GASTROINTESTINAL INTUBATION

At the end of this module, you will be able to:

 Understand the purpose and significance of gastrointestinal intubation.
 Accurately execute the Insertion and Removal of Nasogastric Tube with careful
observation of aseptic technique and safety precautionary measures.
 Be attentive in maintaining client’s privacy to preserve client’s dignity during the said
procedures

INSERTING A NASOGASTRIC TUBE

Gastrointestinal Intubation

It is done to obtain a specimen of stomach contents, to lavage the stomach, to

gavage a patient, or to allow for drainage of stomach contents by suction apparatus. Gastric
intubation via the nasal passage (ie, the nasogastric route) is a common procedure that
provides access to the stomach for diagnostic and therapeutic purposes.

Nasogastric Tube
It is a flexible plastic tube inserted through the nostrils, down the nasopharynx, and
into the stomach or the upper portion of the small intestine. It is placed into the client’s
stomach for the purpose of feeding the client or to remove gastric secretions. The placement
of an NG tube can be uncomfortable for the patient if the patient is not adequately
prepared with anesthesia to the nasal passages and specific instructions on how to
cooperate with the operator during the procedure. Placement of NG tubes is always
confirmed with an X-ray prior to use (Perry, Potter, & Ostendorf, 2014).
Patients who require insertion of a nasogastric (NG) tube may:
• Be unable to swallow or eat normally.
• Be bleeding from the gastrointestinal (GI) tract.
• Have ingested poison or other dangerous substances, requiring
evacuation of stomach contents.
PREPARATION
●The right naris is usually larger and facilitates easier insertion.

●Assessment prior to insertion of an NG tube should include careful

history of any nasal injuries or anatomy-related problems.

 ●Severe coughing or cyanosis during the procedure may mean that

the tube has slid into the trachea. Remove at once, allow the patient
time to recover, and attempt again.

REMOVING A NASOGASTRIC TUBE

An NG tube should be removed if it is no longer required. The process of removal is

usually very quick. Prior to removing an NG tube, verify physician orders. If the NG tube was
ordered to remove gastric content, the physician’s order may state to “trial” clamping the tube
for a number of hours to see if the patient tolerates its removal. During the trial, the patient
should not experience any nausea, vomiting, or abdominal distension.

CLICK THE LINK to watch the video of:

 Inserting a Nasogastric Tube

 Removing a Nasogastric Tube

 Doyle, G.R., McCutcheon, J.A. (2015). Clinical Procedures for Safer Patient Care. Victoria, BC:
BCcampus. Retrieved from https://opentextbc.ca/clinicalskills/

 Pillitteri, A. Maternal & Child Health Nursing Care of the Childbearing and Childrearing Family
(Seventh edition). Lippincott Williams & Wilkins. 2014

 Perry, A. G., Potter, P. A., & Ostendorf, W. (2016). Nursing Interventions & Clinical Skills (6th
ed.). Elsevier.

 Berman, A., Snyder, S., Frandsen G. (2016). Kozier and Erb’s Fundamentals of Nursing (Tenth
Edition).United States of America.
 Rhoads, J., Meeker, B.J., (2008). Davis’s Guide to clinical nursing skills. Philadelphia.
NAME: DATE:

INSERTING A NASOGASTRIC TUBE

DEFINITION

PURPOSE

EQUIPMENT

CONSIDERATIONS BEFORE, DURING and AFTER THE PROCEDURE:

THINGS TO DOCUMENT AFTER THE PROCEDURE:

PROCEDURE RATIONALE
1. Check doctor’s orders.
2. Explain the procedure to the patient.
3. Wash hands and don on clean gloves.
4. Place the patient in a semi-fowler’s position.
Provide privacy.
5. Place a towel across the patient’s chest.
6. Assess the client’s nares.
 •Apply clean gloves.
• Ask the client to hyperextend the head,
and, using a flashlight, observe the intactness
of the tissues of the nostrils, including any
irritations or abrasions.
• Examine the nares for any obstructions or
deformities by asking the client to breathe through
one nostril while occluding the other.
•Select the nostril that has the greater airflow.
7. Prepare the tube
• If a small-bore tube is being used, ensure stylet
or guidewire is secured in position
• If a large-bore tube is being used, place the
tube in a basin of warm water while preparing the
client.
8.

Determine how far to insert the tube.

