Assess the indications and contraindications for nasogastric tube insertion, explain the procedure and obtain informed consent from the simulated patient. Demonstrate safe nasogastric tube insertion on the provided mannequin, explain how placement is confirmed, and outline important complications and patient advice.

Indications: Enteral feeding when swallowing is unsafe but the gastrointestinal tract is functional, or gastric decompression in selected patients.

Safety: Exclude important contraindications, particularly suspected basal skull fracture or severe midfacial trauma; explain the procedure and obtain consent.

Technique: Position upright, measure the insertion length, lubricate and gently advance the tube through the nostril into the stomach.

Confirmation: Check gastric aspirate pH (safe range 1–5.5) or obtain an appropriately interpreted X-ray when required. Do not use the tube before confirming placement.

Completion: Secure the tube, explain discomfort and warning symptoms, document the procedure and communicate whether the tube is safe to use.

1. Assess suitability: Confirm the indication; check for facial or basal skull trauma, major nasal obstruction and significant esophageal pathology. Seek senior guidance if insertion is unsafe.
2. Explain and obtain consent: Inform the patient that a flexible tube will pass through the nose into the stomach. Explain temporary discomfort, benefits, important risks and the option to request a pause.
3. Prepare equipment: Perform hand hygiene, wear gloves, arrange the NG tube, water-soluble lubricant, syringe, gastric pH strips and fixation tape. Position the patient upright.
4. Measure insertion length: Estimate the length from the nose to the earlobe and down towards the xiphisternum, using the tube manufacturer’s recommended measurement technique. Mark the intended insertion length.
5. Insert on the mannequin: Lubricate the tip, advance gently along the floor of the selected nostril, and guide the tube posteriorly. Ask the patient to swallow when safe; stop if resistance, marked coughing or respiratory distress occurs.
6. Confirm placement: Obtain gastric aspirate and test with appropriate pH strips; pH 1–5.5 is acceptable under relevant safety guidance. If aspirate is unavailable, the pH is above 5.5 or uncertainty exists, arrange radiographic confirmation. Never rely on the air-insufflation or “whoosh” test.
7. Secure, counsel and document: Secure the tube after insertion, confirm safety before feeding or medication, explain warning symptoms and record the indication, consent, insertion length, position-check result, complications and instructions for use.

⚠️ Critical patient-safety point: Never administer feeds, fluids, medicines or flushes through an NG tube until correct placement has been confirmed and documented. Respiratory placement can cause life-threatening aspiration or pulmonary injury.

Nasogastric (NG) Tube Insertion — Geeky Medics

OSCE-focused demonstration of equipment preparation, patient positioning, insertion technique, tube fixation and placement assessment. Follow current institutional safety guidance for confirmation before use.

▶ Watch NG Tube Insertion Demonstration