Naspo 

Gastric Tube Feeding (Gavage Feeding)

- is used in patients suffering from dysphagia due to their

inability to meet nutritional needs despite food
modifications and because of the possibility of aspiration

Goal

To improve patient’s nutritional intake and maintain their

nutritional status.

Description

Nasogastric (NG) intubation is a procedure in which a

thin, plastic tube is inserted into the nostril, toward the
esophagus, and down into the stomach.

Once an NG tube is properly placed and secured, food

can be given directly to the stomach or
obtain substances from it.

Purpose

to deliver food and medicine to a patient when they are

unable to eat or swallow.

To suction stomach contents and secretions.

Types of Tubes

Naso Enteric Tubes

-Tube that pass from the nostrils into the duodenum or

jejunum
The length can be

medium (used for feeding)

long (used for decompression, aspiration).

Levine tube and salem sump tube are two most commonly
used GI tubes for NG intubation.

There are various tubes used in GI intubation but the

following two are the most common GI intubation Tube:

Levin tube -Is a single-lumen multipurpose plastic tube

that is commonly used in NG intubation.

Salem sump tube -A double-lumen tube with a “pigtail”

used for intermittent or continuous suction.

Benefits

For patients to gain adequate nutrition and medication

especially for those who are unable to eat and drink.

 NG intubation is a less invasive alternative to surgery in

the event an intestinal obstruction

- can be removed easily without surgery.

Indications

Therapeutic indications for NG intubation include:

1. Gastric decompression
- The naso gastric tube is connected to suction to
facilitate decompression by removing stomach
contents.

- Indicated for bowel obstruction and paralytic

ileus and when surgery is performed on the stomach
or intestine.
2. Aspiration of gastric fluid content

-Either for lavage or obtaining a specimen for analysis.

-  It will also allow for drainage or lavage in drug over
dosage or poisoning.

3. Feeding and administration of medication

-Introducing a passage into the GI tract will enable a
feeding and administration of various medications

 NG tubes can also be used for enteral feeding i

4. Prevention of vomiting and aspiration

- In trauma settings, in the prevention of vomiting and
aspiration, as well as for assessment of GI bleeding.

Contraindications

Naso gastric intubation is contraindicated in the following:

1. Recent nasal surgery and severe mid face trauma.

 These two are the absolute contraindications for NG

intubation due to the possibility of inserting the tube
intracranially.

An oro gastric tube may be inserted, in this case.

Other contraindications include:

1 Coagulation abnormality
2. Esophageal varices
3. Recent banding of esophageal varices and alkaline
ingestion.
Risks and Complications

As with most procedures, NG tube insertion is not

all beneficial to the patient as certain risks and
complications are involved:

1. Aspiration
The main complication of NG tube insertion include
aspiration.

2. Discomfort

A conscious patient may feel a little discomfort while the

NG tube is passed through the nostril and into the
stomach which can induce gagging or vomiting.

A suction should always be present and ready to be

used in this case.

3. Trauma
The tube can injure the tissue inside the sinuses,
throat, esophagus, or stomach if not properly inserted.

4. Wrong placement
Unwanted scenarios such as wrong placement of
an NG tube into the lungs will allow food and medicine
pass through it that may be fatal to the patient.

5. Other complications include: 

A. abdominal cramping or swelling from feedings that

are too large, 
-
B. diarrhea,

C. Regurgitation of the food or medicine, a tube

obstruction or blockage, 
 D. Tube perforation or tear, and tubes coming out of
place and causing additional complications

-NG tube is meant to be used only for a short period of

time.
Prolonged use can lead to conditions such as sinusitis,
infections, and ulcerations on the tissue of your
sinuses, throat, esophagus, or stomach.

Nursing Considerations

The following are the nursing considerations you should

watch out for:

1. Provide oral and skin care. Give mouth rinses and

apply lubricant to the patient’s lips and nostril. Using a
water-soluble lubricant, lubricate the catheter until it
touches the nostrils

Can cauase irritation and dryness.

 Verify NG tube placement. 

by aspirating a small amount of stomach contents.

