KING GEORGE’S MEDICAL UNIVERSITY

KGMU COLLEGE OF NURSING, LUCKNOW

SUBJECT-CHILD HEALTH NURSING

PROCEDURE OF
NASOGASTRIC TUBE INSERTION AND FEEDING

SUBMITTED TO : SUBMITTED BY :
MRS SUPRIYA SINGHCLINICAL AMRITA SINGH
INSTRUCTOR M.SC.NURSING 1ST YEAR
KGMU,COLLEGE OF NURSING KGMU,COLLEGE OF NURSING
LUCKNOW LUCKNOW
Subject Child Health Nursing

Unit/ Ward Pediatric Medicine

Name of the topic NG Tube insertion and IG Tube feeding

Class/ group/batch B.Sc. Nursing 3rd Year

Place Pediatric Medicine ( Ward A)

Date/Time 08-02-2023

Teaching Method Demonstration

AV aids/ Instructional aids Lab Articles , and Dummy

General objectives At the end of the procedure demonstration of NG tube feeding and insertion the students of B.Sc. Nursing
will get aware of the all important aspects of the procedure.

Specific objective
At the end of the health education , group will be able to tell:

 What is Nasogastric Tube Insertion and feeding ?

 Purpose of NG tube insertion and Feeding.

 Articles required and their purpose for the procedure.

 Pre -procedural action of NG tube insertion and feeding.

 Intraprocedural actions for NG tube insertion and feeding.

 Post procedural steps of NG tube insertion and feeding / medication

S. Specific Time Content Method of AV Aids Evaluation
No. Objectives teaching

1. NAGOGASTRIC TUBE INSERTION Lecture cum -------- Describe

1 To give the
introduction of
1
Nasogastric tube Minute
insertion process.
discussion Nasogastric Tube
Insertion.
 INTRODUCTION
It is a medical process involving the insertion of a
plastic tube through the nose , passing the throat and
down into the stomach .

 PURPOSE Lecture Cum -------- Purposes of Ng

2 To list down the 1 Discussion tube insertion
purposes of NG Minute  It is used for feeding and administering drugs and
tube insertion other oral agents like activated charcoal.

 For gastric decompression and aspiration.

 To extract samples of gastric fluid for analysis.

 To feed and unconscious child .

 To feed sick and premature infants .

 To diagnose Tracheo- Esophageal Fistula.

3  ARTICLES Lab Articles

To list down the Demonstration Tray Articles needed
articles needed for for NG tube
NG tube insertion 2 • Nasogastric Tube insertion
Minutes
( Return
• Hypoallergic Tape Demonstration

• Glass of water
S. Specific Time Content Method of AV Evaluation
No. Objectives teaching Aids

• Syringe

• Gloves

• Kidney Tray

• Towel , Mackintosh and Drawsheet

• Paper bag

• Swab Sticks

• Penlight

• Stethoscope

4 3  STEPS OF PROCEDURE Lab Model

To explain the steps Minutes Demonstration Dummy
to do before Steps to do to
 PREPROCEDURAL STEPS before strating
starting the exact
procedure of NG NG tube
 Assess patient for the need of enteral tube insertion insertion.
tube insertion.
whether it is for feeding , aspiration or for some ( Return
other purpose . Demonstration)

 Assess patient for appropriate route of insertion to

evaluate nares for patency.

 Close each nares alternatively and ask patient to

breathe for the confirmation of any obstruction in
the nose.
 Assess for gag reflex to identify ability to swallow
and risk for aspiration.
S. Specific Time Content Method of AV Aids Evaluation
No. Objectives teaching

 Inspect nares for any irritation.

 Review patient’s medical history for nasal
problems and risk for aspiration.

 Review physicians order for the type and size of

the tube to be inserted . There must be physician
order for Ryle’s tube insertion or Ryle’s tube
feeding .

 Bring tray with articles near patient and wash

hands to reduce chances of infection.

 Explain procedure to the child or explain to the

attendant , if the child is too small to understand .It
reduces anxiety and help patient to assist in
insertion.

 Stand on same side of the bed as nares decided for

insertion and assist the child to be in comfortable
position.

 Place small towel over chest . Keep facial tissues

or wipes within reach to prevent the soiling of
clothing.

 Determine length of the tube to be inserted and

mark with tape.

 Method : Measure distance from tip of the nose to

the ear lobe , and then to the xiphoid process of
sternum.
S. Specific Time Content Method of AV Aids Evaluation
No. Objectives teaching

 Cut tape 10 cm long and keep ready to secure the

tube.
5 Lab Model
5 To explain the steps Minutes  INTRAPROCEDURAL STEPS Demonstration Dummy Steps to insert
of NG tube insertion NG tube
procedure  Put on clean gloves to prevent contamination from ( Return
secretions. Demonstration

 Hold the nasogastric tube 1-2 inches away from tip

and lubricate the nasogastric tube with water to
facilitate passage of tube into the nares to GI tract .
Lubrication reduces friction between mucous
membrane and the tube.

 Hold the head of the child and insert the tube gently
by pushing the head little backward through nostrils
to back of the throat.

 Do not forcefully insert the tube.

 Flex the patient’s head toward chest after tube has

passed through the nasopharynx .

 Emphasize swallowing during the procedure to

facilitates passage of tube . Swallowing closes the
glottis over the trachea and facilitates the passage of
tube into the esophagus.

