PAMANTASAN NG LUNGSOD NG MAYNILA COLLEGE OF NURSING

MEDICAL-SURGICAL NURSING II: NASOGASTRIC TUBE SKILLS

NAME: VILLELA, MARICAR B.

INSERTING A NASOGASTRIC TUBE

-Large or small bore tube -pH strip test or meter
-Nonallergic adhesive tape, 2.5 cm (1 inch wide) -Stethoscope
-Sterile gloves -Disposable pad or towel
-Water soluble lubricant -Clamp or plug (optional)
-Facial tissues -Suction apparatus, if required
-Glass of water and drinking straw -Safety pin and elastic band
-20-50ml syringe with adapter (asepto syringe)
-Pen light -Kidney basin -Tissue

Procedure RATIONALE

1. Check the physician’s orders to determine the type of tube to be inserted To ensure the correct type of tube is inserted
and the reason and understand the purpose of the procedure.

2. Introduce self and verify patient’s identity. Explain to the client the need and To gain the trust and cooperation of the patient
purpose of the procedure. Assess the patient’s mental status and
capabilities for cooperating with the procedure.
3. Provide for client privacy. To respects their dignity during the procedure.

4. Wash your hands for infection control. To prevent the transmission of microorganism.

5. Gather the equipment and explain the rationale for each. To ensures preparedness and understanding of
their purpose.

6. Place the client in high Fowler’s position. It helps facilitate NGT insertion by promoting
proper alignment of the upper airway and
esophagus. It also reduces the risk of aspiration
during the procedure.
7. Put a clean towel over the patient’s chest. Have a basin in the patient’s lap To ensures comfort and good hygiene.
and tissues handy.
8. Assess the client’s nares. ( 1 item ) It helps determine the appropriate nostril for
• Ask the client to hyperextend the head, using a flashlight observe the insertion
intactness of the tissues of the nostrils

• Examine the nares for any obstruction by asking the client to breathe To avoid any obstruction and complication while
through one nostril while occluding the other inserting the tube.
• Select the nostril that has the greater airflow.
 To know if there any signs of obstruction in the
nares.

9. Prepare the tube. Preparing the tube correctly ensures its

• If a rubber tube is being used, place it on ice for 5 to 10mins.If plastic tube suitability for insertion.
is too stiff place it in warm water.
To become more softer before inserting the
nares.

10. Put on gloves. It helps maintain aseptic technique during the

procedure.

11. Determine how far to insert the tube. (3 items) Prevents complications and ensures proper
placement.
• Use the tube to mark off the distance from the tip of the client’s nose • To ensures that the NGT is inserted to
to the tip of the earlobe and then from the tip of the earlobe to the tip the appropriate length, reaching the
of the xyphoid process.
desired location within the
gastrointestinal tract. To provides a
standardized method for determining
• If the client is an infant, extend it from the tip of the nose to the earlobe insertion depth based on individual
and then from the earlobe to a point halfway between the xiphoid anatomical landmarks.
process and the umbilicus. • Infants have different anatomical
proportions compared to adults, To
ensures that the tube reaches the
• Mark the tube. appropriate position within the infant's
gastrointestinal tract.
• To determined lengths serves as a
visual guide during the insertion.

12. Lubricate the tube with a water-soluble lubricant from tip to marking. To facilitates insertion and reduces discomfort
for the patient.

13. Insert the tube. ( 1 item) Careful insertion of the tube minimizes
• Grasp the tube with your right hand, about 3 inches from the end, and discomfort and potential injury to the client.
gently insert it into the nostril.
• Ask the client to hyperextend the neck, and gently advance the tube
toward the nasopharynx.
• Slight pressure is sometimes required to pass the tube to the
nasopharynx, 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.
14. Once the tube reaches the oropharynx, the client will feel the tube in the To enhance client comfort, facilitate the
throat and may gag and retch. passage of the tube, and reduce the risk of
• Ask the client to tilt the head forward, and encourage the client to complications, ultimately ensuring a safer and
drink and swallow. more tolerable procedure for the client.
15. If the client gags, stop passing the tube momentarily. Allowing the client to rest, take breaths, and sip
• Have the client rest, take a few breaths, and take sips of water to calm the water aims to manage the gag reflex, enhance
gag reflex. client comfort, and minimize the risk of
complications, ensuring a safer and more
tolerable NGT insertion procedure for the client.

16. In cooperation with the client, pass the tube 5 to 10 cm (2 –4 in) with each To ensures optimal placement, minimizes
swallow until the indicated length is inserted. discomfort, and promotes client participation
and safety during NGT insertion.

17. 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 the tube is coiled in the throat, withdraw it until it is straight, and
try again to insert it.
Inspecting the throat, and correcting any coiling
before attempting reinsertion aims to address
obstacles to tube advancement, minimize
discomfort, and optimize the safety and
effectiveness of NGT insertion for the client.

