The following precautions need to be taken while using Ryle’s Tube.
The tube constantly irritates the nasal mucosa, causing a great deal of discomfort. Ensure that the tube is securely anchored to the patient’s nose to prevent excess tube movement, and is pinned to the gown to avoid excessive pulling or dragging.
Because one nostril is blocked, patients tend to mouth breathe. This causes dehydration of the nasal and oral mucosa, and patients will complain of thirst, but they are usually NPO (nil per os or nothing by mouth). Mouth care will help to relieve the dryness. This can include rinsing the mouth with cold water or mouthwash as long as the patient does not swallow. Some patients may be allowed to suck on ice chips.
If the patient complains of abdominal pain, discomfort, or nausea, or begins to vomit, report it immediately. The drainage flow is probably obstructed and the tube will need to be irrigated.
These patients should never be allowed to lie completely flat. Lying flat increases the patient’s risk of aspirating stomach contents. Patients with an NG tube are at risk for aspiration. The head of bed should always be raised 30 degrees or higher.
The tube may enter the lungs because of the proximity of the larynx to the oesophagus, the nasogastric tube may enter the larynx and trachea. This may cause a pneumothorax.
When the tube is in the airway, it will cause severe irritation and cough. Asking patients to hold some water in their mouth and swallowing it while the tube is in the throat may help to pass the tube into the oesophagus.
The tube may coil up in the patient’s throat. This is particularly likely if the patient retches. Refrigerating the tube may help to avoid coiling and keeps it stiff. Alternatively, using a guide wire can help with both these issues.
The presence of an NG tube in the nose for an extended period may lead to damage to the ciliary epithelium and cause infection, which may lead to sinusitis.
The tube can enter the brain as there are case reports of NG tubes perforating the base of the skull and reaching the brain. A well-lubricated tube may help to decrease friction during insertion. If the nostrils are of unequal size the wider one should be used. If resistance is felt, the tube should not be forced.
Perforation of the oesophagus is rare but may occur in pre-existing oesophageal disease, for example in the presence of an unrecognised diverticulum of the oesophagus.
Retropharyngeal abscess may occur from perforation of a piriform sinus and will cause swallowing problems.
The intraluminal presence of an NG tube may interfere with the lower oesophageal sphincter and cause reflux of stomach contents, leading to aspiration pneumonitis. The risk is increased when patients are fed when lying down flat.
Feeding through a tube incorrectly placed in the bronchial tree may cause severe sepsis, which can be fatal.
Oral bacteria can enter the parotid duct, causing infection of the gland. This can be prevented by good oral hygiene.