Nasogastric Intubation

Updated: Jul 17, 2018
  • Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Vikram Kate, MBBS, MS, PhD, FRCS, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS  more...
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Gastric intubation via the nasal passage (ie, the nasogastric route) is a common procedure that provides access to the stomach for diagnostic and therapeutic purposes. A nasogastric (NG) tube is used for the procedure. The placement of an NG tube can be uncomfortable for the patient if the patient is not adequately prepared with anesthesia to the nasal passages and specific instructions on how to cooperate with the operator during the procedure.



Diagnostic indications for NG intubation include the following:

  • Evaluation of upper gastrointestinal (GI) bleeding (ie, presence, volume)
  • Aspiration of gastric fluid content
  • Identification of the esophagus and stomach on a chest radiograph
  • Administration of radiographic contrast to the GI tract
  • Identification of cancer cells - In a study of patients with gastric cancer, gastric lavage cytology samples collected via an NG tube inserted preoperatively were examined for the presence (GL1) or absence (GL0) of cancer cells; GL1 was significantly associated with poor overall survival and progression-free survival [1]

Therapeutic indications for NG intubation include the following:

  • Gastric decompression, including maintenance of a decompressed state after  endotracheal intubation, often via the oropharynx
  • Relief of symptoms and bowel rest in the setting of small-bowel obstruction
  • Aspiration of gastric content from recent ingestion of toxic material
  • Administration of medication
  • Feeding
  • Bowel irrigation
  • NG tube can be kept following corrosive ingestion for the development of a tract in the esophagus that subsequently can be used for balloon dilatation


Absolute contraindications for NG intubation include the following:

  • Severe midface trauma
  • Recent nasal surgery

Relative contraindications for NG intubation include the following:

  • Coagulation abnormality
  • Esophageal varices (usually, a Sengstaken-Blakemore tube is introduced, but an NG tube can be used for lower-grade varices) or stricture
  • Recent banding of esophageal varices
  • Alkaline ingestion (the tube may be kept if the injury is not severe)