DAVAO ORIENTAL STATE UNIVERSITY

FACULTY OF NURSING AND ALLIED HEALTH SCIENCES

Bachelor of Science in Nursing
Guang-guang, Dahican, City of Mati, Davao Oriental

Modified Observe Structure Clinical Examination (OSCE) Checklist

Name:___________________________________________________ Grade:
Year and Section:__________________________________________ Date:_______________

NASOGASTRIC INTUBATION
TECHNIQUES FOR INSERTION, FEEDING AND REMOVAL

INTRODUCTION

For most patients who cannot attain an adequate oral intake of food, or oral nutritional
supplements, or who cannot eat and drink safely, they may be given
proper nutrition via nasogastric tube feeding.

The goal of this technique is to improve every patient’s nutritional intake and maintain
their nutritional status.

For patients to gain adequate nutrition and medication, especially for those who are
unable to eat and drink. Also, NG intubation is a less invasive alternative to surgery in the event
an intestinal obstruction can be removed easily without surgery.

DEFINITION

Nasogastric tube or NG tube 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.

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, healthcare providers such as nurses can
deliver food and medicine directly to the stomach or obtain substances from it.

The technique is often used to deliver food and medicine to a patient when they are
unable to eat or swallow.
 NG tubes are usually short and are used mostly for suctioning stomach contents and
secretions.

PURPOSE or INDICATIONS

By inserting an NG tube, you are gaining an entry or direct connection to the stomach and its
contents. Therapeutic indications for NG intubation include:

1. Gavage is introduction of material into the stomach by a tube.

Example:
 Feeding and administration of medication. Introducing a passage into the GI tract
will enable the feeding and administration of various medications. NG tubes can also
be used for enteral feeding initially.

2. Lavage is the process of cleaning out the contents of the stomach using a tube.
Example:
 Gastric decompression. The nasogastric tube is connected to suction to facilitate
decompression by removing stomach contents. Gastric decompression is indicated
for bowel obstruction and paralytic ileus and when surgery is performed on the
stomach or intestine.
 Aspiration of gastric fluid content. Either for lavage or obtaining a specimen for
analysis. It will also allow for drainage or lavage in drug overdosage or poisoning.

3. Other indication
 Prevention of vomiting and aspiration. In trauma settings, NG tubes can be used to
aid in the prevention of vomiting and aspiration, as well as for assessment of
GI bleeding.

TYPES OF TUBES

Tubes that pass from the nostrils into the duodenum or jejunum are called nasoenteric
tubes. The length of these tubes can either be medium (used for feeding) or long (used for
decompression, and aspiration).

There are various tubes used in GI intubation but the following two are the most common:
1. Levin tube. It is a single-lumen multipurpose plastic tube that is commonly used in NG
intubation.
2. Salem sump tube. A double-lumen tube with a “pigtail” is used for intermittent or
continuous suction.

CONTRAINDICATIONS
Nasogastric intubation is contraindicated in the following:
 1. Recent nasal surgery and severe midface trauma. These two are the absolute
contraindications for NG intubation due to the possibility of inserting the tube
intracranially. An orogastric tube may be inserted, in this case.
2. Other contraindications include: coagulation abnormality, esophageal varices, 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 the 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: abdominal cramping or swelling from feedings that
are too large, diarrhea, regurgitation of the food or medicine, a tube obstruction or
blockage, a tube perforation or tear, and tubes coming out of place and causing
additional complications
6. An 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 where it touches
the nostrils because the client’s nose may become irritated and dry.
2. Verify NG tube placement. Always verify if the NG tube placed is in the stomach by
aspirating a small amount of stomach contents. An X-ray study is the best way to verify
placement.
3. 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.
4. Face and eye protection. On the other hand, face and eye protection may also be
considered if the risk for vomiting is high. Trauma protocol calls for all team members to
wear gloves, face and eye protection and gowns.
Table 1: Preliminary Activities, Assessment, and Planning.
Note: Refer to Table 8 Rubrics for grading.
Not
Procedures Performed Remarks
Performed

4 3 2 1 0

1. Preliminary Activities

1.1. Greetings and introduce self.

1.2. Explain the procedure.

1.3. State purpose.

1.4. State the materials or

equipment needed.

2. Assessment

2.1. Assess the location for the

feeding of NGT.

2.2. Assess the current inventory of

NGT supplies for any potential
damage and replenish the
equipment if necessary.

3. Planning

3.1. Identify availability of the

equipment needed for,
administering tube feeding.

3.2. Gather all necessary supplies

and ensure that all required
equipment is assembled in
close proximity to the conduct
of the procedure.

PROCEDURE
ADMINISTERING TUBE FEEDING

Supplies and 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 towels)

Table 2: Administering Tube Feeding

Note: Refer to Table 8 Rubrics for grading.
Not
Procedures Performed Remarks
Performed

4 3 2 1 0

Prepare the formula. Follow the sub steps

below:

a. Check the expiration

date. Outdated formulas may be
contaminated or have reduced
nutritional value.

b. Shake the can thoroughly. Feeding

solution may settle and mixing is
necessary just before
administration.

c. For powdered formula, mix

according to the instructions on the
package. Prepare just enough for
the next 24 hours and refrigerate
unused formula. Allow the formula
to reach room temperature before
use. Formula loses its nutritional
value and can be contaminated if
kept for more than 24 hours. Cold
formulas can cause abdominal
discomfort.
Explain the procedure to the
client. Providing the right information may
result in the client’s cooperation and
understanding.
Always check the position of the client.
Make sure that the position of the client
with a tube feeding remains 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.
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.

C. 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.

D. 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 syringe:

A. 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 the
movement of feeding into the
stomach.

B. 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.

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.

7. 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.

Table 4: For Clinical Instructor’s Evaluation

4. Evaluation 4 3 2 1 0 Remarks

18. Maintains good body mechanics

throughout the performance of the
procedure.
19. Manifest neatness in the performed
procedure.
20. Ensure safety and comfort.

21. Receptive to criticisms.

22. Observes courtesy.

23. Show calmness while performing

the procedure.
24. Show mastery of the procedure.

TOTAL

Students’ Signature over Printed Name

Clinical Instructors’ Signature over Printed Name

Table 8: Performance Rubrics.

Score Qualitative Description Criteria

4 Excellent Demonstrates accuracy and integrates

knowledge and skills appropriately. Clearly
stated the steps of every procedure and
profoundly demonstrate with rationale

3 P Good Demonstrate moderately with assistance in

integrating knowledge and skills. Clearly
E stated the steps of every procedure and
R properly demonstrated; however, failed to
state the complete rationale.
F
2 Acceptable Demonstrates average performance
O integrating the knowledge and skills.
Clearly stated the steps of every procedure
R
and properly demonstrated but fail to state
M the rationale. Consequently, failed to
answer pertinent queries appropriately.
E
1 Needs Improvement Demonstrate the gaps in the necessary
D
knowledge and requires frequent and
utmost assistance that lacks the skills.
Partially stated the steps of every
procedure, incorrectly demonstrated
without rationale, or stated the rationale but
failed to perform the procedure or vice
versa.

0 Not Performed Frequently lacks knowledge and skills that

are unable to perform and state every
procedure and rationale.