FFinalistSouthampton · 2027
All procedures
GMC #22/Therapeutic procedures taught Y5

Nasogastric tube placement

Pass a tube into the stomach through the nose and throat for feeding, drug administration or draining stomach contents; know how to confirm correct placement.

Target · Simulation only0% ready First taught in final year

Practise in a simulated setting; further training needed before doing it on a patient (GMC “simulation”).

Overview

The only GMC skill first taught in final year, and target level is simulation-only — a high-attention/new skill. The safety-critical step is confirming gastric placement before using the tube: a misplaced tube in the lung and then fed is a Never Event.

Key numbers

  • Gastric aspirate pH 1–5.5 confirms placement (safe to use); pH >5.5 → do not use, recheck/CXRNPSA / NHSI (misplaced NG tubes)
  • Chest X-ray is the gold-standard confirmation when aspirate cannot be obtained or pH is inconclusiveNPSA / NHSI
  • Auscultation (“whoosh” test) is discredited — never use it to confirmNPSA

Indications

  • Enteral feeding (unsafe swallow)
  • Drug administration
  • Gastric decompression/drainage (e.g. bowel obstruction — Ryle’s tube)

Contraindications & cautions

  • Base-of-skull fracture / severe mid-face trauma → avoid nasal route (risk of intracranial placement)
  • Caution with varices, coagulopathy, oesophageal strictures

Equipment

NG tube (fine-bore for feeding; wider Ryle’s for drainage)Lubricant, glass of water & strawpH indicator paper, catheter-tip syringeTape/securement, drainage bag/feed

Step by step

Prepare & measure
  1. 1Consent; sit the patient upright
  2. 2Measure NEX: from the tip of the Nose to the earElobe to the Xiphisternum — note the marking
Insert
  1. 1Lubricate the tip; insert into a patent nostril, advancing along the floor of the nose
  2. 2As it reaches the pharynx, ask the patient to sip water and swallow while you advance to the measured mark
  3. 3Secure the tube to the nose/cheek
Confirm position (safety)
  1. 1Aspirate gastric contents; test on pH paper — pH < 5.5 confirms gastric placement
  2. 2If unable to aspirate / pH not confirmatory / on acid-suppression: obtain a chest X-ray (gold standard) and get it interpreted
  3. 3NEVER use the discredited “whoosh” auscultation test
  4. 4Do not feed or give drugs until placement is confirmed

Complications

  • Malposition into the lung (feeding into it = Never Event), epistaxis, discomfort, oesophageal/gastric trauma, tube blockage

OSCE tips

  • pH 1–5.5 = safe to use; if in doubt, CXR — this is the marked safety point.
  • Measure NEX before inserting.
  • Never auscultate to confirm; never feed until confirmed.

Watch

Read

Nasogastric tube insertion — OSCE GuideGeeky Medics

Sources & credits

Authored to UK finals standard and verified against UK guidance (NPSA) and Geeky Medics OSCE guides . Southampton teaching materials © University of Southampton. Always follow current local policy.