Nasogastric Tube Insertion Return Demonstration
Student Name: _______________________________________ Student Signature: _______________________________
Evaluator Signature: 1st attempt _____________________ Date: _______________ □ Satisfactory* □ Unsatisfactory^
Evaluator Signature: 2nd attempt ____________________ Date: _______________ □ Satisfactory* □ Unsatisfactory^
Evaluator Signature: 3rd attempt _____________________ Date: _______________ □ Satisfactory* □ Unsatisfactory^
** Critical Behaviors that need to be stated or done in order to pass the skill.
PERFORMANCE BEHAVIORS S* U^ COMMENTS
Assessment
1. Avoid distractions
2. Check patient’s chart for
a. Physician’s order for nasogastric tube insertion
b. ** Allergies (specifically tape and latex), history of facial trauma, polyps,
deviated septum, or previous nasal surgery.
Planning
3. Identify expected outcomes and rationales for insertion.
4. Identify teaching that may need to be provided to the patient.
5. Gather equipment
a. Nasogastric tube
b. Clean gloves
c. Cup of water with straw
d. Lubricant
e. Hypoallergenic tape
f. Safety pin and rubber band
g. Color-coded pH paper
h. Pulse oximeter
i. Stethoscope
j. Blue pad
k. Piston irrigation syringe
l. Pen light
m. Facial tissues
n. Emesis basin
Implementation
6. Upon entering patient’s room
a. ** Perform hand hygiene
b. Be aware of your spatial safety, have call light within reach
c. Identify self
d. ** Identify patient using two patient identifiers (i.e. name, date of birth, medical
record number) while comparing to MAR to patient wrist band
e. ** Ask patient if they have any allergies and check for allergy band
f. Assure privacy
g. Explain what is about to occur, including expected discomforts
h. Allow for patient questions
i. Agree on a cue patient will use if they want to discontinue the procedure
j. Ensure headwall has suction canister and tubing set
k. Raise bed to comfortable working height
l. ** Perform necessary assessments
m. Don clean gloves
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PERFORMANCE BEHAVIORS S* U^ COMMENTS
7. Insertion procedure
a. Using a flashlight, assess condition of nares and oral cavity. Choose nares with better air
flow.
b. Position patient in high Fowler’s position with a pillow behind head and shoulders.
c. Positioning: stand at the right of the patient if right handed, and left of the patient if
left handed
d. Place blue pad over chest and give tissues to patient
e. Prepare split tape
f. Apply pulse oximeter
g. ** Measure distance to insert tube by using the tube to measure from the tip of the
nose, to the earlobe and to the xiphoid process. Mark the length with tape.
h. Curve the tip of tube tightly around the index finger and release
i. Lubricate three inches of tubing generously with lubricant
j. Instruct patient to extend neck back against pillow, holding head straight and upright
k. Begin to insert tube into nares with curved end pointing downward, toward ear
l. Continue to pass tube along floor of nasal passage, aiming toward ear
m. When resistance is being felt apply gentle downward pressure to advance the tube (do not
force after resistance). Note: if resistance continues, withdraw tube, allow patient to rest,
re-lubricate tube and inserts into other nares.
n. Continue insertion of tube until just past nasal pharynx by gently rotating tube toward
opposite nares
o. Stop tube advancement and allow to rest.
p. Explain to patient that the next step requires swallowing
q. ** With the tube just above nasopharynx, instruct patient to flex head forward and
sip water through a straw
r. Advance with each swallow
s. Monitor for respiratory distress
8. Determine placement
a. ** Attach piston irrigation syringe, inject 30 ml of air and auscultate whoosh over
epigastric area, then gently aspirate back to obtain gastric contents.
b. Measure pH of gastric contents with color coded pH paper
c. If tube is not in stomach, advance another 2-2.5 cm and repeat steps 9a and 9b
9. ** Secure proximal end of tube to nose with tape (split), avoiding pressure on nares.
10. Apply to suction machine and set at rate stated in prescriber’s order. If suction is not ordered,
cap the distal end of the tube.
11. Fasten distal end of tube to gown with tape, or loop rubber band around tube with a slip knot
and pin to gown.
12. Unless ordered otherwise, keep head of bed elevated to 30 degrees.
13. Dispose of used equipment.
14. Before leaving room
a. ** Reposition patient for comfort and safety
b. ** Lower bed
c. ** Raise appropriate side rails
d. ** Leave call light and belongings in reach
e. ** Perform hand hygiene
Evaluation
15. Record procedure, patient’s response to procedure and evaluation data.
*S = Satisfactory, ^U = Unsatisfactory
**Critical Behaviors that need to be stated or done in order to pass the skill.
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