Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

Name: ___________________________________________ Grade: _________

Year & Section: ____________________________________ Date: __________
Group No: ________________________________________

PROCEDURE CHECKLIST
CARE OF CLIENTS WITH NASO GASTRIC TUBE (REMOVAL)
Instruction: Below is the grading scale which will be used in rating your performance.
5 EXCELLENT 95 - 100
4 VERY SATISFACTORY 88 - 94
3 SATISFACTORY 82 – 87
2 FAIR 76 – 81
1 NEEDS PRACTICE 70 – 75
A. ASSESSMENT
 For the presence of bowel sounds
 For the absence of nausea or vomiting when tube is clamped

B. PLANNING
Due to the need for assessment of client status, the skill of removing a
nasogastric tube is not delegated to UAP.

C. EQUIPMENT
 Disposable pad or towel
 Tissues
 Clean gloves
 50-mL syringe (optional)
 Moisture-proof trash bag

D. IMPLEMENTATION
PREPARATION 5 4 3 2 1 REMARKS
1. Confirm the primary care provider’s order to
remove the tube.
2. Assist the client to a sitting position if health
permits.
3. Place the disposable pad or towel across the
client’s chest to collect any spillage of
secretions from the tube.
4. Provide tissues to the client to wipe the nose
and mouth after tube removal.

PERFORMANCE 5 4 3 2 1 REMARKS
1. Identify the patient. Introduce yourself.
2. Provide privacy.
3. Explain the procedure.
4. Hand washes thoroughly.
5. Don appropriate PPE.
6. Prepare the equipment.
7. Flush tube with 5-10 mL of NS or SW.
8. Remove tape/securement device.
9. Release suction and CLAMP tube (if
appropriate).
10. Ask client to take a deep breath and hold
breath if they can, or exhale slowly.
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

11. Withdraw tube gently, quickly and steadily.

12. Place NGT in disposable bag. Remove
gloves.
13. Assist client with thorough mouth and nare
care.
14. Assist patient in comfortable position.
Administer oral hygiene.
15. Wash hands.
16. Monitor client for gastrointestinal difficulty, i.e.
nausea, vomiting, abdominal distension, and
food intolerance.
17. Document.
E. EVALUATION
 Perform a follow-up examination, such as presence of bowel sounds, absence of nausea
or vomiting when tube is removed, and intactness of tissues of the nares.
 Relate findings to previous assessment data if available.
 Report significant deviations from normal to the primary care provider.

Date/Time: ______________________________
Clinical Instructor: ________________________