For faculty use only Date

Educator’s name
Score

ATI Skills Modules Checklist for Nasogastric Intubation

Student’s name Date

Check/
Item Comments
initial
Verify order Patient record
Assess for procedure need

Identify, gather, Inserting a nasogastric tube

and prepare (suction apparatus, clean gloves, penlight,
equipment and stethoscope, bath towel, anesthetic gel,
supplies cotton-tipped applicator, cup of water,
straw, empty cup for aspirate, pH reagent
strip, emesis basin, facial tissues, tongue
blade, permanent marker, scissors, tape,
attachment device for gown,
skin adhesive, water-soluble lubricant,
60-mL syringe, tube fixation/anchoring
device for nose, nasogastric tube)
Gastric decompression
(suction apparatus, suction tubing, clean
gloves, stethoscope, 60-mL syringe, towel
or disposable pad, adapter for connecting
suction tubing to nasogastric tube)
Care and maintenance of a
nasogastric tube
(clean gloves, basin of warm water,
washcloth, towel, irrigant solution, 60-mL
syringe, empty cup for aspirate, pH reagent
strips, penlight, water-based lubricant,
toothbrush, toothpaste, emesis basin, cup of
water, straw)
Removing a nasogastric tube
(suction apparatus, clean gloves, towel or
disposable pad, facial tissues)

Apply principles of Hand hygiene

aseptic practice
Personal protective equipment
Disposal of waste

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 Check/
Item Comments
initial
Communicate Privacy
effectively Patient identification
Patient teaching

Provide for a safe Body mechanics

environment Equipment placement
Patient safety

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Demonstrate procedural steps
Check/
Item Task Comments
initial
Inserting a Have suction available.
nasogastric tube Place patient in high Fowler’s position.
Assess nasal passages with penlight.
Assess gag response by gently placing the
tongue blade against uvula.
Explain how patient can communicate
during procedure.
Measure tube for length of insertion and
mark length with tape or permanent marker.
Cover patient’s chest with towel.
Have patient hold emesis basin and cup
of water.
Coat tip of tube with water-based lubricant.
Slowly insert tube into naris.
Instruct patient to touch chin to chest.
Advance tube each time patient swallows
until reaching marked spot.
For resistance, significant coughing,
gagging, choking, or changes in vital signs,
pull back on tube until resolved.
Use penlight to look at back of throat.
Auscultate for breath sounds.
Using syringe, withdraw gastric contents,
assess aspirate, and test pH.
Anchor tube to nose.
Mark tube directly below naris.
Fasten tube to gown.
Keep head of bed above 30 degrees.

Gastric Check nasogastric tube placement.

decompression Auscultate air instillation over stomach.
Place towel under tubing.
Verify that suction is working and set on
prescribed amount.
Connect nasogastric tube to suction tube
via adapter.

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Demonstrate procedural steps
Check/
Item Task Comments
initial
Care and Monitor gastric drainage and gastrointestinal
maintenance of a function.
nasogastric tube Follow facility policy for verifying correct tube
placement and irrigation.
Assess tube placement by looking the mark
below the naris.
Using syringe, withdraw gastric contents,
assess aspirate, and test pH.
Draw irrigation solution into syringe and slowly
instill into tube.
Reconnect nasogastric tube to suction.
With a sump tube, instill 10 to 20 mL of air into
the vent lumen.
Regularly check tape or securement device.
Inspect naris and surrounding skin.
Clean area around tube at least every 8 hr.
Apply water-based lubricant to naris as needed.
Provide oral care frequently.

Removing a Place towel over patient’s chest.

nasogastric tube Provide patient with facial tissues.
Position patient upright.
Have suction apparatus available.
Remove tape from nose and detach
securement device.
Instruct patient to hold breath.
Gently and steadily withdraw tube, controlling
its tip.
Inspect tube.

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Documentation
Check/
Item Task Comments
initial
Document per For gastric lavage:
facility policy Type and size of tube inserted
Patient’s response
Technique used to assess tube placement
Frequency and solution used for flush
or irrigation
Gastrointestinal assessment findings
Net return from lavage
Character and amount of drainage
Type of suction and pressure
setting used
Vital signs and level of consciousness
Results of gastric specimen testing
Decontaminating agents instilled
Time tube was removed
Patient’s tolerance of removal

For gastric decompression:

Type and size of tube inserted
Patient’s response

Technique used to assess tube placement

Character and amount of drainage
Type of suction and pressure setting used
Gastrointestinal assessment findings
Nasal and oral hygiene measures
Patient’s tolerance of decompression

For gastric compression:

Type and size of tube inserted
Patient’s response
Technique used to assess tube placement
Amount of air used to inflate balloon
Confirmation of balloon inflation
Pressure changes made during procedure
Gastrointestinal assessment findings
Nasal and oral hygiene measures
Patient’s tolerance of compression

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Documentation

Comments

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