Nasogastric Tube Insertion

Question 1

Step 1:

Answer 1

-PREPARE SUPPLIES - TAPE AND LUBRICANT PRIOR TO STARTING PROCESS OR GLOVING (3 STRIPS of TAPE)

Perform hand hygiene and don gloves

Verify pt using two identifiers and perform AIDET
-explain procedure

Question 2

Step 2:

Answer 2

Place patient in high Fowler’s position as tolerated

Question 3

Step 3:

Answer 3

Place a clean towel over the pt’s chest

Question 4

Step 4:

Answer 4

Clean the bridge of the pt’s nose w/ soap and water or an alcohol swab

Question 5

Step 5:

Answer 5

Instruct the patient to relax and breathe normally while occluding one nostril. SELECT NOSTRIL w/ GREATER AIRFLOW
-if equal ask pt preference

Question 6

Step 6:

Answer 6

ESTIMATE THE LENGTH OF TUBE TO BE INSERTED

• Traditional method or NEX (nose to ear to tip of xiphoid)
• MARK WITH TAPE

Question 7

Step 7:

Answer 7

Lubricate 3-4 inches of the end of the tube

Question 8

Step 8:

Answer 8

Instruct pt to extend the neck back against a pillow

-insert the NG tube gently through the naris at an angle parallel to the floor of the nasal canal, not upright

Question 9

Step 9:

Answer 9

With the tube just above the oropharynx, instruct the patient to flex his or her head forward and swallow.

Advanced the tube with swallowing until reaching the tape
Anchor the tube to the pt’s cheek w/ tape until tube placement was verified

Question 10

Step 10:

Answer 10

Tape the tube to the pt’s nose

Carefully wrap two split ends of tape around the tube

Question 11

Step 11:

Answer 11

VERIFYING NG TUBE PLACEMENT AFTER INSERTION

-Ask pt to speak
-Instill 20-30 mL of air into the tube with a large syringe
LISTEN FOR AN AIR BOLUS OVER THE UPPER LEFT ABDOMINAL QUADRANT

Question 12

Step 12:

Answer 12

Aspirate gently to obtain gastric contents, observing color and volume

Question 13

Step 13:

Answer 13

Measure aspirate for pH w/ color-coded pH indicator strip that ranged from 1 - 14

CALL FOR XRAY!!!!!!!!!!!!!!!!

Question 14

Step 14:

Answer 14

Discard supplies, remove gloves, and perform hand hygiene

DON NEW GLOVES

Question 15

Step 15:

Answer 15

Connect to suction for decompression

LOW INTERMITTENT: 40-80 IN THE GREEN ZONE

Question 16

Step 16:

Answer 16

Loop a rubber band around the tube in a SLIP KNOT and then pin the distal aspect of the tube to the pt’s gown

Question 17

Step 17:

Answer 17

Otherwise prescribed, elevate the head of the bed 30 degrees (30-45)

Clean area and discard trash

Question 18

Step 18:

Answer 18

Demonstrate proper procedures for discontinuing of the NG tube