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    Insertion of A Nasogastric Tube

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    James Andre P. Morales
    The nurse should follow agency policies and use clinical judgment when inserting a nasogastric tube. Proper tube size selection and gentle, careful insertion are important to avoid complications. Placement must be verified before use.

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    Attribution Non-Commercial (BY-NC)
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    Insertion of A Nasogastric Tube

    Uploaded by

    James Andre P. Morales
    45 views3 pages
    The nurse should follow agency policies and use clinical judgment when inserting a nasogastric tube. Proper tube size selection and gentle, careful insertion are important to avoid complications. Placement must be verified before use.

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    Insertion of a Nasogastric Tube

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    The nurse should follow agency policies and use clinical judgment when inserting a nasogastric tube. Proper tube size selection and gentle, careful insertion are important to avoid complications. Placement must be verified before use.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    45 views3 pages

    Insertion of A Nasogastric Tube

    Uploaded by

    James Andre P. Morales
    The nurse should follow agency policies and use clinical judgment when inserting a nasogastric tube. Proper tube size selection and gentle, careful insertion are important to avoid complications. Placement must be verified before use.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 3

    Able to Able to Unable to Initials

    Insertion of a Nasogastric Tube Perform Perform Perform and


    with Date
    Assistance
    Guidelines
    Type of tube
    For gavage or lavage use a single lumen tube
    For intermittent gastric decompression use a double lumen
    tube.
    For continuous long-term feeding use a silicone tube.
    Tube size
    2 Kg 5 French
    3–9 Kg 8 French
    10–20 Kg 10 French
    20–30 Kg 12 French
    30–50 Kg 14 French
    > 50 Kg 16 French
    Procedure
    1. Gather equipment. Select appropriate size and type of
    nasogastric tube. Some guidelines are presented above;
    however, the nurse must use his or her judgment or follow
    agency policies.
    Comments:

    2. Wash hands. Put on nonsterile gloves.


    Comments:

    3. Prepare child and family.


    Comments:

    4. Position child supine at a 30°–45° angle if possible.


    Comments:

    5. Assess patency of nares.


    Comments:

    6. Measure length of tube to be inserted and mark tube with a


    piece of tape. Several methods of measuring length of
    nasogastric tube to be inserted have been identified.
    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.
    c. Formulas based on height.
    Comments:
    Able to Able to Unable to Initials
    Insertion of a Nasogastric Tube Perform Perform Perform and
    with Date
    Assistance
    7. Place a towel over the child’s chest to protect clothing.
    Comments:

    8. Lubricate 1 to 3 inches of the tube with water or a water-


    soluble gel.
    Comments:

    9. Insert tube back and up into nostril; advance using gentle


    pressure. If resistance is met, withdraw the tube,
    relubricate and try the other nostril.
    Comments:

    10. If the child is able, ask child to swallow as the tube is


    advanced. A pacifier may be used for an infant over 3
    months of age who does not need to mouth breathe.
    Continue to advance the tube until the tape mark is at the
    nostril.
    Comments:

    11. Check back of mouth for kinking of tube.


    Comments:

    12. Remove tube immediately if there is vomiting or signs of


    respiratory distress, e.g., cyanosis, tachypnea, nasal
    flaring, grunting, wheezing, prolonged coughing or
    choking, or if the child is unable to speak or cry. These
    symptoms suggest the tube is in the respiratory tract rather
    than the gastrointestinal tract.
    Comments:

    13. Remove guide wire if applicable.


    NOTE: Some agencies have policies that limit insertion of
    nasogastric tubes with guide wires to physicians. Follow
    agency policy.
    Comments:

    14. Verify placement of nasogastric tube per agency protocol.


    The literature identifies several methods for determining
    appropriate placement of nasogastric tubes (Beckstrand, et
    al., 1990; Gharib, Stern, Sherbin, & Rohrmann, 1996;
    Rakel, et al., 1994). These include insufflation of air while
    listening for the sound of the air, withdrawal of
    gastric/intestinal contents, checking contents withdrawn
    for pH and other characteristics, and inserting end of tube
    in the water and watching for bubbles. Research has
    demonstrated the listening for air (a frequently identified
    Able to Able to Unable to Initials
    Insertion of a Nasogastric Tube Perform Perform Perform and
    with Date
    Assistance
    method) is the least reliable method. The most reliable
    method for confirming placement is X ray.
    Comments:

    15. Secure tube by placing hypoactive dressing on child’s


    cheek and then securing the tube to the dressing with the
    transparent dressing or tape. The tube also may be taped to
    the upper lip or nose. Use a 4 inch length of tape, split
    about 2 inches of the tape lengthwise, place unsplit end on
    nose, wrap spit ends around tube and secure to nose.
    Comments:

    16. Attach tube to suction, feeding, or clamp as ordered.


    Comments:

    17. Remove gloves. Wash hands.


    Comments:

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