NGT PROCEDURE
PROCEDURE
ASSESSMENT
1. Verified Order for type of tube and
feeding schedule, determined if health
care provider wants prokinetic agent
given before tube placement.
2. Identified patient using at least two
identifiers.
3. Assessed patient’s knowledge of
procedure.
4. Performed hand hygiene, had patient
close each nostril alternately and breathe,
examined each naris for patency and skin
breakdown.
5. Reviewed patient’s medical history for
problems that might affect route of
nutritional support.
6. Assessed patient’s baseline height,
weight, hydration, electrolyte balance,
caloric needs, and I&O.
7. Assessed patient’s mental status,
presence of cough and gag reflex, ability
to swallow, critical illness, presence of
artificial airway.
8. Performed physical assessment of the abdominal pain, tenderness, or distention
abdomen.
PLANNING
1. Identified expected outcomes.
2. Explained procedure to patient,
included sensations he or she would feel. in insertion.
3. Explained how to communicate during
insertion.
RATIONALE
Health care provider’s order is needed to
ensure proper type of tube and feeding
schedule. Prokinetic agents such as
metoclopramide given before tube
placement help advance tube into
intestine (Metheny, 2006).
Ensure correct patient. Complies with The
Joint Commission standards and
improves patent’s safety.
Encourages cooperation, reduces
anxiety, and minimizes risks. Identifies
patient teaching needs.
Reduces transmission of microorganisms.
Sometimes nares are obstructed or
irritated, or a septal defect or facial
fractures are present. Place tube in most
patent nostril.
A history of problems may contraindicate
tube placement and require you to
consult with health care provider to
change route of nutrition support.
Provides baseline information to measure
nutritional improvement after enteral
feedings are initiated.
These are risk factors for inadvertent
feeding tube placement into the
tracheobronchial tree (Krenitsky, 2011).
Patients with impaired gag reflex; their
risk of aspiration increases during
insertion of feeding tubes and subsequent
tube feedings (Altman et al.,2013).
Absence of bowel sounds or presence of
may indicate GI problem, contraindicating
feeding.
Reduces anxiety and helps patient assist
Helps patient assist in insertion
IMPLEMENTATION
1. Performed hand hygiene, prepared
supplies at bedside.
2. Stood on same side of bed as naris
chosen for insertion.
3. Applied pulse oximeter, measured vital
signs, ensured patient stability before
inserting tube.
4. Placed bath towel over patient’s chest,
kept facial tissues within reach.
5. Determined length of tube to be
inserted, marked location properly.
6. Prepared NG or nasoenteric tube for
insertion:
a. Obtained order for stylet tube.
b. Injected water from syringe into the
tube if tube has guidewire or stylet.
c. Ensured stylet is positioned securely
within tube, injected water from syringe
into tube.
7. Cut hypoallergenic tape or prepared
other securing device.
8. Applied clean gloves.
9. Dipped tube with surface lubricant into
room temperature water or applied
lubricant.
10. Handed alert patient a cup of water
with straw.
11. Explained next step, inserted tube
through nostril to back of throat, aimed
appropriately.
12. Had patient flex toward chest at
appropriate time.
13. Encouraged patient to swallow with
small sips of water, advanced tube as
patient swallowed, rotated tube while
inserting.
14. Reemphasized mouth breathing and
swallowing.
Reduces transmission of microorganisms.
Helps the HCP perform procedure
smoothly
Allows easier manipulation of tube
Provides objective assessment of
respiratory status during tube insertion.
Prevents soiling of gown. Insertion of tube
frequently produces tearing.
Length approximates distance from nose
to stomach.
Ensures tube is patent. Activates
lubrication of tube for easier passage and
ensure the tube is patent. Aids in
guidewire or stylet removal once the tube
is placed
Improperly positioned stylet induces
serious trauma. Promotes smooth
passage of tube into GI tract.
Fixation device allow the tube to float free
of the nares, thus reducing pressure on
the nares and preventing device-related
pressure ulcer.
Reduces transmission of microorganisms.
Activates lubricant to facilitate passage of
tube into naris to GI tract.
Swallowing water facilitates tube
passage.