• Use the tube to mark off the distance from the
tip of the
client’s nose to the tip of the earlobe and then
from the tip
of the earlobe to the tip of the xiphoid.
 9. Insert the tube.
• Lubricate the tip of the tube well with
water-
soluble lubricant or water to ease insertion.
•Insert the tube, with its natural curve downward,
into the selected nostril. Ask the client to
hyperextend the neck, and gently advance the
tube toward the nasopharynx.
• Direct the tube along the floor of the nostril and
toward the midline.
• Slight pressure and a twisting motion
are sometimes required to pass the tube into
the nasopharynx, and some client’s eyes may
water at this point.
• If the tube meets resistance, withdraw
it, relubricate it, and insert it in the other nostril.
• Once the tube reaches the oropharynx (throat),
the client will feel the tube in the throat and may
gag and retch. Ask the client to tilt the head
forward, and encourage the client
to drink and swallow
• If the client gags, stop passing the
tube momentarily. Have the client rest, take a
few breaths, and take sips of water to calm the
gag reflex.
•In cooperation with the client, pass the tube 5 to
10 cm (2 to 4 in.) with each swallow, until
the indicated length is inserted.
• If the client continues to gag and the tube does
not advance with each swallow, withdraw
it slightly, and inspect the throat by looking
through the mouth.
•If a CO2 detector is used, after the tube has
been advanced approximately 30 cm (12 in.),
draw air through the detector. Any change in color
of the detector indicates placement of
the tube in the respiratory tract. Immediately
withdraw the tube and reinsert.
10. Ascertain correct placement of the tube.
• Nasogastric tubes are radiopaque, and position
can be confirmed by x-ray. If a SBFT is
used, leave the stylet or guidewire in place until
correct position is verified by x-ray.
• This is the only definitive method of
verifying feeding tube tip placement. If an x-
ray is not feasible, at least two of the
following methods should be used.
• Aspirate stomach contents, and check the pH,
which should be acidic. Rationale: Testing pH is a
 reliable way to determine location of a
feeding tube. Gastric contents are commonly pH
1 to 5; 6 or greater would indicate the contents
are from lower in the intestinal tract or in the
respiratory tract. However, pH may not
discriminate between gastric and esophageal
placement (Stepter,
2012).
•Aspirate can also be tested for bilirubin. Bilirubin
levels in the lungs should be almost zero, while
levels in the stomach will be approximately
1.5 mg/dL and in the intestine more than 10
mg/dL.
• Historically, nurses placed a stethoscope over
the client’s epigastrium and injected 10 to 30 mL
of air into the tube while listening for a whooshing
sound. This method does not guarantee tube
position.
• If the signs indicate placement in the
lungs, remove the tube and begin again.
• If the signs do not indicate placement in
the lungs or stomach, advance the tube 5 cm (2
11.
in.), and repeat the tests.

Secure the tube by taping it to the bridge of the

client’s nose.
•If the client has oily skin, wipe the nose first
with alcohol to defeat the skin.
•Apply a commercial securement device
12. Once correct position has been determined,
attach the tube to a suction source or feeding
apparatus as ordered, or clamp the end of the
tubing.
13. Connect to suction or feeding, if required.
14. Document relevant information: the insertion of
the tube, the means by which correct placement
was determined, and client responses (e.g.,
discomfort or abdominal distention).
15. Establish a plan for providing daily
nasogastric tube care.
• Inspect the nostril for discharge and irritation.
• Clean the nostril and tube with moistened,
cotton-tipped applicators.
• Apply water-soluble lubricant to the nostril if
it appears dry or encrusted.
• Change the adhesive as required.
• Give frequent mouth care. Due to the presence
of the tube, the client may breathe through
the mouth.
16. If suction is applied, ensure that the patency
of both the nasogastric and suction tubes
is maintained.
• Irrigation of the tube may be required at regular
intervals. Prior to each irrigation, recheck tube
placement.
• Keep accurate records of the client’s fluid intake
and output, and record the amount
and characteristics of the drainage.
17. Document the type of tube inserted, date and
time of tube insertion, type of suction used, color
and amount of gastric contents, and the
client’s tolerance of the procedure.

