A new RN nurse is about to insert a nasogastric tube into a client with Guillain-Barre Syndrome. To determine accurate measurement of length of tube to be inserted, nurse should:

Correct Answer: B. Place the tube at the tip of the nose, and measure by extending the tube to the earlobe and then down to the xiphoid process.

Estimate the length of insertion by measuring the distance from the tip of the nose, around the ear, and down to just below the left costal margin. This point can be marked with a piece of tape on the tube. When using the Salem sump NG tube (Kendall, Mansfield, MA) in adults, the estimated length usually falls between the second and third preprinted black lines on the tube.

• Option A: Apart from the nose-to-ear-to-xiphisternum (NEX) method, several other methods for determining the length of the tube have been described. Among the various options, a formula based on gender, weight, and nose-to-umbilicus measurement while lying flat was found to be safer and more accurate in a study by Santos et al.
• Option C: While the stomach is a highly distensible structure and therefore, can vary in length, the empty stomach is generally around 25 cm long. Thus if one intended to place a tube through the nares and place it in the middle of the stomach, then approximately 55 cm of the tube should be inserted.
• Option D: There are several methods to estimate the depth that an NG should be placed. All methods for estimation will have some margin of error. A common pre-procedure maneuver is to loop the tube over one of the patient’s ears and place the tip at the patient’s xiphoid process and use this as an estimate for the length of the tube that should be inserted.