Nasogastric Tube insertion


  • Aspiration of stomach contents to decompress the stomach of fluid, air, or blood.
  • Introducing fluids to the stomach such as charcoal, enteral feeding and oral contrast media.
  • Reducing the risk of vomiting or aspiration such as in bowel obstruction
  • Sometimes used to in still air into the stomach to detect a gastric perforation on erect CXR


  • Caustic ingestion or esophageal strictures (risk of perforation)
  • Coagulopathy (epistaxis risk)
  • Base of skull fracture
  • Severe mid-face trauma (risk of cribriform plate disruption with NGT entering the brain!)

Handy hints:

  • Coagulopathy or facial trauma, consider an orogastric tube placement.
  • Ameliorate the pain and gagging associated with tube placement by using vasoconstrictors (e.g. 0.05% oxymetolazine spray), topical anesthetics, and antiemetics — ALWAYS use these if time permits.
  • Withdraw the tube promptly into the oropharynx if the patient has excessive choking, gagging, coughing, a change in voice, or the appearance of condensation on the inner aspect of the tube
  • Suspect an esophageal location if the patient immediately burps upon insufflation when checking position.
  • Do not attempt to re-use a NGT that has already used for a failed insertion. Use a fresh tube from the fridge (the colder the better), as these are more rigid and less pliable, and are therefore easier to pass.
  • Nebulised lignocaine (4 mL of 10%) or lignocaine lubricating gel should be administered prior to insertion of the tube to reduce discomfort and increase patient compliance.
  • DO NOT use the NGT for any fluid administration until CXR confirmation of position.
  • If the tube continually curls up in the pharynx, flex the patient’s neck as much as possible and re-insert, which may change the angle sufficiently to pass an obstruction
  • Options if unable to place NGT (unconscious patient)
    • Use McGills forceps
    • Use ETT with a slit in the lesser curvature as guide
    • Use soft well lubricated NPA
    • Anterior manipulation of laryngeal cartilage
    • Fibreoptic scope placement using guidewire

Nasogastric tube images

Correct nasogastric placement

Coiled oesophageal nasogastric tube

NGT coiled in Hiatus Hernia

NGT in right main bronchus (RMB)

NGT in lateral ventricles

Print Friendly