Nasogastric Tube

Check the health care provider orders. Gather nasogastric tube, tape, gloves, water soluble lubricant, tissues, cup of ice with spoon or cup of water, twenty to sixty milliliter syringe with an adapter, emesis or washbasin, PH test strip or meter, stethoscope, absorbent pad, towel, suction apparatus with tubes and canister connected if prescribed, safety pin, and elastic band. Verbalize items you don't have. Perform hand hygiene. Introduce yourself to the patient and correctly identify the patient utilizing two identifiers. Explain the procedure. Raise the bed to high-Fowler position if tolerated by the patient. Provide privacy, comfort and patient and nurse safety. Assess the patient's nares. Ask the patient to hyperextend their head and, using a penlight, observe intactness of tissues of the nostrils, including any irritation or abrasions. Examine nares for obstructions or deformities, and ask the patient to breathe through one nostril while occluding the other. Select the nostril that had greater airflow. Place a towel or absorbent pad across the patient's chest. Prepare the tube. For large bore tubes, place the tube in a basin of warm water while preparing the patient. Determine how far to insert the tube by using the tube to mark off the distance from the tip of the patient's nose to the tip of their earlobe, then from the tip of their ear lobe to the tip of the xiphoid process. Mark the length with adhesive tape if the tube does not have markings. Lubricate the tip of the tube well with water soluble lubricant or water to ease insertion. Apply clean gloves. Insert the tube with its natural curve toward the patient into the selected nostril. Ask the patient to hyperextend their neck and gently advance the tube toward the nasopharynx. Direct the tube along the floor of the nostril and toward the ear on that side. If the tube met resistance, withdraw it, relubricate it, and insert it into another nostril. Once the tube reaches the oropharynx, the patient feels the tube in the throat and may have to gag or retch. Ask the patient to tilt their head forward and encourage the patient to drink and swallow. If the patient gags, stop passing the tube momentarily. Have the patient rest, take a few breaths, and take sips of water to calm the gag reflex. Pass the tube five to ten centimeters (two to four inches) with each swallow until the indicated length is inserted. Check for correct placement of the tube following facility policy. Aspirate the stomach contents and check pH, utilizing the pH testing strip. If signs indicated that the placement was incorrect, remove the tube and begin again. Secure the tube by taping it to the bridge of the patient's nose. Secure the tubing to the patient's gown.

How does it feel?

Good.

Okay. I am going to take some tape, and I'm going to clip it to your gown, okay? So it will stay in place and be out of line of sight. Okay, I'm going to get you more comfortable.

Sure, thanks.

Return the bed to its lowest position. Review if confirmation was done by X-ray. Once the correct position is determined, attach the tube to suction source or feeding apparatus or, as prescribed, the clamped end of the tubing. If suction was applied, maintain patency of NG and suction tubing. Perform hand hygiene. Keep accurate records of the amount and characteristics of the drainage. Establish a plan for daily hang tube care. Leave the patient safe and comfortable and document procedure, care provided, assessment data, and patient's response in the patient's record.