NEW ERA UNIVERSITY

College of Nursing

Performance Evaluation Tool

REMOVING A NASOGASTRIC TUBE

Name:___________________Date: __________________Grade:_______________

INSTRUCTION: Rate the student’s performance utilizing the scale below:

3 – Demonstrated procedure accurately, correctly stated rationale.

2 - Demonstrated procedure accurately, incomplete rationale stated.
1 - Demonstrated procedure inaccurately, incorrect/no rationale stated
0 – Not Demonstrated

COMPETENCIES 3 2 1 0 Remarks
1. States the objectives of the procedure
2. Checks the Physician’s order
3. Introduces self and verifies the client’s identity
4. Explains the procedure to the client.
5. Performs hand hygiene
6. Provides for client privacy
7. Detaches the tube
7.1 Applies clean gloves
7.2 Disconnects the nasogastric tube from the
suction apparatus, if present.
7.3 Unpins the tube from the client’s gown
7.4 Removes the adhesive tape securing the
tube to the nose
8. Removes the nasogastric tube.
8.1 Instills 50 ml of air into the tube (optional)
8.2 Asks the client to take a deep breath and to
hold it.
8.3 Pinches the tube with the gloved hand
8.4 Smoothly, withdraws the tube
8.5 Observes the intactness of the tube.
9. Ensures client comfort
10. Disposes the soiled items (NGT tube,asepto
syringe etc)
11. Removes and disposes gloves
12.. Documents all relevant information

EVALUATED BY:

_____________________________ ________________________
Clinical Instructor Student’s Signature

Nursing Procedure Elimination and Nutrition Page 1