Natural contour facilitates passage of
tube into GI tract and reduces gagging by
patient.
Closes off glottis and reduces risk of tube
entering trachea.
Swallowing facilitates passage of tube
past oropharynx. A tug may be felt as
patient swallows, indicating tube is
following desired path.
Helps facilitate passage of tube and
alleviates patient’s fears during
procedure.

15. Did not advance tube during
inspiration or coughing, monitored
oximetry and capnography.
16. Advanced tube each time patient
swallowed, until desired length had been
passed.
17. Checked for position of tube at back
of throat.
18. Anchored tube to nose temporarily
19. Checked placement of tube by
aspirating stomach contents.
20. Anchored tube to patient’s nose,
marked exit site on tube, selected
appropriate option for anchoring
a. Applied membrane for dressing or tube
fixation device properly.
b. Applied tape properly.
21. Fastened end of NG tube properly to
patient’s gown.
22. Assisted patient to a comfortable
position.
23. Removed gloves, performed hand
hygiene.
24. Obtained x-ray film of chest/abdomen. for verifying tube placement (Stewart,
25. Performed hand hygiene, applied
clean gloves, administered oral hygiene, oral mucous membranes.
cleansed tubing at nostril properly.
26. Removed gloves, disposed of
equipment, performed hand hygiene.
27. Removed tube:
a. Verified order for tube removal.
b. Gathered equipment.
c. Explained procedure to patient.
d. Performed hand hygiene, applied
gloves.
Can cause tube to inadvertently enter
patient’s airway, which will be reflected in
changes in O2 saturation or end tidal
CO2.
Reduces discomfort and trauma to
patient.
Tube could become coiled, kinked, or
enter the trachea.
Movement of tube stimulates gagging.
Allow for assessment of tube position
before anchoring the tube securely.
Proper tube placement is essential before
initiating feeding. Properly obtained pH of
1.0 to 4.0 is good indication of gastric
placement (Fernandez et al., 2010)
Properly secured tube allows patient
more mobility and prevents trauma to
nasal mucosa.
Secures tube and reduces friction on
nares
Helps tape adhere better. Protects skin.
Reduces traction on nares if tube moves.
Safety pins become unfastened and
possibly cause injury to patient.
Reduces transmission of microorganisms.
X-ray film examination is gold standard
2014).
Promotes patient comfort and integrity of
Reduces transmission of microorganisms
Informs patient and enhances
cooperation.
Reduces transmission of microorganisms.
 Reduce risk of aspiration in the event the
e. Positioned patient appropriately.
patient vomits.
f. Placed disposable pad over patient’s Prevents mucus and secretions from
chest. soiling patient’s gown.
g. Disconnected tube from feeding
administration.
h. Removed securement device from Allows for easy tube removal.
patient’s nose.
i.Instructed patient to take a deep breath Prevents inadvertent aspiration of gastric
and hold, kinked end of tubing, withdrew contents during tube removal.
tube appropriately.
j. Offered tissues to patient. Provides patient comfort.
k. Offered mouth care. Provides patient comfort.
l. Removed gloves, performed hand Reduces transmission of microorganisms.
hygiene.
EVALUATION
1.Observed patient’s response to tube Malposition of tube causes gagging,
placement, assessed for signs of coughing and difficulty of breathing
placement in respiratory tract.
2. Confirmed x-ray film results with Verifies position of tube before initiating
healthcare provider. enteral feeding.
3. Removed stylet after verification of
placement.
4. Routinely checked condition of nares, Routine checking ensures correct tube
location of marking on tube, and color placement and reduces the risk of
and pH of fluid aspirated from tube. aspiration.
5. Assessed patient’s LOC after removal.
6. Asked patient to explain how he or she Reflects patient’s understanding
will communicate during NG tube
instertion.
7. Identified unexpected outcomes.
RECORDING AND REPORTING
1. Recorded type and size of tube placed,
location of distal tip of tube, patient’s
tolerance of procedure, condition of naris,
and confirmation of tube position.
2. Recorded removal of tube, condition of
naris, and patient’s tolerance.
3. Reported any type of unexpected
outcome and interventions performed.
4. Documented evaluation of patient
learning.