PERFORMANCE EVALUATION CHECKLIST

Nasogastric Tube Intubation and Administering

Enteral Nutrition via Nasogastric Tube

Name:________________________________ Group: ______ Date: __________ Rating:_________

Done Done Multiple

PROCEDURE Correct but with Errors
with No 1 Error Seen
Errors (2) (1)
(3)
ATTITUDE: 30% (15 points)
1. Displays readiness in performing the procedure
2. Displays conscientious efforts to correct mistakes.
3. Shows enthusiasm and interest in performing the procedure.
4. Employs professionalism, reliability and confidence in the procedure.
5. Answers rationale questions readily.

TOTAL

KNOWLEDGE AND SKILLS 70% (117 points)

A. NASOGASTRIC TUBE INTUBATION
1. Verifies the patient’s need for enteral tube feedings.
2. Assesses for presence of skin breakdown and patency of nostrils:
Ask the patient to breathe, occluding one nostril at a time.
3. Reviews patient’s medical history (gag reflex, nostril surgery, unusual
nostril bleeding, bowel sounds, mental status).
4. Explains the procedure to the patient.
5. Informs the patient on how to communicate during intubation (hand signal
or raise index finger for discomfort).
6. Prepares the equipment.
7. Positions patient in sitting or high-Fowler’s position.
If patient is comatose: semi-Fowler’s position with head propped forward
using pillow
8. Covers the patient’s chest with a towel.
9. Washes hands and puts on clean gloves.
10. Determines the length of the tube to be inserted and mark with a
tape.
11. Lubricates first 4 inches of the tube with water-soluble lubricant.
12. Asks the patient to slightly flex the neck backward.
13. Gently inserts the tube into a naris.
14. Asks patient to flex head forward once the tube reaches the nasopharynx.
15. Advances the tube several inches at a time as the client swallows.
Withdraw the tube immediately if there are signs of respiratory
distress.
16. Advances the tube until the taped mark is reached.
17. Secures the tube to the nose with a tape.
18. Checks the placement of the tube:
a. Injects 10 cc of air and auscultate.
b. Aspirates gastric content and measure pH.
c. Prepares the patient for x-ray check-up, if prescribed.
19. Caps or clamps the distal end of the tube or connects to suction machine or
drainage bag.
20. Fastens the tube to patient’s gown with a tape.
21. Removes gloves, disposes used materials appropriately, and washes hands.
22. Assists patient to a comfortable position.
23. Documents procedure.

B. ADMINISTERING ENTERAL NUTRITION VIA NASOGASTRIC TUBE

1. Assesses patient’s need for enteral tube feedings, food allergies.
2. Auscultates bowel sounds.
3. Obtains baseline weight and reviews laboratory values. Assesses patient for
fluid volume excess or deficit, electrolyte abnormalities and metabolic
abnormalities such as hyperglycemia.
4. Verifies health care provider’s order.
5. Explains the procedure to the patient.
6. Prepares feeding and the materials needed.
7. Positions patient in high-fowler’s position.
 8. Washes hands and applies gloves.
9. Checks tube placement.
10. Checks gastric residual volume. Measure residual volume if present.
11. Irrigates tube.
12. Starts tube feeding.
13. When feeding is done, irrigates the tube.
14. Caps or clamps the distal end of the tube.
15. Maintains patient in high-fowler’s position for 30 minutes to1 hour after
feeding.
16. Documents procedure.

TOTAL

Instructor’s Comments:
_________________________________________________________________________________________
_________________________________________________________________________________________

___________________________ _____________________________________________
Signature of the Student Signature over Printed Name of Clinical Instructor

Prepared:

ANTHONY JOSEPH C. MERCADO, RN, MAN

MS Lecturer

Approved:

MICHELLE B. YU, DM, RN

Dean