Procedure 30 — Treatment: Gastric Tube

What is the clinical indication for gastric tube placement?

To relieve gastric distention in intubated patients.

What ingestion is a contraindication for gastric tube placement?

Known or suspected ingestion of a caustic substance.

What medication use requires caution with gastric tube placement?

Anticoagulants.

What esophageal condition is a contraindication for gastric tube placement?

Esophageal varices.

In what trauma situation is the nasogastric route contraindicated?

Facial and/or head trauma.

What French size gastric tube is used for an adult?

16 or 18 Fr.

What French size gastric tube is used for a child?

10 or 12 Fr.

What French size gastric tube is used for an infant?

6 or 8 Fr.

Name three supplies that should be assembled before gastric tube placement, besides the tube itself.

Suction, a 60cc catheter tip syringe, and lubricant jelly.

Name two more supplies that should be assembled before gastric tube placement.

Tape and an emesis bag.

Where does tube-length measurement begin for gastric tube placement?

With the distal tip lying over the left upper quadrant of the patient's abdomen.

What path does the imaginary measuring line follow after the left upper quadrant?

Up the center of the chest and the side of the patient's face, passing to the corner.

Where does gastric tube measurement terminate for an orogastric tube?

At the earlobe.

Where does gastric tube measurement terminate for a nasogastric tube (NGT)?

At the nose.

What should be done once the tube is measured for gastric tube placement?

Mark with tape to identify the terminal point of insertion.

How is a gentle curve created in the gastric tube before insertion?

By coiling 3 inches of the distal tube around the fingers.

How much of the gastric tube's distal tip should be lubricated, and with what?

Approximately 2 to 3 inches, with a generous amount of lubricating jelly.

What is attached to the suction port of the gastric tube before insertion?

A syringe filled with 50-60 cc of air.

Where is the gastric tube initially inserted?

Into the patient's mouth or nose.

What does inserting the gastric tube into the mouth/nose facilitate?

Travel down the posterior pharynx and into the esophagus.

What instrument is used to auscultate for epigastric gastric tube placement?

A stethoscope.

How is air injected while auscultating to confirm gastric tube placement?

In a rapid fashion, injecting the syringe full of air.

What two findings confirm epigastric gastric tube placement?

Auscultation of air in the stomach and return of gastric contents by aspirating the syringe.

How is the gastric tube secured once placement is verified?

With tape.

What type of suction may be applied once gastric tube placement is verified?

Low, intermittent suction, to evacuate the stomach and decompress the epigastrium.

How is suctioning managed for infants and children after gastric tube placement?

Attach a syringe to the OG tube for suctioning.

What provider levels can perform gastric tube placement?

EMT-A, EMT-B, and EMT-P.