INSERTION OF NASOGASTRIC TUBE

DEFINITION

 Nasogastric intubation is the insertion of a tube via the nares into the gastro-intestinal
tract.

PURPOSE
Nasogastric (NG) tubes are used for several purposes, including feeding for nutrition when the
client is comatose, semiconscious, or unable to consume sufficient nutrition orally. Nasogastric
suction tubes are used for decompression of gastric content after gastrointestinal surgery, and to
obtain gastric specimens for diagnosis of peptic ulcer. They are also used to lavage the stomach
after ingestion of poisons.

 To restore or maintain nutritional status.

 To administer medications.
 To facilitate drainage.
 To empty gastric content

EQUIPMENT

 Single lumen tube  Tongue blade

 Water base lubricant  Clean gloves
 Emesis basin  Stethoscope
 Syringe  Clean towel
 Glass of water  Tape
 Kidney dish  Penlight or flashlight
ASSESSMENT RATIONALE
1. Assess client's level of consciousness. 1. To determine the ability of the client
to cooperate during the procedure.
2. Check the client's chart for any previous 2. To assist in identifying
medical history of nostril surgery or contraindications.
injury or unusual nostril bleeding.
3. Use a penlight to assess nostrils for a 3. To determine which nare to insert
deviated septum. tube, and for contraindications.
4. Ask the client to breathe through each 4. To assist in determining which nare to
nostril occluding the other with a finger. use, to ensure to maintain patient’s
respiratory status.

PLANNING RATIONALE
1. Plan work flow. 1. For smooth implementation of
procedure.
2. Wash hands 2. Adhere to all standard precautions
3. Gathers equipment 3. For ease of work flow and to assure all
equipment on hand
4. Prepares trolley 4. Carbolize trolley to prevent spread of
microorganisms
5. Places emesis basin and waterproof 5. For ease of work flow
receptacle within reach.
6. Selects appropriate size of NG tube 6. Select size as per purpose and to avoid
damage to nares
7. Cut tape 7. For ease of work flow.
IMPEMENTATION RATIONALE
1. Gather equipment. Select appropriate 1. For smooth work flow and to avoid
size and type of nasogastric tube. damage to patient’s nares.
2. Wash hands 2. To reduce number of microorganisms
and to avoid transfer of bacteria.
3. Identify patient, introduce self. 3. To ensure correct patient and to put
patient at ease.
4. Educate patient concerning procedure. 4. To put patient at ease.
5. Put on non-sterile gloves. 5. Nasogastric intubation is a clean
procedure and clean gloves are
adequate.
6. Position patient supine at a 30°–45° 6. Semi-fowlers position is appropriate
angle if possible. for insertion of tube as gravity assists
in intubation.
7. Assess patency of nares. 7. To determine which nare to use.
8. Measure length of tube to be inserted 8. Measure tube to determine
and mark tube with a piece of tape. approximate length to insert into
Several methods of measuring length patient to reach the stomach. For taller
of nasogastric tube to be inserted have patients use second method of
been identified. measuring.
 a. Measure from the tip of the
nose to the earlobe and from
the earlobe to the lower end of
the xyphoid process. This is a
commonly used method.
b. Measure from the nose to the
earlobe and from the earlobe to
a point halfway between the
xyphoid and the umbilicus. 9. To provide a clean work surface and
9. Place a towel or drape over the to protect the patients clothing
patient’s chest
10. Open a prepared tray if indicated. 10. Although nasogastric intubation is not
Place water soluble lube in work a sterile procedure, you will still need
surface or onto back of non-dominant a clean work surface for items and to
hand. place lubricant if needed.
11. Lubricate 1 to 3 inches of the tube 11. Water based lubricant is necessary in
with water or a water-soluble gel. case tube is accidently inserted into
the respiratory tract. Oil based
lubricant will not dissolve in the lungs
and may cause pneumonia.
12. Have patient hyper extend neck. 12. Hyper extension of neck allows for
insertion past the nasal turbines and
assist in a flat direction of entry.
13. Insert tube back and up into nostril; 13. To not force tube against resistance as
advance using gentle pressure. If it can damage the nasal mucosa and
resistance is met, withdraw the tube, cause nose bleeds.
re-lubricate and try the other nostril.
14. If the patient is able, ask patient to 14. The patient may begin to gage and
swallow as the tube is advanced. If it retch as the tube reaches the back of
is a child, a pacifier may be used for the throat. Pause and allow the patient
an infant over 3 months of age who to sip water sooths the gag reflex.
does not need to mouth breathe.
Continue to advance the tube until the
tape mark is at the nostril.
15. Check oropharynx for kinking of tube. 15. If the patient continues to gage the
tube may be coiling in the
oropharynx, and same may be
visualized in the back of the throat.
16. Remove tube immediately if there is 16. These symptoms suggest the tube is in
vomiting or signs of respiratory the respiratory tract rather than the
distress, e.g., cyanosis, tachypnea, gastrointestinal tract. Remove tube
nasal flaring, grunting, wheezing, immediately.
prolonged coughing or choking, or if
the patient is unable to speak.
 17. Verify placement of nasogastric tube 17. Research has demonstrated the
per agency protocol. There are several listening for air (a frequently
methods for determining appropriate identified method) is the least reliable
placement of nasogastric tubes. These method. The most reliable method for
include: confirming placement is X-ray. If x-
a. Insufflations of air while ray placement verification is not
listening for the sound of the agency protocol, and if chemical pH
air, indicators are not available, check
b. Withdrawal of gastric/intestinal tube placement by 3 indicators –
contents, aspirate gastric contents, check for air
c. Checking contents withdrawn bubbles, and check sound with air
for pH and other insufflation.
characteristics, and
d. Inserting end of tube in the
water and watching for
bubbles.
18. Secure the tube by taping to the upper 18. To secure the tube and prevent pulling
lip or nose. Use a 4-inch length of on the tube. May also secure the tube
tape, split about 2 inches of the tape to the patient’s gown with tape of
lengthwise, place un-split end on nose, safety pin.
wrap spit ends around tube and secure
to nose.
19. Attach tube to suction, feeding, or 19. As per doctor’s orders and purpose of
clamp as ordered. intubation.
20. Reposition patient. 20. Position patient in position of comfort
and safety.
21. Doff gloves, wash hands. 21. Adhere to all safety and standard
precautions.
22. Care for equipment. 22. Maintain clean work environment and
prevent spread of contaminants due to
cross contamination.
EVALUATION
 Evaluate patient’s tolerance of procedure.
 Evaluate gastric return
 Evaluate proper placement of tube
 Report deviations from normal or unexpected finding with primary physician

