Nursing Procedure Checklist

Administering a Tube Feeding

Instruction: Check under Correctly Done if identified skill is correctly performed; Incorrectly Done if
skill is not performed correctly; and Not Done if the student failed to perform the skill.
Correctly Incorrectly Not Done
Procedure Done Done
1. Identify the patient.
2. Explain the procedure to the patient and why this
intervention is needed. Raise the bed. Pull the patient’s bedside
curtain. Perform key abdominal assessments as described
above.
3. Assemble equipment. Check amount, concentration, type,
and frequency of tube feeding on patient’s chart. Check
expiration date of formula.
4. Perform hand hygiene. Put on non-sterile gloves.
5. Position patient with head of bed elevated at least 30 to 45
degrees or as near normal position for eating as possible.
6. Unpin tube from patient’s gown. Check to see that the NG
tube is properly located in the stomach, by first instilling air,
then aspirate for gastric contents. At times, due to the tendency
of small-bore tubes to collapse upon aspiration, several
attempts may be necessary to aspirate gastric contents. After
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repeated instillations of 30 mL of air, accompanied by

repositioning the patient, if unable to aspirate gastric contents,
the tube placement should be checked by radiograph verified by
physician’s order.

7. After multiple steps have been taken to ensure that the

feeding tube is located in the stomach or small intestine,
aspirate all gastric contents with a syringe and measure to
check for the residual amount of feeding in the stomach. Flush
tube with 30 mL of water for irrigation. Proceed with feeding if
amount of residual does not exceed agency policy or physician’s
guideline. Disconnect syringe from tubing and cap end of tubing
while preparing the formula feeding equipment. Remove gloves.
8. Put on non-sterile gloves before preparing, assembling and
handling any part of the feeding system.

9. Administer feeding.
When Using a Feeding Bag (Open System)
a. Hang bag on IV pole and adjust to about 12″ above the
stomach. Clamp tubing.
b. Check the expiration date of the formula. Cleanse top of
feeding container with a disinfectant before opening it. Pour
formula into feeding bag and allow solution to run through
tubing. Close clamp.
c. Attach feeding setup to feeding tube, open clamp, and
regulate drip according to physician’s order, or allow feeding to
run in over 30 minutes.
d. Add 30 to 60 mL (1–2 oz) of water for irrigation to feeding
bag when feeding is almost completed and allow it to run
through the tube.
e. Clamp tubing immediately after water has been instilled.
Disconnect from feeding tube. Clamp tube and cover end with
cap.
When Using a Large Syringe (Open System)
a. Remove plunger from 30- or 60-mL syringe.
b. Attach syringe to feeding tube, pour premeasured amount of
tube feeding into syringe, open clamp, and allow food to enter
tube. Regulate rate, fast or slow, by height of the syringe. Do
not push formula with syringe plunger.
c. Add 30 to 60 mL (1–2 oz) of water for irrigation to syringe
when feeding is almost completed, and allow it to run through
the tube.
d. When syringe has emptied, hold syringe high and disconnect
from tube. Clamp tube and cover end with cap.
When Using an Enteral Feeding Pump
a. Close flow-regulator clamp on tubing and fill feeding bag with
prescribed formula. Amount used depends on agency policy.
Place label on container with patient’s name, date, and time the
feeding was hung.
b. Hang feeding container on IV pole. Allow solution to flow
through tubing.
c. Connect to feeding pump following manufacturer’s directions.
Set rate. Maintain the patient in the upright position throughout
the feeding. If the patient needs to temporarily lie flat, the
feeding should be paused. The feeding may be resumed after
the patient’s position has been changed back to 30 to 45
degrees.
d. Check residual every 4 to 8 hours.
10. Observe the patient’s response during and after tube
feeding and assess the abdomen at least once a shift.
11. Have patient remain in upright position for at least 1 hour
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after feeding.
12. Wash and clean equipment or replace according to agency
policy. Remove gloves and perform hand hygiene.

Evaluated by: ________________________________ Date of Evaluation: ________________

(Signature over Printed Name)

