Ryles tube Size - Rnnursingexam

Ryle’s tube or Nasogastric tube is made of various material such as rubber, silicone or polyurethane which can be inserted through mouth or nose into stomach to administer medications , to give feeding through tube. The ryles tubes are available at various sizes which are used according to age. It is important to have knowledge about different sizes of ryles tube or nasogastric tube for effective and safe medical procedure. Correct Ryle`s tube size allows proper treatment and avoids chances of complications.

Ryles tube uses

Ryles tube are of various lengths and used according to intended need of patient. Nasogastric tube can be used as Diagnostic purpose and therapeutic purposes .

Diagnostic Ryles tube Uses :

Ryle’s tube can be used for diagnosis of internal bleeding.
Ryles tube is also used in Diagnosis of Tracheoesophageal fistula (TEF).
To aspirate gastric content for Chemical analysis.
Nasogastric tube is also used for location of esophageal stricture.
Nasogastric tube used for assessing the gastric function test.

Therapeutic Nasogastric tube Uses

To remove the gas or fluid from the stomach by process called decompression.
For lavage stomach and to remove ingested poison or other harmful fluids.
To administer medication and feeding for unconscious as well as conscious patient.
Nasogastric tube is also used in Hematemesis.
Also used postoperatively

Ryles tube size chart with colour code

Size in FG	Colour code
6	Light Green
8	Blue
10	Black
12	White
14	Green
16	Orange
18	Red
20	Yellow
22	Violet
24	Light Blue

Ryle’s tube or nasogastric tube size and colour coding

Ryles tube According to age

Age	Ryles tube size
0- 6 month	6 – 10 Fr
1 year	10 Fr
2 years	10 Fr
3 years	10-12 Fr
5 years	12 Fr
6 years	12 Fr
8 years	14 Fr
12 years	14-16 Fr

Ryles tube size according to age

Ryle’s tube Parts

1. Tip : Tip is beaded at the end with lead which is tough and blunt and avoids kinking.
2. Body : body is middile part from base to tip which includes marking and radio-opaque line on it.
3. Base : Base is the upper open part of tube which includes drainage port with lock
4. Radio- opaque line : Radio- opaque line is for confirmation of tube at right place which can be seen in X-ray.
5. Eyes : Eyes are the opening near the tip for easy drainage of content or helps in aspiration of gastric contents.
6. Drainage port or opening : It is at upper end which can be left open to decompress stomach or can be also used for administration of medication and feeding. It has lock which can be used to close the opening while no feeding is given and also through this opening drainage bag can be attached.

Ryles tube procedure for insertion

Before inserting the tube it is important to measure the length of tube that will be needed to reach the stomach. Marking is available on the tube which indicates desired length of tube to be inserted.

Ryle’s Tube Insertion Measurement

Ryle’s tube length is Measured by estimating the distance from tip of nose to the earlobe and from earlobe to the xiphoid process.
Adding 6 inches for NG placement .

Ryles tube Length

The lengh of ryles tube is marked as 50cm, 60cm, 70cm from the distal end to estimate the correct placement of tube.

Ryles tube procedure

Ryle’s tube insertion position : Have the patient to sit upright position in bed /chair or elevate the head of the patient`s bed at least 30 degree or 45 degree.
The nose should be inspected for patancy and spray tetracaine to numb the nasal passes and suppress gag reflex.
Wear the clean sterile gloves
The tube should be lubricated with water soluble lubricant .
The tip of patient`s nostril is tilted and tube is inserted into nose and when the tube reaches the nasopharynx, patient head is lowered and ask patient to begin swallow as tube is advanced.
The patient can be also asked for to take sip of water through a straw to facilitate tube .
The oropharynx should be inspected to ensure that the tube is not coiled in mouth or pharynx.
After the procedure the tube should secured with tape.

Confirmation of ryles tube placement

While inserting ryles tube there is chance that the tube can go into trachea or lungs mainly right main bronchus. The following method are recommended to confirm the placement of tube :

Tradition method is air auscultation. In this method the air is injected through tube while ausculting the epigastric area with a stethoscope.
To take X-ray which confirms the visualization of tube tip . It is most accurate method to verify tube placement.
Measurement of exposed tube length and document it. At each shift nurse should measure the length and compare with original length documented.
pH measurement of gastric content. the pH of gastric content is usually acidic ( 1 to 5). pH of intetinal fluid is 6 or higher whereas pH of respiratory aspirate is alkaline i.e 7 or more.

Complication of ryles tube

Discomfort to the patient
Rhinitis
Sinusitis
Upper respiratory tract infection
Esophagitis
Esophageal perforation
Risk of aspiration pnemonia

Contraindications of Ryle’s tube

Absolute contraindication of ryles tube is Acute corrosive poisoning because in case of alkali or acidic poisoning i.e mucosal oedema if you try to insert ryles tube it may dilate or perforate the mucosa.
- Relative Contraindication is Severe maxillofacial trauma , Skull Base Fracture, Esophageal stricture