Xray best way to verify placement

2. Wear gloves. Gloves must always be worn while

starting an NG because potential contact with the
patient’s blood or body fluids increases especially with
inexperienced operator.

3. Face and eye protection

face and eye protection if the risk for vomiting is high. 


Inserting a Nasogastric Tube

Procedure.

Supplies and Equipment

 Gloves
 Nasogastric tube
 Water-soluble substance (K-Y jelly)
 Protective towel covering for client
 Emesis basin
 Tape for marking placement and securing tube
 Glass of water (if allowed)
 Straw for glass of water
 Stethoscope
 60-mL catheter tip syringe
 Rubber band and safety pin
 Suction equipment or tube feeding equipment

Preparation

Patient may need to blow their nose and take a few sips of
water (if allowed) before the procedure.

Once the tube is inserted into the nostril, the patient may

need to swallow or drink water to help ease the NG tube
through the esophagus.

Anesthesia

In some institutions, topical anesthesia for naso gastric

(NG) intubation have been considered. It is used
or pain relief and improve the possibility of successful NG
intubation.

viscous lidocaine (the sniff and swallow method)

 It was found to significantly reduce the pain and gagging
sensation associated with NG tube insertion.

Alternative techniques include the following:

 Nebulization of lidocaine 1% or 4% through a face

mask
 An anesthetic spray of benzocaine or a
tetracaine/benzocaine/butyl aminobenzoate
combination

Steps in Inserting a Naso gastric Tube

1 Review the physician’s order and know the type,

size, and purpose of the NG tube. 

Acceptable

16 or 18 French for adults

French 5 for children

French 12 for older children.

2 Check the client’s identification band. 

3 Gather equipment, set up tube-feeding equipment or

suction equipment

4 Briefly explain the procedure to the client and

assess his capability to participate. 

to lessen anxiety about the procedure may interfere with

its success.
 It is important that the client relax, swallow, and cooperate
during the procedure.

5 Observe proper hand washing and don non-sterile

gloves. Clean, not sterile, technique is necessary
because the gastrointestinal (GI) tract is not sterile.

6 Position client upright or in full Fowler’s position if

possible. Place a clean towel over the client’s chest. Full
Fowler’s position assists the client to swallow, for optimal
neck-stomach alignment and promotes peristalsis. A towel
is used as a covering to protect bed linens and the client’s
gown.

7 Measure tubing from bridge of nose to earlobe, then

to the point halfway between the end of
the sternum and the navel. Mark this spot with a small
piece of temporary tape or note the distance. Each client
will have a slightly different terminal insertion point.
Measurements must be made for each individual’s
anatomy.

8 Wipe the client’s face and nose with a wet

towel. Wipe down the exterior of the nose with an alcohol
swab. The NG tube will stay more secure if taped on a
clean, non oily nose. If the nose has been cleaned with an
alcohol swab, the tape will stay more secure and the tube
will not move in the throat—causing gagging or discomfort
later.

9 Cover the client’s eyes with a cloth. This protects the

client’s eyes from any alcohol fumes from the alcohol
swab.

10 Examine nostrils for deformity or obstruction by

closing one nostril and then the other and asking the
client to breathe through the nose for each attempt. If
the client has difficulty breathing out of one nostril, try to
insert the NG tube in that one. The client may breathe
more comfortably if the “good” nostril remains patent.The
blocked nasal passage may

11 Lubricate 4 to 8 inches of the tub with a water-

soluble lubricant. 

12 Flex the client’s head forward, tilt the tip of the

nose upward and pass the tube gently into the nose to
as far as the back of the throat. Guide the tube
straight back. 

Flexing the head aids in the anatomic insertion of the

tube.The tube is less likely to pass into the trachea.

Once the tube reaches the nasopharynx, allow the

client lower his head slightly. 

Ask the assistant to hold the glass of water. Ready the

emesis basin and tissues.

 The positioning helps the passage of the NG to follow

anatomic landmarks.

Swallowing water, if allowed, helps the passage of the

NG tube.

14 Instruct the client to swallow as the tube

advances. 