Inserting a Nasogastric Tube

Instruction: Check under Correctly Done if identified skill is correctly performed; Incorrectly Done if
skill is not performed correctly; and Not Done if the student failed to perform the skill.
Correctly Incorrectly Not Done
Procedure Done Done
1. Check physician’s order for insertion of NG tube and consider
the risks associated with NG tube insertion.
2. Identify the patient.
3. Explain the procedure to the patient and provide the rationale
as to why the tube is needed. Discuss the associated
discomforts that may be experienced and possible interventions
that may allay this discomfort. Answer any questions as needed.
4. Gather equipment including selection of the appropriate NG
polyurethane tube.
5. Perform hand hygiene. Put on non-sterile gloves.
6. Close the patient’s bedside curtain or door. Raise the bed.
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.
7. 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. Mark tube with an indelible marker.
8. Lubricate tip of tube (at least 2″–4″) with water-soluble
lubricant. Apply topical anesthetic to nostril and oropharynx, as
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appropriate.
9. After selecting the appropriate nostril, ask patient to slightly
flex head back against the pillow. Gently insert the tube into the
nostril while directing the tube upward and backward along the
floor of the nose. Patient may gag when tube reaches pharynx.
Provide tissues for tearing or watering of eyes. Offer comfort
and reassurance to the patient.
10. When pharynx is reached, instruct patient to touch chin to
chest. Encourage patient to sip water through a straw or
swallow even if no fluids are permitted. Advance tube in
downward and backward direction when patient swallows. Stop
when patient breathes. If gagging and coughing persist, stop
advancing the tube and check placement of tube with tongue
blade and flashlight. If tube is curled, straighten the tube and
attempt to advance again. Keep advancing tube until pen
marking is reached. Do not use force. Rotate tube if it meets
resistance.

11. Discontinue procedure and remove tube if there are signs of

distress, such as gasping, coughing, cyanosis, and inability to
speak or hum.
12. While keeping one hand on tube or temporarily securing
with tape, determine that tube is in patient’s stomach:
a. Attach syringe to end of tube and aspirate a small amount of
stomach contents.
b. Measure the pH of aspirated fluid using pH paper or a meter.
Place a drop of gastric secretions onto pH paper or place small
amount in plastic cup and dip the pH paper into it. Within 30
seconds, compare the color on the paper with the chart supplied
by the manufacturer.
c. Visualize aspirated contents, checking for color and
consistency.
d. Obtain radiograph (x-ray) of placement of tube (as ordered
by physician).
13. Apply tincture of benzoin or other skin adhesive to tip of
nose and allow to dry. Secure tube with tape to patient’s nose:
a. Cut a 4″ piece of tape and split bottom 2″ or use packaged
nose tape for NG tubes.
b. Place unsplit end over bridge of patient’s nose.
c. Wrap split ends under tubing and up and over onto nose. Be
careful not to pull tube too tightly against nose.
14. Clamp tube and cap or attach tube to suction according to
the physician’s orders.
15. Secure tube to patient’s gown by using rubber band or tape
and safety pin. For additional support, tube can be taped onto
patient’s cheek using a piece of tape. If double-lumen tube (eg,
Salem sump) is used, secure vent above stomach level. Attach
at shoulder level.
16. Assist with or provide oral hygiene at every 2- to 4-hour
interval. Lubricate the lips generously and clean nares and
lubricate as needed. Offer analgesic throat lozenges or
anesthetic spray for throat irritation if needed.
17. Remove all equipment, lower the bed, and make the patient
comfortable. Remove non-sterile gloves and perform hand
hygiene.

Evaluated by: ________________________________ Date of Evaluation: ________________

(Signature over Printed Name)

Nursing Procedure Checklist

Removing a Nasogastric Tube

Instruction: Check under Correctly Done if identified skill is correctly performed; Incorrectly Done if
skill is not performed correctly; and Not Done if the student failed to perform the skill.
Correctly Incorrectly Not Done
Procedure Done Done
1. 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 non-sterile 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 towel or disposable pad across patient’s chest.
Give tissues and emesis basin to patient.
7. Discontinue suction and separate tube from suction. Unpin
tube from patient’s gown and carefully remove adhesive tape
from 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
cc of air.
9. Instruct 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 patient holds breath. Coil the
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tube in a disposable towel as you remove 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.

Evaluated by: ________________________________ Date of Evaluation: ________________

(Signature over Printed Name)

Collecting Peripheral Blood for Glucose Testing

Correctly Incorrectl Not
Procedure Done y Done
Done
1. Review the physician’s or qualified practitioner’s order for
glucose monitoring
2. Identify which type of equipment is available at your
facility.
3. Identify the patient and explain the procedure
Wash hands.
Assemble the equipment at the bedside
Reagent strips
• Disposable gloves
• Lancet or automatic lancing device
Paper towels
• Alcohol wipe
• 232 gauze
• Cotton ball
• Blood glucose meter

Have client wash hands with soap and water and position
client comfortably in a semi-fowler’s position or upright in a
chair.
Remove a reagent strip from the container and reseal the container
cap.Then, turn on meter.
Calibrate meter following manufacturer’s instructions by inserting strip
into meter.
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Remove unused reagent strip from the meter and place it on a clean, dry
surface (paper towel) with the test pad facing up.
Apply disposable gloves.
Select appropriate puncture site, and perform
skin puncture

Wipe away the first drop of blood from the

site.
Gently squeeze the site to produce a large
droplet of blood.
Transfer the drop of blood to the reagent strip by carefully moving the
site over the strip. The droplet should transfer without smearing (see
Figure 1-12-6). (Note: Some meters require that the blood droplet be
applied to the strip that is already in the meter.)
Quickly press the timer on the meter and lay the strip next to the meter on
a clean, dry surface.
Apply pressure to the puncture site
After 60 seconds, wipe the blood from the test pad with a cotton ball;
place the strip into the meter. (Note: This step may vary with meter.)
Allow the timer to continue.
Read the meter for results found on the unit display.

