Nasogastric Tube
Insertion
Nursing Guidelines and considerations
Gregor Alfonsin C. Pondoyo
Refersto the insertion of a tube to the
nasopharynx into the stomach
Nasogastric (NG) intubation
Decompression
Relieving nausea and vomiting after
surgery or traumatic events
Diagnostic procedures
Irrigation (lavage) for active bleeding and
poisoning
Purposes
Treatment for mechanical obstruction
Administering meds and food (gavage)
Specimen procurement of gastric contents
for Lab studies when pyloric or intestinal
obstruction is suspected.
Unconscious pt’s- advance tube between
respiration
1
a. Stroke the neck to facilitate passage of
tube to esophagus
b. Watch out for cyanosis during procedure,
it may indicate that the tube entered the
trachea
Consider this!
Nasal obstructions- pass tube to the
mouth instead.
a. Remove dentures, slide distal end over
the tongue then proceed just like usual
way of NGT insertion
b. Coil end of the tube, directing it
downward the pharynx
Pain or vomiting- indicates obstruction or
wrong placement
If NGT is not draining, reposition the tube
(per physician’s order)
Assess the color, consistency, odor of
gastric contents and report any
unusualities2
Auscultate! Auscultate! Auscultate!
Irrigate before and after giving
medications
Know the complications if tube stays for
prolonged periods:
nasal erosion and sinusitis
Esophagitis and esophagotracheal fistula
gastric ulceration, and pulmonary and oral
infections
Let’s Begin
Nasogastric (NG) tube- usually single-
lumen Levin
H20-soluble lubricant
Clamp for tubing
Towel, tissues, emesis basin
Glass of H2o and straw
Tape (preferably hypoallergenic)
Equipments (basic)
Asepto syringe 3
Stet
Penlight
Disposable gloves
Normal saline
1. Ask the patient if he has ever had nasal
surgery, trauma, a deviated septum, or
bleeding disorder .
4
2. Explain procedure to the patient
5
3. Place the patient in a sitting or high-
Fowler's position and place a towel across
chest .
6
Procedure: Preparation
4. Determine with the patient what sign he
might use, such as raising the index
finger, to indicate “wait a few moments”
because of gagging or discomfort .
7
5. Remove dentures (if there’s any) place
emesis basin and tissues within the
patient's reach .
8
6. Inspect the tube for defects; look for
partially closed holes or rough edges .
9
7. Place rubber tubing in ice-chilled water
for a few minutes (if too stiff, dip in warm
water) .
10
8. Determine the length of the tube needed
to reach the stomach .11
9. Have the patient blow nose to clear
nostrils .
12
10. Inspect the nostrils with a penlight,
observing for any obstruction. Occlude
each nostril, and have the patient
breathe. This will help determine which
nostril is more patent.
11. Wash your hands. Put on disposable
gloves .
13
12. Measure the patient's NEX (nose,
earlobe, xiphoid), and mark the tube
appropriately .
14
1. Coil the first 3-4 inches (7-10 cm) of the
tube around your fingers .
15
2. Lubricate the coiled portion of the tube
with water-soluble lubricant. Avoid
occluding the tube's holes with lubricant .
16
3. Tilt back the patient's head before inserting
tube into nostril, and gently pass tube into
the posterior nasopharynx, directing
downward and backward toward the ear . 17
Performance
4. When tube reaches the pharynx, the
patient may gag; allow patient to rest for
a few moments .18
5. Have the patient tilt head slightly
forward. Offer several sips of water
through a straw, or permit patient to suck
on ice chips, unless contraindicated.
Advance tube as patient swallows .
19
6. Gently rotate the tube 180 degrees to
redirect the curve .
20
7. Continue to advance tube gently each
time the patient swallows .
21
8. If obstruction appears to prevent tube
from passing, do not use force. Rotating
tube gently may help. If unsuccessful,
remove tube and try other nostril .
22
9. If there are signs of distress such as
gasping, coughing, or cyanosis,
immediately remove tube .
23
10. Continue to advance the tube when the
patient swallows, until the tape mark
reaches the patient's nostril .
24
11. Check placement!!!
Ask the patient to talk .
25
Use the tongue blade and penlight to
examine the patient's mouth (especially
an unconscious patient) . 26
Attach a syringe to the end of the NG
tube. Place a stethoscope over the left
upper quadrant of the abdomen, and
inject 10 to 20 cc of air while
auscultating the abdomen . 27
To check whether the tube is in the
stomach:
Obtain aspirate with 30 to 60 mL syringe.
If stomach contents cannot be aspirated,
reposition the patient and repeat air
insufflation. Attempt to aspirate again .
28
X-rays may be done to confirm tube
placement .
29
12. After tube is passed and the correct
placement is confirmed, attach the tube to
suction or clamp the tube . 30
13. Anchor tube with tape .
31
14. Anchor the tubing to the patient's
gown. Use a rubber band to make a slip-
knot to anchor the tubing to the patient's
gown. Secure the rubber band to the
patient's gown using a safety pin .32
15. Clamp the tube until the purpose for
inserting the tube takes place .
33
1. Assure the patient that most discomfort
he feels will lessen as he gets used to
the tube.
2. Irrigate the tube at regular intervals
(every 2 hours unless otherwise
indicated) with small volumes of
prescribed fluid .
34
3. Cleanse nares and provide mouth care
every shift .
35
Follow up phase
4. Apply petroleum jelly to nostrils as
needed, and assess for skin irritation or
breakdown . 36
5. Keep head of bed elevated at least 30
degrees .
37
6. Record the time, type, and size of tube
inserted. Document placement checks
after each assessment, along with
amount, color, consistency of drainage .
38
NGT Removal
Towel
Disposable gloves
Mouth hygiene materials
Equipments
1. Make sure that gastric or small bowel
drainage is not excessive in volume.
2. Make sure, by auscultation, that audible
peristalsis is present.
3. Determine whether the patient is
passing flatus; this indicates peristalsis .
39
Procedure: Preparation
4. Verify the health care provider's order
for removal.
1. Place a towel across the patient's chest,
and inform him that the tube is to be
withdrawn .
40
2. Apply disposable gloves .
41
3. Remove the tape from the patient's
nose.
4. Instruct the patient to take a deep
breath and hold it .
42
Performance phase
5. Slowly, but evenly, withdraw tubing and
cover it with a towel as it emerges . (As
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the tube reaches the nasopharynx, you
can pull quickly.)
6. Provide the patient with materials for
oral care and lubricant for nasal dryness .
44
7. Dispose of equipment in appropriate
receptacle.
8. Document time of tube removal and the
patient's reaction.
9. Document tube removal and color,
consistency, and amount of drainage in
suction canister.
10. Continue to monitor the patient for
signs of GI difficulties .
45
TY!!!