Advance the tube until the correct marked position on the

tube is reached.

Encourage the client to breathe through his mouth. 

Swallowing of small sips of water may enhance passage
of tube into the stomach rather than the trachea.

15 If changes occur in patient’s respiratory status, if

tube coils in mouth, if the patient begins to cough or
turns cyanotic, withdraw the tube immediately. The
tube may be in the trachea.

16 If obstruction is felt, pull out the tube and try the

other nostril. 

17 Advance the tube as far as the marked insertion

point. Place a temporary piece of tape across the nose
and tube.

In this way, you can check for placement before securing

the tube. The tube may move out of position if not
secured before checking for placement.

18.  Check the back of the client’s throat to make sure

that the tube is not curled in the back of the throat. 

19 Check tube placement with these methods. Check

the tube for correct placement by at least two and
preferably three of the following methods:

A. Aspirate stomach contents. 

Stomach aspirate will appear cloudy, green, tan, off-white,

bloody, or brown. It is not always visually possible to
distinguish between stomach and respiratory aspirates.
Special note:

The small diameters of some NG tubes make aspiration

problematic.

The tubes themselves collapse when suction is applied via

the syringe. Thus, contents cannot be aspirated.
B. Check pH of aspirate. Measuring the pH of stomach
aspirate is considered more accurate than visual
inspection.

Stomach aspirate generally has a pH range of 0 to 4,

commonly less than

. The aspirate of respiratory contents is generally more

alkaline, with a pH of 7 or more.

C. Inject 30 mL of air into the stomach and listen with

the stethoscope for the “whoosh” of air into the
stomach. The small diameter of some NG tubes may
make it difficult to hear air entering the stomach.

D. Confirm by x-ray placement. X-ray visualization is the

only method that is considered positive.

20. Secure the tube with tape or commercially

prepared tube holder once stomach placement has
been confirmed.

Administering Tube Feeding

Equipment

 Gloves Feeding pump (if ordered)

 Clamp (optional)
 Feeding solution
 Large catheter tip syringe (30 mL or larger)
 Feeding bag with tubing
 Water
 Measuring cup
 Other optional equipment (disposable pad, pH
indicator strips, water-soluble lubricant, paper
Steps in Tube Feeding

The following are the step in administering tube feeding

via naso gastric tube.

1 Prepare formula. Follow the sub steps below:

1.1. Check expiration date. Outdated formula may be

contaminated or have reduced nutritional value.

1.2. Shake can thoroughly. Feeding solution may settle

and mixing is necessary just before administration.

1.3. For powdered formula, mix according to the

instructions on the package. Prepare just enough for
the next 24 hours and refrigerate unused formula.

Allow formula to reach room temperature before

using. Formula loses its nutritional value and can be
contaminated if kept for more than 24 hours. Cold
formulas can cause abdominal discomfort.

2 Explain the procedure to the client. Providing the right

information may result to client’s cooperation and
understanding.

3 Always check the position of the client. Make sure

that the position of the client with a tube feeding
remain with the head of bed elevated at least 30 to 40
degrees. Never feed the client with supine
position. Semi-Fowler’s or full-Fowler’s position
prevents aspiration pneumonia and possible death due
to pulmonary complications.

4. Check placement of feeding tube by:

A. Aspirating stomach contents. This indicates that the

tube is in its proper place in the stomach. The amount of
residual reflects gastric emptying time and indicates if
feeding should proceed. This contents are returned to the
stomach because they contain valuable electrolytes and
digestive enzymes.

1. Connect syringe to end of feeding tube.

2. Pull back on plunger carefully.
3. Determine amount of residual fluid (clamp tube if it is
necessary to remove the syringe).
4. Return residual to stomach via tube and continue with
feeding if amount does not exceed agency protocol or
physician’s orders.

B. Injecting 10 to 20 mL of air into tube (3–5 mL for

children). A whooshing or gurgling sound usually
indicates that the tube is in the stomach.This method may
not be a reliable indicator with small-bore feeding tubes.