Turn meter off and dispose of test strip, cotton ball, and lancet properly.

Remove disposable gloves and place them in appropriate receptacle.

Wash hands.

Notify physician or qualified practitioner of results.

Evaluated by: ________________________________ Date of Evaluation: ________________

(Signature over Printed Name)

Nursing Procedure Checklist

ASSISTING PATIENTS USING ASSISTIVE DEVICES

Correctly Incorrectl Not
Procedure Done y Done
Done
Inform client that you will be assisting with ambulation using
crutches.
Assess client for strength, mobility, range of motion, visual acuity,
perceptual difficulties, and balance. Note: The nurse and physical
therapist often collaborate on this assessment.
Adjust crutches to fit the client. With the client supine, measure
from the heel to the axilla.

With the client standing, set the crutch position at a point 4–5
inches lateral to the client and 4–6 inches in front of the client.
The crutch pad should fit 1.5–2 inches below the axilla (3-finger
width). The hand grip should be adjusted to allow for the client to
have elbows bent at 30° flexion.
Lower the height of the bed.
Dangle the client at the side of bed for several minutes. Assess for
vertigo.
Instruct client on method to hold the crutches; that is, with elbows
bent 30° and pad 1.5–2 inches below the axilla. Instruct client to
position crutches lateral to and forward of feet. Demonstrate
correct positioning.
Apply the gait belt around the client’s waist if balance and stability
are unreliable.
Assist the client to a standing position with crutches. Stand close
to the client to support as needed.
Four-Point Gait
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Position the crutches 4.5–6 inches to the side and in front of each
foot. Move the right crutch forward 4–6 inches and move the left
foot forward, even with the left crutch. Move the left crutch
forward 4–6 inches and move the right foot forward, even with the
right crutch. Repeat the four-point gait.

Three-Point Gait
Advance both crutches and the weaker leg forward together 4–6
inches. Move the stronger leg forward, even with the crutches.
Repeat the three-point gait.

Two-Point Gait
Move the left crutch and right leg forward 4–6 inches. Move the
right crutch and left leg forward 4–6 inches. Repeat the two-point
gait.

Swing-Through Gait
Move both crutches forward together 4–6 inches. Move both legs
forward together in a swinging motion, even with the crutches.
Repeat the swing-through gait.
Set realistic goals and opportunities for progressive ambulation
using crutches.
Consult with a physical therapist for clients learning to walk with
crutches.
Wash hands.

Inform client that you will be assisting with ambulation using a cane.

Lower the height of the bed.

Dangle the client at the side of bed for several minutes. Assess for
vertigo.
Assess client for strength, mobility, range of motion, visual acuity,
perceptual difficulties, and balance. Note: The nurse and physical
therapist often collaborate on this assessment.
Apply the gait belt around the client’s waist if balance and stability are
unreliable.
Have the client hold the cane in the hand opposite the affected leg.
Explain the safety and body mechanics underlying using the cane on the
strong side.
Have the client push himself up from the sitting position while pushing
down on the bed with his arms.
Have the client stand at the bedside for a few moments.

Assess the height of the cane. With the cane placed 6 inches ahead of the
client’s body, the top of the cane should be at wrist level with the arm
bent 25%–30% at the elbow.
Walk to the side and slightly behind the client, holding the gait belt if
needed for stability.
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Move the cane and the weaker leg forward at the same time for the same
distance. Place weight on the weaker leg and the cane. Move the strong
leg forward. Place weight on the strong leg.

Inform client that you will be assisting with ambulation using a walker.

Lower the height of the bed.

Dangle the client at the side of bed for several minutes. Assess for
vertigo.
Provide a robe or other covering and shoes with firm, nonslip soles.

Assess client for strength, mobility, range of motion, visual acuity,

perceptual difficulties, and balance. Note: The nurse and physical
therapist often collaborate on this assessment.
Apply the gait belt around the client’s waist if balance and stability are
unreliable.
Place the walker in front of the client.

Have the client push himself up from the sitting position while pushing
down on the bed with his arms.
Have the client transfer his hands to the walker handgrips, one at a time.

Be sure the walker is adjusted so the handgrips are just below waist level
and the client’s arms are slightly bent at the elbow.
Walk to the side and slightly behind the client, holding the gait belt if
needed for stability.
Move the walker and the weaker leg forward at the same time (see Figure
10-15-8). Place as much weight as possible or as allowed on the weaker
leg, using the arms for supporting the rest of the weight. Move the strong
leg forward and shift the weight to the strong leg
Wash hands.

Evaluated by: ________________________________ Date of Evaluation: ________________

(Signature over Printed Name)

Nursing Procedure Checklist