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Insertion of a Nasogastric Tube

  • All premature and newborn babies should have size 6 Fr nasogastric tube. The size should be small to avoid blocking respiration, to avoid damage on mucous membranes and to reduce the discomfort and irritation of the feeding tube.
  • If the baby is in respiratory distress, needs oxygen therapy, has other problems with breathing or is less then 1000 grams, the nasogastric tube is to be placed in the mouth as orogastric tube. For everyone else, the tube is to be placed in the nose.

PROCEDURE​

  • When inserting a nasogastric tube there should be two nurses present. One nurse to administrate dextrose 10 % and support the baby, while the other nurse inserts the nasogastric tube. Swaddle the baby, and position the baby supine or on the side.
  • Before insertion of the nasogastric tube make sure you have all needed equipment present:

- Dextrose 10% / Sucrose 25% cotton wick

- Nasogastric tube, size 6 Fr

- 5 ml syringe

- Adhesive tape

- Gloves

- Stethoscope

  1. Clean hands
  2. Administer Dextrose 10% / sucrose 25% over cotton wick.
  3. Measure the distance of the tube; Place the tip of the tube at the tip of the nose, down to base of ear lobe, and down to the tip of the xiphoid process. Measure the distance while the tube is still in its cover, to maintain a clean procedure and then mark the tube with an ink pen.
  4. Open the tube, syringe and gloves packages without touching the sterile content.
  5. Put on gloves and attach the syringe to the tube with the non-dominant hand.
  6. If needed, lubricate the tube with mother's milk or baby's own saliva.
  7. Gently insert the tube in the nose or orally until correct position is reached. Never force the tube.
  8. If baby becomes distressed or unstable, remove the tube immediately and try again once the baby is stabile.
  9. Verify the placement of the tube by aspirating the content.
  10. If no aspiration appears, a small amount of air (2 ml) during auscultation can be injected. Be aware that this is not a reliable procedure as the tube might still be in the lungs.
  11. Secure the tube with tape.
  12. Observe baby carefully during the feed.

References​

  • Neonatal Intensive Care by Merenstein and Gardner (2011),
  • Comprehensive Neonatal Nursing Care by Kenner and Lott (2014)
  • Practical Procedures for the Newborn Nursery, A Manual for Physicians & Nurses, by Deorari, Paul, Singhal, Scotland and McMillan, Third Edition (2010)
  • Oslo University Hospital Procedure on Insertion of a Nasogastric Tube (2013)

Document Information​

Current Version

Version: 2.0
Published: August 20, 2015
Revised by: Johanne M. E. Huurnink, Dr Chetan Meena
Contributors: Nurse Meena Nair and Nurse Helene Bjornstad
Previous Versions: v1.0