18. Ascertain correct placement of the tube. ( 6 items) • This step involves withdrawing fluid
• Aspirating visually recognizable gastrointestinal secretions from the NGT and examining it for
characteristics such as color,
consistency, and ph. Presence of
• Auscultate air insufflation by placing a stethoscope over the client’s
gastric contents confirms placement
epigastrium and injecting 10 to 30 ml of air into the tube while
of the tube in the stomach, indicating
listening for a whooshing sound, or gurgling ,bubbling noise with the
successful insertion and proper
use of a syringe.
positioning.
• Ph testing of aspirates • Can detect sounds indicative of air
entering the stomach. A whooshing
• Placing open end of the tube in a glass of water
sound, gurgling, or bubbling noise
• X-ray suggests that the tube is in the
gastrointestinal tract, confirming
• If the signs do not indicate placement in the stomach, advance the
correct placement.
tube 5 cm (2 in) and repeat the tests.
• Gastric aspirate typically has an acidic
ph (approximately 1 to 4), whereas
aspirates from other areas of the
body, such as the respiratory tract,
are usually alkaline. Ph testing helps
differentiate between gastric and non-
gastric placement of the NGT,
providing further confirmation of
correct tube placement.
• Submerging the open end of the NGT in
water and observing for bubbles upon
aspiration can indicate placement in
the stomach. Bubbles forming in the
water suggest that air from the
stomach is being released through the
tube, confirming correct placement.
 • Can clearly visualize the position of the
tube within the gastrointestinal tract,
providing conclusive evidence of
correct placement or identifying any
malpositioning that requires
correction.
• Advancing the tube slightly and
repeating the tests allows healthcare
providers to confirm placement or
make adjustments as necessary.

19. Secure the tube to the client’s gown. Prevents accidental removal or displacement.
20. Help the patient to a comfortable position. Assisting the client into a comfortable position
enhances their comfort post-procedure.

21. Dispose of gloves and wash hands. Proper disposal of gloves and handwashing
reduces the risk of contamination.

22. Evaluate client and document relevant information To ensure continuity of care and communication
among healthcare providers.

23. Establish a plan for providing daily nasogastric tube care. Promotes patient safety and well-being.

Total (30
items)

ADMINISTERING A NASOGASTRIC TUBE FEEDING

Equipment:
1. Large or small bore tube 7. Ph strip test or meter
2. Facial tissues 8. Stethoscope
3. Glass of water 9. Disposable pad or towel
4. Tube feeding at room temperature 10. Clamp or plug (optional)
5. 20-50ml syringe with adapter (asepto syringe) 11. Safety pin and elastic band
6. Kidney basin
Procedure RATIONALE

1. Check the physician’s orders and Check the amount, concentration, type and It helps prevent errors in feeding
frequency tube feeding on client’s chart. administration and ensures the client receives
the appropriate nourishment.

2. Introduce self and verify patient’s identity. Explain to the client the need and Introducing oneself and verifying their identity
purpose of the procedure. promotes trust and cooperation, helps the
patient understand the purpose of the NGT
placement and fosters informed consent,
 enhancing their overall experience and
compliance with the procedure.

3. Provide for client privacy. Maintains their dignity and confidentiality.

4. Wash your hands for infection control. To prevent the transmission of microorganism,
reduce the risk of contamination.
5. Gather the equipment and explain the rationale for each. Ensures preparedness and efficiency during
the procedure.
6. Place the client in high Fowler’s position. It helps facilitate NGT insertion by promoting
proper alignment of the upper airway and
esophagus. It also reduces the risk of
aspiration during the procedure.

7. Put a clean towel over the patient’s chest. Have a basin in the patient’s lap and Minimizes the risk of contamination and
tissues handy. promotes patient comfort and safety.

8. Unpin tube from client’s gown and check to see that the gastric tube is properly To ensure that the NGT is properly positioned in
located in the stomach. the stomach to prevent complications such as
aspiration. Verifying the tube placement helps
confirm its correct placement and ensures
safe and effective delivery of nutrition.

9. Aspirate all gastric contents with syringe and measure the residual. Facilitates appropriate management of enteral
• Return immediately through tube and proceed with feeding if amount of feeding, and promotes adherence to
residual does not exceed policy of agency or physician’s guidelines. established protocols to optimize patient
• Disconnect syringe from tubing outcomes and minimize complications.