Ability to answer questions

Date of completion:
Completed: Yes No

REMARKS:
NAME: DATE:

REMOVING A NASOGASTRIC TUBE

DEFINITION

PURPOSE

EQUIPMENT

CONSIDERATIONS BEFORE, DURING and AFTER THE PROCEDURE:

THINGS TO DOCUMENT AFTER THE PROCEDURE:

PROCEDURE RATIONALE
1. Check doctor’s orders.
2. Explain the procedure to the patient.
3. Wash hands and don on clean gloves.
4. Place the patient in a semi-fowler’s position.
Provide privacy.
5. Place a towel across the patient’s chest.
 6. Wet adhesive tapes attached to the NGT, and
carefully remove the tapes away from the face.
7. Instruct the patient to take a deep breath and
hold it.
8. Kink NGT then quickly and carefully remove tube
while patient’s holding his breath.
9. Dispose NGT as per agency’s policy.
10. Offer oral care to the client then place in a
comfortable position.
11. Remove gloves and do handwashing.
12. Document procedure done.

Ability to answer questions

Date of completion:
Completed: Yes No

REMARKS:
 ENTERIC NUTRITION

At the end of this module, you will be able to:

 Understand the importance of Enteric Nutrition
 Accurately execute Nasogastric Tube Feeding and Gastric Lavage following proper
timing and safety precautionary measures.
 Be attentive in maintaining client’s privacy to preserve client’s dignity during the said
procedures

NASOGASTRIC TUBE FEEDING

Enteral feeding is a method of supplying nutrients directly into the gastrointestinal

tract. Enteral feeding tubes can be used to:
 Administer bolus, intermittent feeds and continuous feeds
 Medication administration
 Facilitate free drainage and aspiration of the stomach contents
 Facilitate venting/decompression of the stomach
 Stent the esophagus

To lower patient’s risk of complications from NG intubation and feeding, health care
provider:
 ensure the tube is always taped securely to your face
 check the tube for signs of leakage, blockage, and kinks
 elevate your head during feedings and for an hour afterwards
 watch for signs of irritation, ulceration, and infection
 keep your nose and mouth clean
 monitor your hydration and nutrition status regularly
 check electrolyte levels through regular blood tests
 make sure drainage bag is regularly emptied, if applicable
 GASTRIC LAVAGE

Gastric lavage is the washing out of the stomach

via a nasogastric tube or stomach tube. Lavage is
ordered to wash out the stomach (after ingestion of
poison or an overdose of medication, for example)
or to control gastrointestinal bleeding. If the patient
does not have a nasogastric tube in place already,
the physician will order the insertion of the
appropriate tube.
Lavage Technique. There are two basic
techniques used in performing gastric lavage. The
technique used depends upon the reason for
p the rocedure and the physician’s preference. Check
the
doctor’s orders to see which method is specified. If the physician does not specify
the
technique, consult with the professional nurse. The two techniques used are as follow.
(1) Solution is instilled and aspirated 50cc at a time, using a catheter tip syringe. The
procedure is repeated until the stomach contents return clear, the entire amount of
prescribed solution has been used, or otherwise directed.
(2) Solution is slowly poured into the tube through a funnel, allowing the solution to
enter the stomach by gravity. Up to 500cc of solution may be instilled at a time, depending
upon the size and tolerance of the patient. The tube is then lowered below the level of the
patient, allowing the solution to drain out of the stomach by gravity. When using this
technique to lavage, it is imperative that the patient be assessed carefully for abdominal
distension. Repeat the procedure until the stomach contents return clear, the entire amount
of solution has been used, or otherwise directed.

CARING FOR A GASTROTOMY TUBE

A gastrostomy tube is surgically placed directly into the client’s stomach and provides
another route for administering medications and nutrition. Correct placement of the
tube should be confirmed prior to administration of an enteral feed by checking insertion site
at the abdominal wall and observing the child for abdominal pain or discomfort. If the nurse is
unsure regarding the position of the gastrostomy or jejunostomy tube contact the
medical team immediately.
CLICK THE LINK to watch the video of :

Nasogastric Tube Feeding https://www.youtube.com/watch?v=Il0iJUNnq7k

Gastric Lavage https://www.youtube.com/watch?v=2iLPfCAMgZs
Caring for a Gastrostomy Tube

 Doyle, G.R., McCutcheon, J.A. (2015). Clinical Procedures for Safer Patient Care. Victoria, BC:
BCcampus. Retrieved from https://opentextbc.ca/clinicalskills/

 Pillitteri, A. Maternal & Child Health Nursing Care of the Childbearing and Childrearing Family
(Seventh edition). Lippincott Williams & Wilkins. 2014
 Perry, A. G., Potter, P. A., & Ostendorf, W. (2016). Nursing Interventions & Clinical Skills (6th
ed.). Elsevier.

 Berman, A., Snyder, S., Frandsen G. (2016). Kozier and Erb’s Fundamentals of Nursing (Tenth
Edition).United States of America.