1. Connect syringe filled with air to tube.

2. Inject air while listening with stethoscope over left
upper quadrant.

D. Measuring the pH of aspirated gastric secretions.

 Gastric contents are acidic, and a pH indicator strip

should reflect a range of 1 to 4.

Pleural fluid and intestinal fluid are slightly basic in nature.

E. Taking an x-ray or ultrasound. 

This may be needed to determine tube placement. X-ray

visualization is the only method that is considered positive.

Intermittent or Bolus Feeding If using a feeding bag:

 Suspend the feeding bag about 12 to 18 inches

inches above the stomach.
Clamp the tubing.

Fill the bag with prescribed formula and prime the

tubing by opening the clamp, allowing the feeding to
flow through the tubing.

Clamp the tube. Formula clears air from the tubing and

prevents it from entering the stomach.

1 Clamp the gastric tube. Connect the tip of the large

syringe, with the plunger or bulb removed, into the
gastric tube.

Gently pour feeding into the syringe.

Raise the syringe 12 to 18 inches above the stomach.

Open the clamp. Gravity promotes movement of feeding
into the stomach.

2 Allow feeding solution to flow slowly into the

stomach.

Raise and lower the syringe to control the rate of

flow.

Add additional formula to the syringe as it empties

until feeding is complete. 

Controlling administration and flow rate of feeding solution

prevents air from entering the stomach and nausea
and abdominal cramping from developing.
Continuous Feeding

If using a feeding pump:

1 Clamp the feeding setup and suspend on pole. Add

feeding solution to the bag. Open the clamp and prime
the tubing. 

Formula clears air from the tubing and prevents it from

entering the stomach.

Feeding pump.

2. Thread the tubing through or load tubing into the

pump, according to the manufacturer’s specifications.

7.3 Connect the tip of the setup to the gastric tube. Set

the prescribed rate and volume according to the
manufacturer’s directions. Open the clamp and turn
on the pump. Pump regulates the rate of administration
and volume of formula.

7.4. Stop the feeding every 4 to 8 hours and assess

the residual. Flush the tube every 6 to 8 hours.

 The amount of residual reflects gastric emptying time

and indicates whether the feeding should continue.
Flushing clears the tube and keeps it patent.

8 Stop feeding when completed. Instill prescribed

amount of water.

Keep the client’s head elevated for 20 to 30 minutes.

 Elevated position prevents the client from aspiration of
feeding solution into the lungs.

9 Regularly assess the skin around the injection site

of surgically placed tubes.

Cleanse skin with mild soap and water and dry

thoroughly.

Check site for redness, swelling, pain, or additional

signs of inflammation. 

Careful assessment and care can prevent spread infection

and skin breakdown.

10 Always observe proper hygiene by providing

mouth care such as brushing teeth, offering
mouthwash, and keeping the lips moist. These
activities promote oral hygiene and improve comfort.

Monitoring a Nasogastric Tube

Objectives

 To check the tube it is intact into the stomach.

 To monitor the flow rate of feeding.

Charting

 Record if the tube is intact

 Check amount, color, consistency and odor of
drainage from Naso gastric tube.
 Patient’s activities and reaction.
Steps in Monitoring a Naso gastric Tube

The following are the step-by-step procedures in

monitoring a nasogastric tube:

1 Confirm physician’s order for NG tube, type of

suction, and direction for irrigation. Ensures
correct implementation of physician’s order.

2 Observe drainage from NG tube. Check amount,

color, consistency, and odor.

Hema test drainage to confirm presence of blood in

drainage. 

Normal color of gastric drainage is light yellow to green in

color due to the presence of bile.

Bloody drainage may be expected after gastric surgery

but must be monitored closely.

Presence of coffee-ground type drainage may be indicate

bleeding.

3 Inspect suction apparatus.

Check that setting is correct for type of suction

(continuous or intermittent), range of suction
(low,medium,high) and that movement of drainage
through tubing is present.

 Ensures correct implementation of physician’ order.

Ensures that suction is present and correctly adjusted.

Loose connections or a kind or blockage in tube may
interfere with suction.

4 Assess placement of NG tube.

 NG tube may be displaced into trachea through

movement or manipulation.

