CHECKLIST FOR INSERTING A NASOGASTRIC TUBE

Definition- Insertion of a small-bore tube to the stomach through the nasopharynx.

Purpose

1. Decompression of stomach (to remove fluids and gas)

2. To prevent of relieve nausea and vomiting after surgery or traumatic events by decompressing
stomach.
3. To determine the amount of pressure and activity of GI tract.
4. To give gastric lavage.
5. To obtain specimen for laboratory studies.
6. To administer medications.
7. To give gastric gavage.

S.NO STEP/TASK YE NO
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Before procedure
1.
Identify the patient. Check physician’s order for insertion of NG tube and
consider the risks associated with nasogastric tube insertion.

2. Explain the procedure to the patient and provide rationale as to why the tube
is needed. Discuss the associated discomforts that may be experienced and
possible interventions that may ally this discomfort. Answer any questions as
needed.

3. During procedure

Perform hand hygiene. Put on nonsterile gloves.

4. Assist the patient to high Fowler’s position and elevate the head of the bed 45
degrees. Drape chest with bath towel or disposable pad. Have emesis basin and
tissues handy.

5. Measure the distance to insert tube by placing tip of tube at patient’s nostril
and extending to tip of ear lobe and then to tip of xiphoid process and mark
tube with tape.

6. Cut adhesive tape 10cm long and keep ready to fix the tube. Put on clean
gloves.

7. Lubricate tip of tube about 6-8 inches with water-soluble lubricant. Apply
topical anesthetic to nostril and oropharynx, as appropriate.

8. After selecting the appropriate nostril, ask the patient to slightly flex head back
against the pillow. Gently insert the tube into the nostril to the back of the
throat, aiming back and down towards the ear.

9. Encourage the patient to sip water through a straw or swallow, even if no

fluids are permitted. pharynx.
10. Advance the tube in a downward and backward direction when the patient
swallows. If gagging and coughing persist, stop advancing the tube and
check placement of tube with tongue blade and flashlight. If the tube is
curled, straighten the tube and attempt to advance again. Keep advancing the
tube until pen marking is reached. Do not use force.

11. Discontinue procedure and remove tube if there are signs of distress, such
as gasping, coughing, cyanosis, and inability to speak or hum.

12. Confirm Placement of tube

a. Aspirate the stomach contents and check pH using litmus paper, if available.

b. Place the end of the tube in a bowl of water to check for continuous air
bubbles in water.

d. Obtain radiograph (x-ray) of placement of tube (as ordered by physician).

13. Secure tube with tape and avoid pressures on nares. Use a 10 cm (4 inch) piece
of tape, split at one end.

14. Clamp tube and cap or attach tube to suction according to the physician’s
orders.

15. After procedure

Make patient comfortable in bed and provide oral hygiene every 4-6 hours.

16. Remove all equipment, lower the bed, and make the patient comfortable.
Remove nonsterile gloves and perform hand hygiene.

17. Record type of tube placed, aspirate returned, and patient tolerance.
 CHECKLIST FOR ADMINISTRATION OF NASOGASTRIC TUBE FEEDING

Definition: Administration of feed directly into the stomach through a tube passed into the stomach
through the nose (nasogastric) or mouth (orogastric).

Purpose:

1. To provide adequate nourishment to patients who cannot feed themselves e.g. surgery in oral
cavity, unconscious or comatose state.
2. To administer medication.

Indication:

1. Head and neck injury

2. Coma
3. Obstruction of esophagus or oropharynx
4. Severe anorexia nervosa
5. Recurrent episodes of aspiration
6. Increased metabolic needs-burns, cancer, etc.
7. Poor oral intake.

Articles:

1. Formula feed
2. Graduated container
3. Large syringe (30-60 ml)
4. Water in a container
5. Stethoscope
6. Kidney tray
7. Towel
8. Clean gloves

S.NO STEP/TASK YE NO
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Before procedure:
1.
Identify the patient and explain the procedure to the patient and why this
intervention is needed. Raise the bed. Assess for food allergies, time of last
feed, bowel sounds and laboratory values.

2. Position the patient with the head of the bed elevated Fowler’s position at
least 30 to 45 degrees.

3. Assemble equipment. Check amount, concentration, type, and frequency of

tube feeding on patient’s chart. Check expiration date of formula.

4. During procedure
 Perform hand hygiene.

5. Spread towel and mackintosh over patient’s chest.

6. Put on nonsterile gloves and attach syringe to nasogastric tube.

7. Aspirate stomach contents. If there is doubt about tube placement inform

physician and obtain an order for chest X-ray.

8. If residual content is within normal limits and placement has been confirmed,
return gastric content to stomach through syringe using gravity to regulate
flow.

9. If tube placement is confirmed in stomach, pinch the feeding tube and attach
barrel of feeding syringe to tube.

10 Fill syringe barrel with water and allow fluids to flow in by gravity, by raising
barrel above level of patient’s head.

11. Pour feed into syringe barrel and allow it to flow by gravity. Keep on pouring
feed to barrel when it is three quarters empty

10. After feeding is completed, flush the tube with at least 30cc of plain water.

11. After tube is cleared close end of feeding tube.

12. Keep head of bed elevated for 30-60 minutes.

13. After procedure

Wash and clean equipment or replace. Remove gloves and perform hand
hygiene.

14. Document type and amount of feeding, amount of water given, and tolerance
of feed.

15. Monitor for breath sounds, bowel sounds, gastric distention, diarrhea,
constipation and intake and output.

16. Instruct patient to notify nurse if he experiences sensation of fullness, nausea

or vomiting.

Remarks:

Signature of student Signature of Faculty

 CHECKLIST REMOVING A NASOGASTRIC TUBE

S.NO STEP/TASK YE NO
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1.
Goal: The tube is removed with minimal discomfort to the patient, and the
patient maintains an adequate nutritional intake.

Check physician’s order for removal of NG tube.

2. Identify the patient.

3. Explain the procedure to the patient and why this intervention is warranted.
Describe that it will entail a quick few moments of discomfort. Perform key
abdominal assessments as described above.

4. Gather equipment.

5. Perform hand hygiene. Put on nonsterile disposable gloves.

6. Pull the patient’s bedside curtain. Raise the bed to the appropriate height and
place the patient in a 30- to 45-degree position. Place a towel or disposable
pad across the patient’s chest. Give tissues and emesis basin to the patient.

7. Discontinue suction and separate tube from suction. Unpin tube from the
patient’s gown and carefully remove adhesive tape from the patient’s nose.

8. Check placement and attach syringe and flush with 10 mL of water or

normal saline solution (optional) or clear with 30 to 50 mL of air.
9. Instruct the patient to take a deep breath and hold it.

10. Clamp tube with fingers by doubling tube on itself. Quickly and carefully
remove tube while the patient holds breath. Coil the tube in a disposable
towel as you remove it from the patient.

11. Dispose of tube per agency policy. Remove gloves and place in bag. Perform
hand hygiene.

12. Offer mouth care to patient and facial tissue to blow nose. Lower the bed and
assist the patient to a position of comfort as needed.

13. Put on gloves and measure the amount of nasogastric drainage in the collection
device and record on output flow record, subtracting irrigant fluids if
necessary. Add solidifying agent to nasogastric drainage according to hospital
policy.

14. Remove gloves and perform hand hygiene