RECORDING AND REPORTING

 Patient’s tolerance of procedure.
 Insertion procedure with date and time
 Type and size of tube
 Which nare used
 Patency
 Amount, color and consistency of gastric return
 Lab tests done on gastric contents, if applicable
  Legal signature
 Any unexpected findings.

REFERENCE
 Berman, A., & Snyder, S. (2012). Kozier & Erb's: Fundamentals of nursing - Concepts,
process, and practice (9 ed.). Upper Saddle River, NJ: Pearson Education Incorporated.
 UNIVERSITY OF BELIZE
FACULTY OF NURSING, ALLIED HEALTH & SOCIAL WORK
DEPARTMENT OF NURSING

Code and Name of Course: NURS 3101 L Venue: - Nursing Laboratory

Student’s NAME/ ID #: __________________________ Date: ______________________

Time allotted: 25 minutes Time Start: ___________ Time End: __________________

Total Points: ______/ ____ Pass_________ Fail: ___________

INSTRUCTIONS TO CANDIDATES:
Steps done correctly =1 point is allotted
Steps done incompletely = 0.5 point is allotted
Steps done incorrectly = 0 points are allotted

SKILLS CHECKLIST FOR NASOGASTRIC INTUBATION

PROCEDURE POINTS COMMENTS

ASSESSMENT
1. Assess client's level of consciousness.
2. Check the client's chart for any previous medical
history of nostril surgery or injury or history of
epitaxis
3. Use a penlight to assess nostrils for a deviated septum.
4. Ask the client to breathe through each nostril
occluding the other with a finger.
1.
PLANNING
1. Washes hands
2. Gathers equipment
3. Prepares trolley
4. Places emesis basin and waterproof receptacle within
reach.
5. Selects appropriate size of NG tube
6. Cut tape

IMPLEMENTATION
1. Washes hands
2. Identifies patient, introduces self
3. Educates patient concerning procedure.
4. Gains verbal consent
5. Raises bed to working height, lowers bed rails
6. Position patient supine at a 30°–45° angle if possible
7. Assess patency of nares
8. Place a towel or drape over the patient’s chest.
9. Open a sterile tray, drop nasogastric tube and syringe
onto tray
10. Place water soluble lubricant onto tray
11. Sanitize hands
12. Don sterile gloves
13. Measure length of tube needed and mark with piece of
tape or note measurement on tubing
14. Lubricate 1 to 3 inches of the tube with water or a
water-soluble gel
15. Have patient hyper extend neck.
16. Insert tube back and up into nostril; advance using
gentle pressure.
17. If the patient is able, ask patient to swallow as the tube
is advanced. Continue to advance the tube until the
tape/mark is at the nostril.
18. Check oropharynx for kinking of tube.
19. Check placement of tube by 3 methods.
a. Listen for insufflation of 20 cc air into the stomach,
b. Place tip of catheter in emesis basin under water and
observe for air bubbles,
c. Aspirate for gastric contents.
20. Secure the tube by taping to the upper lip or nose. Use a
4-inch length of tape, split about 2 inches of the tape
lengthwise, place un-split end on nose, wrap spit ends
around tube and secure to nose. Secure to gown as
necessary.
21. Attach tube to suction, feeding, or clamp as ordered.
22. Repositions patient.
23. Lowers bed, raises bed rails
24. Doffs gloves
25. Washes hands
26. Cares for equipment.

EVALUATION
1. Evaluate patient comfort level and tolerance
2. Evaluate patency
3. Evaluate any secondary procedures, amount of gastric
secretions if suctioned, or amount of feeding
administered

DOCUMENTATION
1. Date and time
2. Nare used, size of tube inserted
3. Methods used to assure patency
4. Amount and color of gastric secretions obtained
5. Drainage, feeding or suction if attached to tubing

Student’s Comments:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________

Student Signature: ________________________ Date: _____________________________

Evaluator Comments:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________

Evaluator Signature/s: ______________________ Date: _________________________________________