 Rhoads, J., Meeker, B.J., (2008). Davis’s Guide to clinical nursing skills. Philadelphia.
NAME: DATE:

NASOGASTRIC TUBE FEEDING

DEFINITION

PURPOSE

EQUIPMENT

CONSIDERATIONS BEFORE, DURING and AFTER THE PROCEDURE:

THINGS TO DOCUMENT AFTER THE PROCEDURE:

PROCEDURE RATIONALE
1. Remove the osteorized feeding or formula
from the refrigerator. Warm feeding or
allow to come to room temp.
2. Explain the procedure to the patient.
3. Do handwashing.
4. Bring OF and equipment to the bedside.
5. Place the patient in a fowler’s position and
provide privacy.
 6. Check tube placement. Attach asepto
syringe to the end of the NGT. Place a
stethoscope over the left upper quadrant of
the abdomen just below the coastal margin.
Inject 10-20 cc of air.
7. Assess for residual feeding contents.
8. Kink the tubing, remove the bulb, fill the
asepto syringe with the feeding, and then
unkink the tube.
9. Allow the feeding to flow in by gravity. Give
feeding slowly keeping the asepto syringe
filled at all times.
10. Always keep the asepto syringe at least 1
foot above the edge of bed.
11. After feeding, flush tubing with at least 30 cc
of water.
12. Kink the tube. Remove asepto syringe and
clamp the tube tightly and securely.
13. Maintain semi-fowler’s position for 30-60
minutes after feeding is completed.
14. Wash equipment with soap and water, dry,
and store properly.
15. Chart type and amount of feeding, including
water, and patient’s tolerance.

Ability to answer questions

Completed: Yes No Date of completion:

REMARKS:
NAME: DATE:

GASTRIC LAVAGE

DEFINITION

PURPOSE

EQUIPMENT

CONSIDERATIONS BEFORE, DURING and AFTER THE PROCEDURE:

THINGS TO DOCUMENT AFTER THE PROCEDURE:

PROCEDURE RATIONALE
1. Check doctor’s orders.
2. Explain the procedure to the patient.
3. Gather the necessary equipment.
4. Place patient in a semi-Fowler’s
position. Provide privacy.
5. Do handwashing then don on clean
gloves.
6. Check NGT placement.
 7. Aspirate stomach contents with
syringe attached to the NGT before
instilling water or antidote. Save
specimen for analysis.
8. Remove the syringe. Attach funnel or
50 mL syringe to the NGT.
9. Elevate the funnel above the patient’s
head and pour about 150-200 mL of
solution into the funnel.
10. Lower the funnel and siphon gastric
contents into the bucket. Save
samples of the first two washings.
11. Repeat lavage procedure until the
returns are relatively clear and no
particulate matters are seen.
12. At the completion of lavage:
 Stomach may be left empty
 An absorbent may be instilled
and allowed to remain in the
stomach
 A saline cathartic may be instilled
in the NGT.
13. Kink NGT, remove syringe or funnel,
and then clamp tubing.
14. Place the patient in a comfortable
position.
15. Remove gloves and do handwashing.
16. Do aftercare.
17. Chart procedure, solution instilled,
characteristics of return flow, and
patient’s response.

Ability to answer questions

Completed: Yes No Date of completion:

REMARKS:
NAME: DATE:

CARING FOR A GASTROSTOMY TUBE

DEFINITION

PURPOSE

EQUIPMENT

CONSIDERATIONS BEFORE, DURING and AFTER THE PROCEDURE:

THINGS TO DOCUMENT AFTER THE PROCEDURE:

PROCEDURE RATIONALE
1. Explain the procedure to the patient.
2. Gather the necessary equipment.
3.
Do handwashing and don on clean gloves.

4.
If the gastrostomy tube is new, dip a cotton-
tipped swab into a sterile solution and
gently clean around the insertion site.
 5.
If the gastro-tube insertion site has healed
and has no more sutures, wet a washcloth
and apply a small amount of soap. Gently
cleanse the insertion site and then rinse.

6.
Pat the skin around the insertion site dry.

7. If there are no more sutures, rotate the

guard or external bumper 90° at least once
a day.
8. Remove gloves and do handwashing.
9. Place patient in a comfortably in bed.
10. Do aftercare.
11. Record procedure; include appearance of
site, any discharges, and patient’s
response.
Ability to answer questions

Completed: Yes No Date of completion:

REMARKS: