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PROTOCOL ON INSERTION OF A NASOGASTRIC TUBE

Aims​

Administering medications and nutrition to neonates who are unable to eat normally.

Responsible​

Doctors and nursing staff

Indications​

  • Babies less than 1500 grams should have a size 6 Fr tube
  • Babies over 1500 grams should have a size 6 or 8 Fr tube
  • If the baby is in respiratory distress, needs oxygen therapy, have other problems with breathing or is under 1000 grams, the nasogastric tube is to be placed in the mouth. 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:

  • Dextose 10% / Sucrose 25%
  • Nasogastric tube
  • 2, 5 ml syringe
  • Tape
  • Sterile gloves
  • Stethoscope
  1. Clean hands
  2. Administer Dextrose 10% / Sucrose 25%
  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.
  4. Open the tube, syringe and gloves packages without touching the sterile content.
  5. Put on gloves and attach the syrige to the tube with the nondominent hand.
  6. If needed, lubricate the tube with mothers milk or babys 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 immidiately 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.

Change short term (PVC) nasogastric tubes every 3-4 days.

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​

Archived Version

Version: 1.0 (Archived)
Published: August 3, 2015
Contributors: Nurse Meena Nair and Nurse Helene Bjornstad
View: Current Version