Naso gastric/ Oro gastric

tube
Dr. Sandya
KIMS hospital
Oro gastric tubes:
neonates are obligatory nasal breathers.
helps to stimulate sucking
Nasogatric tubes:
best for indwelling tube
use pacifier to stimulate sucking
Nasojejanal tubes:
for continuous infusion of feed
Nasogastric tube/ orogastric tube:

Indication:

For feeding or administering medication in Neonate unable to maintain

adequate nutrition by breast/bottle feeding e.g. preterm, respiratory
problems.
Decompression: Neonate ventilated or on NCPAP
 Appropriate size nasogastric tube.

Wt. Based criteria

Size 4-5 for weight <1Kg
Size 5 for weight 1K 1.5Kg and
Size 6 for weight >1.5Kg
For babies > 3.5Kg you may consider using a size 8 tube

Age based criteria

5Fg feeding tube for all infants 34 weeks gestation or < 1750gms.
6Fg feeding tube may be used if infant > 35 weeks.
8Fg tube on free drainage is generally used to aid gastric decompression in infants
with abdominal distension or following surgery
Procedure:

Measurement:
Measure the length of tubing from the infants nose to the infants ear lobule
and then to the point midway between the xiphoid and umbilicus (this was
established as a more accurate measurement than the traditional
measurement up to xiphoid process)
anthropometric measurements for accurate estimation of gastric tube
insertion:
Orogatric tube placement Length = 3 X weight (kg) + 12
Nasogastric placement Length =3 X weight (kg) + 13
 Method of insertion:
assemble all the required equipment
appropriate size feeding tube
2 cc or 5 cc syringe
stethoscope
tape
Donot leave catheter under radiant warmer light for ANY length of time as it
becomes too soft for insertion
 Flex the newborns chin on the chest to facilitate passage
The tube may be lubricated with sterile water. Insert tube to the distance
measured through the mouth or nares pointing downwards
Monitor the neonates heart rate and colour during the procedure
After desired placement has been reached confirm with the tape(avoid occlusion of
nares)
Confirm the tube position
Perform aspiration/feeding
Document the size of catheter used, time of insertion and distance fixed at and
amount of aspirate or residue obtained.
What can go wrong here??

Gastric tube can be misplaced into trachea or oesophagus leading to

aspiration and pneumonia.
Gastro-oesophageal reflux.
Vasovagal response on passage of tube resulting in apnoea, bradycardia and
cyanosis.
Nasal, pharyngeal and oesophageal trauma.
Trauma to skin underlying tube fixation device.
Gastric tube malpositioned following coughing or retching during feed.
Gastric tube embedded in the gastric wall.
Feeding tube passes down the right main
stem bronchus and to the base of the R lung.
Confirmation of ng/og tube position

Regardless of the method of measurement, the position of a tube should be

confirmed prior to beginning a feeding.
Radiography remains the gold standard
However, repeated x-rays for confirming gastric tube placement in neonates
is unrealistic and carries its own risks due to the frequency that these x-rays
would be required
 Initial assessment of placement will be verified by x-ray and/or pH of gastric
contents.
Ongoing assessment:
pH measurement, external tube length, and/or clinical condition of patient
If x-ray is obtained for another clinical reason, NG/OG location should be
verified.
The following methods MUST NOT be
used:
Auscultation of air insufflated through the feeding tube (whoosh test) There
are many reports on the ineffectiveness of this method. In several cases,
results indicated correct tube placement but feeding was started with
disastrous results.
The auscultation method requires staff to distinguish between air passed
through the tube via the oesophagus into the stomach, and air passed via the
main bronchus into the lungs; a position not anatomically far from the
stomach
Testing acidity/alkalinity of aspirate
using blue litmus paper
Universal pH testing paper or strips are recommended for testing the
acidity/alkalinity of aspirate, rather than litmus
Blue litmus paper is not sensitive enough to distinguish between bronchial and
gastric secretions.
Interpreting absence of respiratory distress as
an indicator of correct positioning

Observing for signs of respiratory distress is ineffective in detecting a

misplaced tube. Small bore tubes can enter the respiratory tract with few, if
any, symptoms and large bore tubes can enter a patients respiratory tract
without any symptoms being shown initially.
 Monitoring bubbling at the end of the tube :
Looking for bubbling at the proximal end of the tube is unreliable because
the stomach also contains air and could falsely indicate gastric placement.
Observing the appearance of feeding tube aspirate :
Research and anecdotal evidence indicate that relying on the appearance of
feeding tube aspirate is unreliable as a primary testing method as gastric
contents can look similar to respiratory secretions
Documentation

1. Initial placement of tube

a. Type of tube
b. Size
c. Location
d. External length measurement
e. Purpose of tube (activity)
f. Method of placement confirmation, including pH measurement
g. Tolerance of insertion procedure
h. Pain management strategies employed
2. Ongoing verification of placement
a. Type of tube
b. Size
c. Location
d. External length measurement
e. Activity of tube
f. pH measurement
g. Any changes in clinical condition
3. Removal
a. Patients tolerance of procedure
Distance A: Measure from nostril to ear and then down to
the xiphisternum. This equals length A, for insertion of a
nasogastric tube into the stomach.

Distance B: Measure the distance from the bridge of the

nose down to an ankle with the leg fully extended. This
Distance B is length B, for placing a nasojejunal tube into
the jejunum
Nj tube

A naso-jejunal tube is a long silastic tube which is inserted via the nostril into
the stomach, through the pylorus, past the duodenum and into the proximal
part of the jejunum.
Once in the correct place, milk feeding can be commenced safely without the
risk of reflux as the stomach is effectively bypassed.
Gut peristalsis moves the feed along the small bowel where it is digested and
absorbed by the child.
Feeding can only be given by continuous infusion as there is no capacity for
storage in the small bowel.
Indications:

Severe gastro-oesophageal reflux disease

Life threatening episode of aspiration related to reflux
Rarely, anatomical problems of stomach or oesophagus
Risks

: Small bowel perforation especially duodenal perforation

Gastric bleeding
NJT displacement e.g. back into stomach
Failure of NJT to pass beyond pylorus with resultant coiling in stomach
Radiation exposure from serial X-rays
Thank you