PREPARATION FOR THE PROCEDURE
Purpose
Permits nutritional support through the GI
tract.
Evacuates or decompresses unwanted gastric
contents and undesirable substances.
Promotes healing after bowel surgery by
resting the GI tract.
Monitors bleeding in the GI tract.
Treats an intestinal obstruction.
Assessment
Check for the Physician’s order for
indications of inserting an NGT, the type and
size of the tube.
Check for present GI status, including
nausea,vomiting or diarrhea, bowel sounds,
abdominal distension or girth and passage of
flatus.
Review history of GI problems requiring use
of tube and include the size of the previous
tube used, if any.
History of nasal or sinus problems and history
of nasal surgery.
Patency of nares.
Presence of gag reflex.
Mental status or ability to cooperate with the
procedure.
Assemble equipment and supplies
• Nasogastric tube of appropriate size (8-18 French)
• Non-allergenic adhesive tape, 1 inch wide
• Nonsterile disposable gloves (additional PPE, as
indicated)
• Water-soluble lubricant
• Facial tissue or towel
• Glass of water with drinking straw or ice chips
• 30-60 ml asepto syringe
• Stethoscope
• Tongue blade (depressor)
• Penlight
• Emesis basin
• pH paper or test strip
• Disposable pad or towel
• Safety pin and rubber band
• Pen
• Suction apparatus (if ordered)
• Optional: Topical anesthetic (lidocaine spray or
gel)
STEPS IN PERFORMING THE PROCEDURE RATIONALE
We must ensure that the order has all the
1. Verify the medical order for insertion of an NGT. necessary parts and is accurate and appropriate
for the specific patient.
Preparation ahead of time conserves time and
2. Gather all needed equipment and supplies. energy. In order to save time and effort.
3. Perform hand hygiene and provide client’s To reduce the risk of infection transmission
privacy. among patients and health care personnel.
4. Introduce yourself and verify the client's identity. -To be able to perform the procedure to the right
patient.
Explain the procedure to the client, why it is necessary,
and how the client can cooperate.
Answer any questions as needed. -Explaining the procedure lessens patient anxiety
and promotes patient cooperation.
5. Assist the client to a position of comfort by -This allows the NG tube to pass more easily
lowering the siderails, elevating the head of the through the nasopharynx and into the stomach.
bed either in semi or high fowler’s position.
- It is often easier to swallow in this position and
gravity helps the passage of the tube.
6. Check for nasal patency:
• Ask the client to breathe through one naris while the - Examine the nares for any obstructions or
other is occluded. Repeat with the other naris.
deformities
• Have the client blow his/her nose with both nares
open. Clean mucus and secretions from nares with - To clear nasal passage without pushing
moist tissues or cotton tipped swabs. microorganisms into inner ear
7. Place towel or disposable pad across the client’s - to protect her gown and bed linens from spills.
chest.
8. Give tissue and emesis basin to the client. -Nasal and oral secretions may be evident during
the procedure
9. Don gloves. -To reduce transmission of microorganisms
10. Prepare the tube: -To help the tube hold its shape and facilitate
• If necessary, place tube in ice-water bathe. easy insertion of the tube.
-To determine the appropriate length of the NG
• Measure the length of tube by measuring distance
from tip of the nose, to earlobe, and then from earlobe tube to be inserted. Distance from the nares to
to the sternal notch. Mark the location on the tubing the stomach; Tape for markings
with a small piece of tape.
- Using a water-soluble lubricant prevents lipoid
• Use water soluble lubricant or dip feeding tube in pneumonia, which may result from aspiration of
water to lubricate tip. an oil-based lubricant or from accidental slippage
of the tube into the trachea.
-Ease insertion and prevents mucosal trauma
when tube is inserted
11. Ask client to tilt head backward and then insert the
tube into clearer naris. - Hyperextension of the neck reduces the
curvature of the nasopharyngeal junction.
• Gently insert the tip of the tube into the nose and
slide along the floor of the nasal cavity.
• Optional: Apply topical anesthetic to nostril and
oropharynx, as appropriate.
12. As the tube advances, have client hold head and - Slight pressure and a twisting motion are
neck straight. sometimes required to pass the tube into the
nasopharynx, and some clients’ eyes may water
• Expect to feel mild resistance as the tube passes
through the posterior nasopharynx. at this point. Rationale:
Tears are a natural body response. Provide the
client with tissues as needed.
- If the tube meets resistance, withdraw it,
relubricate it, and insert it in the other nostril.
Rationale: The tube should never be forced
against resistance because of the danger or
injury.
