Nasogastric tube placement

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Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.
Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.
Esophagus anatomy and nomenclature based on two systems.


  • Severe facial trauma (due to possible cribriform plate disruption)

Relative Contraindications

Equipment Needed

  • PPE
  • NG Tube- typically a 16F or 18F Sump
  • Syringe/Bulb - 50-60cc
  • Tape
  • Emesis basin
  • Cup of water with straw


Nasogastric tube below the diaphragm and in the stomach in correct position as seen on CXR (bottom arrow).
  1. Consent by informing patient of risk, benefits, and alternatives
  2. Position patient upright
  3. Place towel over patient's gown and emesis basin in lap
  4. Estimate length of insertion
    • A standard of 56cm is reasonable[1])
    • Alternatively measure from tip of nose to earlobe to xyphoid and then add 15cm
  5. Check nares for obstruction and pass through the most widely patent nare
  6. Provide relief from discomfort
  7. Insert tube along floor of nose under inferior turbinate
  8. Pause when NGT is in OP
  9. Flex neck to decrease chance of tracheal passage
  10. Advance into esophagus
    • Sipping water may aid in esophageal passage
    • Withdraw to OP promptly if excessive coughing, gagging, choking or voice change
  11. Once NGT is in esophagus, rapidly insert rest of tube to pre-measured length
  12. Confirm placement
    • Insufflate air while listening over stomach
      • One study shows this discovers only 6% of malplacement[2]
      • Should not be primary confirmation technique[3]
    • Obtain abdominal xray
    • Check pH of aspirate
      • pH<5.5 in 99% of cases and has sen of 0.78 and spec of 0.86 at or below this level[4]
  13. Secure to patients nose with tape
  14. Attach to desired suction, not to exceed 120 mmHg


  • Pulmonary placement
  • Intracranial placement
  • Increased cervical and cranial pressures with gagging/vomiting
  • Epistaxis
  • Invagination of stomach lumen into eyes of NGT

See Also

External Links



  1. Phillips DE, Sherman IW, Asgarali S, and Williams RS. How far to pass a nasogastric tube? Particular reference to the distance from the anterior nares to the upper oesophagus. J R Coll Surg Edinb. 1994; 39(5):295-296.
  2. Neumann MJ, Meyer CT, Dutton JL, et al. Hold that x-ray: aspirate pH and auscultation prove enteral tube placement. J Clin Gastroenterol. 1995; 20(4):293-295.
  3. Christensen M. Bedside methods of determining nasogastric tube placement: a literature review. Nurs Crit Care. 2001; 6(4):192-199.
  4. Boeykens K, Steeman E, Duysburgh I. Reliability of pH measurement and the auscultatory method to confirm the position of a nasogastric tube. Int J Nurs Stud. 2014; 51(11):1427-1433.