Appendix 5. Placing an oro/nasogastric tube

Gastric tubes must always be used with great caution. There is a risk of aspiration if the tube is used incorrectly.

If possible, use the orogastric route rather than the nasogastric route in cases of respiratory distress or weight below 1500 g. Both nostrils must remain unobstructed for effective breathing.

5.1 Technique

– Choose a CH6 or CH8 tube, depending on the size of the infant’s nostrils. The tube must not completely block the opening of the nostril.

– Measure the distance from the mouth (oro-) or bridge of the nose (naso-) to the tragus of the ear, and then the distance from the tragus of the ear to the xyphoid process of the sternum. Mark this insertion length on the tube with a pen.

– Lubricate the tube with water. Hold the infant’s head firmly to prevent injury. Insert the tube in a continuous motion to the pen mark.

– Secure the tube with adhesive tape.

– Check for correct tube placement:
1) aspirate the stomach contents
2) inject 2 ml of air into the stomach via the tube. Place a stethoscope on the abdomen to listen for the noise of the air in the stomach.
If there is any doubt about the tube position, withdraw the tube and start over.
Intrapulmonary administration of the liquid contents can be fatal.

To feed, connect a 20-ml syringe, without its plunger, to the tube (tulip) and allow the milk in the syringe to flow by gravity (Appendix 3, Section 3.4).

Rinse the tube with a few ml of 0.9% sodium chloride after each use.

5.2 Monitoring

The tube position should always be checked before administering any liquid or medication; check the position of the reference mark, check that aspiration brings up gastric liquid, and inject air into the stomach. If not correctly positioned, re-insert the tube and verify that it is correctly positioned.

Replace the tube every 3 days, switching nostrils with each new tube, or sooner if the tube becomes clogged. Evaluate if tube is still necessary before replacing.