insertion.The tube may be used to provide nutrition such as liquids and medication or to remove stomach contents.

There are two main types of Nasogastric tube insertion:-

• Blind insertion: The most popular method for inserting a nasogastric tube is called blind insertion. A nasogastric tube is inserted through the nose and into the stomach during this procedure.This method is considered to be relatively safe if done adequately, but it can cause complications such as epistaxis (nosebleeds) and esophageal perforation.
• Radiologic insertion: Radiologic insertion of a Nasogastric tube uses imaging guidance from an x-ray or ultrasound to make sure that the tip of the tube ends up in the stomach without damaging any other structure such as the lungs or heart. This technique is much more accurate than blind insertion, due to its ability to verify where exactly the Nasogastric tube is going before pushing it further into place.

• Allows for accurate delivery of medications and nutrition directly into the stomach.
• Reduces risk of aspiration.
• Allows for quicker, more efficient introduction of nutrition compared to other methods.
• Allows for ease of periodic review of gastrointestinal contents and reduction in discomfort caused by frequent suctioning or vomiting.
• Can be used for short-term or long-term nutritional support depending on patient needs.

• Nasogastric (NG) tube insertion is commonly performed on patients suffering from certain medical conditions that require nutritional support, or to remove accumulated fluid from the stomach.
• It may also be used for investigative purposes, such as to obtain gastric contents for analysis or to avoid further contamination of the stomach.
• In addition, it is sometimes used as a diagnostic tool to examine the contents of the stomach in order to confirm a diagnosis or check for any foreign bodies in the gastrointestinal tract.

The main risks associated with nasogastric tube insertion include:

• Infection
• Esophageal or nasal trauma.
• Gastric irritation from frequent tube insertion.
• Aspiration of gastric contents into the lungs.
• Air embolism due to incorrect placement of tubing.
• Misdiagnosis and improper treatment of underlying conditions.

• Dress in comfortable clothing.
• Empty your stomach by drinking clear liquids and/or taking laxatives.
• Take any pre-procedure medications prescribed by your doctor.
• Remove dentures, jewellery, and any other objects from the mouth or nose.
• Lie down on your back with or without pillows as instructed by the doctor.
• Remain still during the procedure.
• Follow the instructions of medical staff during the procedure.

The process begins with lubricating the end of an NG tube with water-soluble jelly or petroleum jelly. The practitioner then puts one hand on top of the patient’s forehead while placing two fingers below the side of the nose near their cheekbone to stabilise it. Once inserted, they check if it has gone in properly by aspirating and measuring pH levels. After successful placement is confirmed, practitioners then secure and dress the tube for continued use.

• Assembling the tools required for the task.
• The patient should be positioned in a relaxed manner.
• Sterile barriers such as gloves, gown and mask should be applied.
• Nasogastric tubes should be inspected for any signs of damage.
• Site of insertion should be marked prior to the procedure.
• Sufficient lubricant must be obtained.

• Skin at the site of insertion should be cleansed with antiseptic solution.
• Tube must then be inserted gently through the nose, passed down into the stomach.
• Care must be taken during passage to avoid irritation or trauma to surrounding tissue.
• Proper placement of the tube must then be confirmed with an X ray.

• A sample from the gastric contents can thereafter be obtained for analysis. The patient's vital signs must also be monitored after the procedure.
• The occlusion port and cuff on nasogastric tube must also be checked periodically and sutures may need applying depending on the design of the tube.
• The patient's skin may need to be monitored at site regularly for any signs of irritation or injury.
• Finally, equipment used during the procedure needs to be covered in an appropriate manner before being disposed of safely.

The cost of Nasogastric tube insertion in India will depend on the treatment centre and hospital involved. Usually, costs range anywhere from 1,500 INR to 5,000 INR.

• It is recommended that you start with soft, bland foods such as broth, yoghurt, applesauce, mashed potatoes, and toast after a nasogastric tube insertion.
• It's critical to pay attention to your body's cues and consume food only when you're satisfied.
• Although it is recommended that you avoid raw vegetables and red meat following a nasogastric tube insertion, moderate amounts of cooked vegetables and lean proteins are generally allowed.
• Other items to avoid include acidic foods (e.g., oranges) as well as high-fibre or chewy foods (e.g., celery).

Yes, nasogastric tube insertion is generally considered safe when performed by trained medical professionals. It is a common procedure used to provide nutrition and medication and to remove fluids from the stomach. Proper technique and continued monitoring of the tube can help reduce the risk of these potential side effects.

Recovery time after a nasogastric tube insertion can vary depending on the cycle of feeding and medications that the patient is following. Generally, recovery for all patients should be complete within a couple of days with many patients reporting feeling normal again within 24 hours.

The most common side effects of Nasogastric tube insertion are:

• Mild pain, such as a pressure or fullness in the abdomen.
• Nausea, vomiting and abdominal bloating.
• Local inflammation due to skin contact with stomach acid.
• A slight possibility of infection at the insertion site.
• Abdominal pain or cramping (in extreme cases).
• Damage to nearby organs if the tube is incorrectly placed.

• As much as possible, keep your head up to lessen pain at the insertion site.
• Keep an eye out for any infection-related symptoms including swelling, redness, or discharge close to the insertion site.
• Drink plenty of fluids to replace potential fluid lost during the procedure and help prevent constipation.
• Avoid vigorous exercise, heavy lifting or strenuous activities until after reviewing with the doctor which activities are safe to do again.
• Follow any changes in diet prescribed by your doctor or health care provider.
• Monitor medications used to manage symptoms related to your condition closely and inform your doctor if they are not working as expected or if you experience any side effects from them.
• After the removal of the nasogastric tube, report any unexpected discomfort, increased bleeding, fever, vomiting, or diarrhoea right away to your medical team.

Nasogastric tube insertion is a useful and safe procedure for providing nutritional support, administering medications, and delivering various treatments. When done correctly, the procedure has minimal risk for complications.