10. Administer the tube feeding. ( 5 items) Ensures that clients who are unable to
• Remove plunger or bulb from syringe and attach syringe to nasogastric consume adequate nutrition orally receive
tube which has been pinched with finger and introduce the prescribed essential nutrients.
amount slowly.
• Ensures a clear pathway for the
• Hold the syringe approximately 12 inches above the stomach. Allow solution to enter the NGT, facilitating
solution to run in by gravity. Raise the syringe to increase the rate of flow, smooth administration.
and lower the syringe to decrease the rate of flow. • Allows for the controlled delivery of
the feeding solution by gravity, and
• Do not let the syringe empty while introducing the nourishment ensuring that the solution is
administered at a rate that is safe
• Introduce 30ml – 60ml (1 oz – 2 oz) of water into the tube after the and comfortable for the client.
nourishment is introduced. • Minimize interruptions in feeding
delivery and reduces the risk of
aspiration or discomfort for the
client.
• Helps clear any residual solution from
the tube
 Prevent complications, reduce the risk of
• .Clamp the gastric tube immediately after nourishment and water are
contamination
instilled. Disconnect the syringe and cover end of tubing with gauze
secured with rubber band.
11. Observe client’s response during and after tube feeding. To identify any signs of intolerance, such as
nausea, vomiting, abdominal discomfort, or
respiratory distress, which may indicate
complications or inadequate feeding tolerance.

12. Have client remain in upright position for at least 30 minutes after feeding. Helps prevent reflux and aspiration of gastric
contents.

13. Wash and clean equipment or replace according to agency policy. Wash your Reduce the risk of contamination and
hands. preventing the transmission of
microorganisms.
14. Record type and amount of feeding and client’s response. Monitor urine or blood Helps assess the client's metabolic status and
glucose if ordered by physician response to enteral nutrition, particularly in
clients with diabetes or those at risk of glucose
dysregulation.

Total (18 items)

REMOVING A NASOGASTRIC TUBE

Equipment:
Disposable pad or towel Tissues
Clean gloves 50-ml syringe (optional) Plastic trash bag
Procedure RATIONALE

1. Verify that the tube is no longer needed and that the physician has ordered Promotes patient safety and adherence to
for its removal medical protocols.

2. Assess client’s ability to swallow and for the presence of gag reflex. Indicate that the client can protect their
airway and safely manage oral intake after
tube removal, reducing the risk of aspiration
or other complications.

3. Gather equipment to be used and explain each. Ensures that the process is conducted
efficiently and safely, reducing anxiety and
promoting a positive experience for the client.

4. Identify the patient and assist him/her to a sitting position. Helps the patient feel more in control and
engaged in the removal process, enhancing
cooperation and reducing apprehension.
5. Explain to the client what you are going to do, why it is necessary, and Helps reduce fear and promotes cooperation,
how he or she can cooperate. Explain that the procedure will cause no facilitating a smoother and more tolerable
discomfort. experience for the client.

6. Wash hands and observe other appropriate infection control procedures To prevent the transmission of
microorganism.
7. Provide for client privacy Maintains their dignity and confidentiality.

8. Place the disposable pad across the client’s chest to collect any Minimizes the risk of contamination and
spillage of mucous and gastric secretions from the tube. promotes patient comfort and safety.
9. Provide tissues to the client to wipe the nose and mouth after tube removal. Promotes comfort and hygiene

10. Detach the tube • Prevents the application of negative

A. Disconnect from suction apparatus. Turn off suction machine before pressure during tube removal, which
disconnecting can cause discomfort or injury to
(if the pt. Is connected to a suction the nasal passages or throat
apparatus) • Promotes patient comfort and
B. Unpin the tube from client’s gown minimizes the risk of injury or
C. Remove the adhesive tape securing the tube to the nose. trauma to the client.
• Allows for easier extraction of the
tube from the nasal passage,
reducing the risk of discomfort or
injury to the client during removal.

11. Put on disposable clean gloves. Protects both the healthcare provider and the
patient from potential contamination and
reduces the risk of infection during the
removal procedure.

12. Ask the client to take a deep breath and to hold it Reducing the risk of accidental inhalation or
aspiration during tube removal.

13. Pinch the tube with the gloved hand. Minimizing the risk of aspiration or spillage
during tube removal

14. Withdraw the tube smoothly in a continuous motion. Minimizes discomfort and reduces the risk of
trauma to the nasal passages or throat.

15. Place the tube in the plastic bag.(If towel is used, place it in the Towel and cover Prevents contamination and ensures safe
it) disposal of the tube.

16. Observe the intactness of the tube and assess the nasogastric tube drainage, Helps ensure that the removal process was
noting for its color and characteristics. successful and that there are no signs of
damage or abnormalities. This assessment
informs further care and helps identify any
potential issues that may require attention.
17. Provide comfort and give mouth care. Assist client as required to blow the nose. Helps alleviate any discomfort or irritation
the client may experience, helps clear any
residual secretions or fluids from the nasal
passages, promoting comfort and facilitating
recovery.

18. Dispose of the equipment appropriately by placing the pad, bag with tube and Helps maintain infection control and prevents
gloves in the receptacle designated by the agency. the spread of microorganisms.

19. Wash hands To prevent the transmission of

microorganism, reduce the risk of
contamination.
20. Document all relevant information. Document the signs while inserting the tube.
Document the length of the tube. To ensures
accurate and comprehensive information.

Total (20 items)