5 Assess comfort of client.

Check for presence of nausea and vomiting, feeling of

fullness, or pain.

 May indicate incorrect operation of NG suction or

blockage in tube.

6 Assess client’s abdomen for distension and

auscultate for presence of bowel sounds.

 Abdominal distention may be related to the accumulation

of gas or internal bleeding.

Presence of bowel sounds indicates the return of

peristalsis.

7 Assess mobility of client and respiratory status.

Turning from side to side in bed and ambulation when

permitted encourage the return of peristalsis and facilitate
drainage.

Presence of NG tube may discourage client from coughing

and deep breathing necessary for adequate respiratory
exchange.

8 Observe condition of client’s nostrils and oral

cavity. 
Nostrils need cleansing and lubrication with water-soluble
lubricant and tape must be changed when necessary to
minimize irritation from NG tube.

Frequent mouth care (at 2-hr intervals) improves comfort

and maintains moisture in oral mucosa.

Monitor overall safety of client with NG tube.

NG tube that is secured to client’s nose with tape and

pinned to gown allows easier movement.

Call bell within reach allows client ready access to

nursing assistance.

Any kinks or obstruction interferes with patency of NG

tube.

A semi-Fowler’s position facilitates drainage and

minimizes any risk or aspiration.

10 Monitor NG tube and suction apparatus at least

every 2 hours.

Irrigate at interval ordered by physician. 

Promotes safe operation of system.

Any change in client’s condition or type of drainage

necessitates more frequent observation and notification of
physician.

11 Record and measure NG irrigations and drainage

on intake/output chart according to schedule and
agency protocol.
 Documents description of drainage and client’s
response on chart. 

Irrigations are recorded as intake.

Drainage from NG tube is measured as output every 8

hour.

If drainage is copious, more frequent emptying of

collection container will be necessary.

Documentation provides accurate record of client’s

response to NG drainage.

12 Replenish supplies and maintain equipment

according to agency policy and manufacturer’s
recommendations. 

Ensures availability of necessary supplies.

Provides for safe operation of equipment and efficient

drainage of client’s gastric contents.

Irrigating a Nasogastric Tube

A nasogastric tube is irrigated regularly to determine and

ensure the tube’s patency.

It will help release any formula stuck to the inside of the

tube.

Objective

 To ensure the patency of the naso gastric tube.

Indication
  Stomach contents fail to flow through tube.
Contraindication

 Some tubes are maintained by airflow, not normal

saline solution.

Nursing Alert:

Connect proper end (main lumen) of double lumen tube to

suction.

The short lumen is an airway, not a suction-drainage tube.

With double-lumen tube, if main lumen is probably
blocked, clear the main lumen, then inject up to 60 cc of
air through the short lumen above the level of the stomach
where the end of the main lumen is located.

Supplies and Equipment

 Nasogastric tube connected to continuous or

intermittent suction.

 Irrigation or Toomey syringe and container for
irrigating solution.
 Normal saline for irrigation
 .
 Disposable pad or bath towel

 Disposable gloves (optional)
 Stethoscope

Steps in Irrigating Nasogastric Tubes

The following is the step-by-step procedure in irrigating

nasogastric tubes:

1 Check physician’s order for irrigation.

Explain procedure to client. Clarifies schedule and
irrigating solution. An explanation encourages client
cooperation and reduces apprehension.

2 Gather necessary equipment. Check expiration

dates on irrigating saline and irrigation set. Provides
for organized approached to task. Agency policy dictates
safe interval for reuse of equipment.

Wash your hands. Handwashing deters the spread of

microorganisms.

4 Assist client to semi-Fowler’s position unless this is

contraindicated. Minimizes risk of aspiration.

5 Check placement of NG tube using the following

techniques: 

A. Attach Asepto or Toomey syringe to the end of tube

and aspirate gastric contents. The tube is in the
stomach if its contents can be aspirated.

B. Place 10mL-50ml of air in syringe and inject into the

tube. Simultaneously, auscultate over the epigastric
area with a stethoscope. A whooshing sound can be
heard when the air enters the stomach through the tube.

