SOUTHERN LUZON STATE UNIVERSITY

College of Allied Medicine

Lucban, Quezon
Bachelor of Science in Nursing

Name:_______________________________ Year and Section:________________

Group:______________________________ Date:__________________________
Nasogastric Tube Feeding Checklist
Excellent - 5
Competent - 4
Good - 3
Needs Improvement - 2
Poor - 1

NO. Procedure 5 4 3 2 1
1. Verify Doctor’s Order. Check the Diet and
Frequency of feeding.

2. Perform hand hygiene. Wash hands with soap and

water.

3. Prepare the equipments needed

a. Osteorized Feeding/ Formula
b. Asepto Syringe with bulb
c. Water for flushing
d. Calibrated glass
e. Pulverized medications (if any)
f. Stethoscope
g. Tongue depressor

4. Prepare the Osteorized feeding according to

Doctor’s prescription.

5. Identify patient and explain the procedures.

6. Provide privacy if the client desires.

7. Place patient on a semi- fowlers position.

8. Check the placement of tube by asking the patient to

open his/her mouth and check the back of the throat
to ensure that the tube is not coiled. (if the patient is
conscious)

9. Check the patency of the tube by removing the

rubber stopper. Kink the tube to prevent air from
entering. Connect the Asepto Syringe with bulb to
the kinked feeding tube. Place the stethoscope below
 the xiphoid process.

10. Inject 10-30ml of air down on the tube and

Auscultate for the “whoosh sound”. Positive
Gurgling sound indicate that air is entering the
stomach, while absence of suggests the tip of the
NGT is elsewhere.

11. Assess residual formula; re-instill gastric contents

according to agency/ doctor’s order.

10. Flush the tube with 30ml of water or as per

prescribed.

11. Feed patient accordingly to the feeding schedule.

Pour ampule amount of Osteorized Food/ formula to
the asepto syringe. Fill and refill the asepto syringe.

12. Position the syringe slightly above the head.

13. Ensure the tube is not empty during feeding to

prevent entrance of air.

14. Pour the crash or dissolve medications. (if any)

15. Complete the feeding by flushing 20ml of water, or

as per prescribed.

16. Clamp and cover the feeding tube before all the
water is instilled. Pin the tubing to the client’s gown.

17. Maintain on semi- fowlers position for at least 30

minutes.

18. Wash the equipment’s thoroughly with soap and

water so that it is ready for reuse.

19. Document all relevant information.

TOTAL SCORE:

REMARKS:

CLINICAL INSTRUCTOR:

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