13. Instruct the client to open the mouth.
• Through the use of tongue blade and penlight, - to examine the patient’s mouth and throat for
assess if the tube can be seen and client can feel
the tube in pharynx, ask him/her to take sips of signs of a coiled section of tubing (especially in an
water through a straw and advance the tube unconscious patient). Coiling indicates an
during the swallows. (Offer ice chips or sips of water, obstruction.
unless contraindicated)
- Direct her to sip and swallow as you slowly
advance the tube to help the tube pass to the
esophagus (as shown below). If you aren’t using
water, ask the patient to swallow.
14. The client will swallow the tube, facilitating -Same as above
passage into the esophagus.
• Continue to advance the tube during swallows till
the predetermined depth using the black marks on
the tube as guidance. Encourage client to take breaths.
15. If client breathes or there is presence of gagging - It is common for the patient to feel discomfort,
and coughing, stop advancing the tube. and this may be expressed with light coughing
and gagging. More aggressive coughing and
• Check placement of tube with tongue blade and
gagging may indicate that the tube has entered
penlight. If tube is coiled, straighten the tube by
retracting and gently advancing it. the airways, in which case you should withdraw
the NG tube.
• Do not use force and rotate tube if it meets - If the tube meets resistance, withdraw it,
resistance. relubricate it, and insert it in the other nostril.
Rationale: The tube should never be forced
against resistance because of the danger of
injury.
16. As the tape/black mark reach the entrance of the
nose, stop or hold the insertion and check the
placement of the NGT by:
• Assess proper tube placement by asking the client to
speak. If client is unable to speak, has a hoarse voice,
is violently gagging, or is in respiratory distress, the
tube is probably in the trachea and should be removed
immediately.
17. Check for proper placement of the tube:
-The contents aspirated from the tube should be
• Inject 20 to 30 mL of air with asepto syringe and acidic with a pH <5. If the pH is more than 6, it
listen with the stethoscope under the left subcostal
region. The sound of a rush of air helps confirms the may indicate the presence of respiratory fluids or
tube’s location in the stomach. small bowel content, and the tube should be
removed.
• Aspirate gastric contents using asepto syringe and
visualize the contents by checking the color and
consistency.
- Examine the aspirate and place several drops on
a piece of pH paper to determine whether gastric
contents are present. The desired gastric range is
from 0 to 5, unless the patient is receiving acid
• Measure the pH of aspirated fluid using a pH strip. inhibiting agents; then the pH may increase to 6.
Place a drop of gastric secretions onto the pH strip or The probability of gastric placement is increased
place small amount in plastic cup and dip the pH paper if the aspirate has a typical gastric fluid
into it. Following the manufacturer’s instructions, appearance (grassy green, clear and colorless
compare the color on the paper with the chart provided.
with mucus, or brown) and pH is less than 5.0.
Alternately, use a carbon dioxide detector to
confirm placement isn’t in the lungs.
- Testing pH is a reliable way to determine
location of a feeding tube. Gastric contents are
commonly pH 1 to 5; 6 or greater would indicate
the contents are from lower in the intestinal tract
or in the respiratory tract. However, pH may not
discriminate between gastric and esophageal
placement (Morton & Fontaine, 2018).
18. Secure the tube to the client’s nose. To secure the tube.
• If available: Apply benzoin to the skin.
The tube is attached to prevent it from dangling
• Use a 4-to-5-inch piece of adhesive tape that is
ripped vertically for half of its length and attach and pulling.
the wide half to client’s nose. Tape loop of tube
to side of client’s face (if feeding tube) or pin to
client’s gown
19. Obtain order for chest x-ray; delay tube feeding or -To check for placement
flushing with fluid until the physician verifies tube
placement.
20. Store stylet from small-bore feeding tube in a
plastic bag at the bedside after correct placement is
confirmed by x-ray.
21. When ordered, begin suction or tube feeding as
ordered, elevate the head of the bed to at least
30° to help prevent aspiration.
• Flush small tubes, such as intestinal feeding tubes,
with 20 to 30 mL of tap water at least 2 to 3 times a -To check for tube patency and prevent clogging
day. of enteral tubes
22. Restore or discard all equipment appropriately.
23. Reposition client for comfort.
24. Remove and discard gloves and perform hand To prevent transmission of microorganism.
hygiene.
25. Document all relevant information. Timely and accurate documentation promotes
• Date and time of tube of insertion patient safety.
• Size and type of tube
• Number of attempts in inserting the tube
• Site of tube entry
• Color and consistency of aspirated gastric contents
• pH result
• Confirmation of tube placement by x- ray
• Suction applied (amount)
• If tube feeding has started and its rate
• Client’s tolerance to the procedure
Procedure Checklist for Inserting a Nasogastric Tube
https://www.scribd.com/document/521654675/PERFORMING-NASOPHARYNGEAL-and-
NASOTRACHEAL-SUCTIONING-3#