C. Ask client to speak. If tube is misplaced in trachea,

client will not be able to speak.

6 Clamp suction tubing near connection site.

Disconnect NG tube from suction apparatus and lay
on disposable pad or towel. Protects client from leakage
of NG drainage.

7 Pour irrigating solution into container. Draw up 30

ml of saline (or amount ordered by physician) into
syringe. Delivers measured amount of irrigant through NG
tube. Saline compensates for electrolytes lost through NG
drainage.

Place tip of syringe in NG tube. Hold syringe upright

and gently insert the irrigant (or allow solution to flow
in by gravity if agency or physician indicates). Do not
force solution into NG tube. Position of syringe prevents
entry of air into stomach. Gentle insertion of saline (or
gravity insertion) is less traumatic to gastric mucosa.

9 If unable to irrigate tube, reposition client and

attempt irrigation again. Check with physician if
repeated attempts to irrigate tube fail. Tube may be
positioned against gastric mucosa making it difficult to
irrigate.

10 Withdraw or aspirate fluid into syringe. If no return,

inject 20 ml of air and aspirate again. Injection of air
may reposition the end of tube.

11 Reconnect NG tube to suction. Observe movement

of solution or drainage. Determine patency of NG tube
and correct operation of suction apparatus.

12 Measure and record amount and description of

irrigant and return solution. Irrigant placed in NG tube is
considered intake: solution returned is recorded as output.

13 Rinse equipment if it will be reused. Promotes

cleanliness and prepares equipment for next irrigation.

14 Wash your hands. Handwashing deters the spread of

microorganisms.

15 Record irrigation procedure, description of

drainage and client’s response. Facilitates
documentation of procedure and provides for
comprehensive care.

RObjectives

 To check if the patient can tolerate oral feeding.

Contraindications

 Continuing need for feeding/suction.

Nursing Alert: Removal is easier with the patient in semi-
Fowler’s position.

Supplies and Equipment

 Tissues
 Plastic disposable bag
 Bath towel or disposable pad
 Clean disposable glove
Steps in Removing Nasogastric Tube

The following is the step-by-step procedure in

removing nasogastric tubes:

1 Check physician’s order for removal of nasogastric

tube. Ensures correct implementation of physician’s order.

Removing a Nasogastric Tube

Explain procedure to client. Explanation facilitates client

cooperation and understanding.

3 Gather equipment. Makes every step within reach and

provides for organized approach to task.

4 Wash your hands. Don clean disposable glove on

hand that will remove tube. Handwashing deters the
spread of microorganisms. Gloves protect hand from
contact with abdominal secretions.
5 Discontinue suction and separate tube from suction.
Unpin tube from client’s gown and carefully remove
adhesive tape from bridge of nose. Allows for
unrestricted removal of nasogastric tube.

6 Place towel or disposable pad across client’s chest.

Hand tissues to client. Protects client from contact with
gastric secretions. Tissues are necessary if client wishes
to blow his nose when tube is removed.

7 Instruct client to take a deep breath and hold it. 

Prevents accidental aspiration of any gastric secretions in
tube.

8 Clamp tube with fingers. Quickly and carefully

remove tube while client holds his breath. Minimizes
trauma and discomfort for client. Clamping prevents any
drainage of gastric contents in tube.

9 Place tube in disposable plastic bag. Remove glove

and place in bag. Prevents contamination

with any microorganisms.

10 Offer mouth care to client and make client feel

comfortable. Provides comfort.

11 Measure nasogastric drainage. Remove all

equipment and dispose according to agency policy.
Wash your hands. Measuring nasogastric drainage
provides for accurate recording of output. Proper disposal
deters spread of microorganisms.

12 Record removal of nasogastric tube, client’s

response, and measurement of drainage. Facilitates
documentation and provides for comprehensive care.

Charting
  Record date of removal of nasogastric tube.
 Record client’s response.
 Record measurement of drainage.
After Care

 Discard the disposable equipment used.

 Wash your hands.
 Position the patient in a comfortable or in his desired position.