 Advance the tube each time child swallows until

desired length has been passed .If resistance is met or
patient starts to cough , choke ,or become cyanotic ,
stop advancing the tube and pull the tube back.It
reduces discomfort and prevents trauma.
S. Specific Time Content Method of AV Aids Evaluation
No. Objectives teaching

 Incase child is showing any sign of distress such as

gasping , coughing , or cyanosis , immediately pull
back the Ryle’s tube for some length and check. After
some time once the child is normal re insert the tubing
.

 Once the tube is inserted up to the marked length , any

of the following methods can be used to verify
placement of the tube.

 Aspirate the GI content with a syringe .

 Gastric contents are usually cloudy and grassy green
or tan off-white.
 In contrast intestinal fluid is deep yellow and is
clearer than gastric fluid.
 Measure pH of the aspirated GI contents.
 Fasting gastric pH is usually in a range of 1-4 .
 Intestinal pH is 7 or greater.

 Flush the tube with air in case of child 2ml-5ml is

sufficient and simultaneously auscultate the air sound
by keeping stethoscope at the lower part of
xiphisternum. If sounds are present , the tube is in
stomach and confirm by withdrawing air in the
syringe.

 Another method to check the correct placement of

Ryle’s tube placement is to keep the distal end of the
tube in the water. If bubbles starts appearing that
means the tube is in trachea and if does not appear
that ensures correct placement of the Ryle’s tube.
S. Specific Time Content Method of AV Aids Evaluation
No. Objectives teaching

 Remove the gloves .

 Ryle’s tube should be fixed properly with adhesive

or micropore .

 Obtain X-Ray film of abdomen as per hospital

policies . Placement of the tube is verified by the
X- Ray examination .

6 2  POSTPROCEDURAL STEPS Lab -------

To explain the steps Steps to do
Minutes Demonstration
have to follow after after
exact procedure of  Replace equipments and wash hands . administration
Ng tube insertion NG Tube
 Inspect nares and oropharynx for any irritation
after insertion. .

 Ask if patient feels comfortable.

 Discard the wastes .

 Observe patient for any difficulty in breathing or

gagging .Malposition causes the symptoms written.
 S. Specific Time Content Method of AV Evaluation
No. Objectives teaching Aids

2. NASOGASTRIC TUBE FEEDING

Lecture cum ------- NG tube feeding
1 INTRODUCTION discussion process
7 To introduce the NG Minute
tube insertion It is an appropriate administered of desired strength or
procedure quantity of medicine or food through the nasogastric
tube to infant child to improve their health.

1 PURPOSE
8 To enumerate the Minute Lecture cum ------
purposes of NG  Any sick child who cannot take food orally.
discussion Purposes of NG
tube feeding /  Premature infants who is unable to suck or tube feeding or
medication swallow. medication
administration  Infants and children with congenital anomalies and
surgery of throat or esophagus.
 Child with respiratory distress.
 Difficulty in swallowing .
 Unconscious child.

ARTICLES
9 2 Lab Article
Minutes Demonstration tray Articles needed
To list down the • Stethoscope for NG tube
articles needed for feeding and
the NG tube • 5 ml syringe. medication
feeding or ( Return
medication Demonstration
• 20 ml-50 ml syringe to administer feed.

• A clean bowel

• A glass of drinking water to administer water.

S. Specific Time Content Method of AV Aids Evaluation
No. Objectives teaching

• Kidney tray or paper bag to collect waste.

• Food material in liquid form ( No granules should

be present in any case )

• Mackintosh / Towel to avoid soiling of dress or

cloth.

• Gloves to ensure sterility to the procedure.

• Food or medicine ( to be administered ) with its

container / strip.

10 3 STEPS OF PROCEDURE
To explain the steps Minutes Lab Model
to do before  PREPROCEDURAL STEPS Demonstration Dummy
starting exact Steps to do
procedure of NG before NG tube
tube feeding of • Explain the procedure to parents and child to the feeding /
drug administration level of understanding to gain confidence and medication
cooperation. ( Return
Demonstration
• Confirm the child’s identity by asking his/her
name bed number , CR number and age.

• Give comfortable position to the child .

• Arrange the articles in tray.

• Verify the order on the patients treatment record by

checking it against the doctors’ order
S. Specific Time Content Method of AV Aids Evaluation
No. Objectives teaching

11 3  INTRAPROCEDURAL STEPS Lab Model Steps of NG

To demonstrate the Minutes Demonstration Dummy tube feeding
steps of NG tube /insertion
feeding or • Wash hands as it reduces transfer of microorganisms ( Return
medication to food , medicine , equipments as well as patients. Demonstration

• Bring trolley with the articles near the patient on right

side , same time .

• Read the physician’s order and compare it with intake

output chart / mediation card.

• Check 7 rights in case of administration of

medication.

• After reading the intake output chart or medicine card

take appropriate amount of food or medicine. (Food
content should not have any granule particle .)
Compare the medicine label with medication card ,
check for the expiry date .

• Take appropriate amount of food to be administered

Calculate the dose and measure the medication to be
administered .Take time and double check calculation
12 *3 of doses to ensure accuracy . Lab Articles
Minutes Demonstration tray
To demonstrate the  PREPARATION OF TABLETS AND CAPSULES Method of
process of
preparing
preparing tablets  Place packaged until dose capsules or tablets from tablets and
and capsules capsules for
bottle or strip directly into the medicine cup , do not
touch with finger to prevent transfer of the medication
microorganisms through NG
tube
S. Specific Time Content Method of AV Aids Evaluation
No. Objectives teaching

 Crush the tablet with mortar and pestle to a fine

powder.

 Dissolve it in calculated amount of water .

13 To demonstrate the *3 Lab Articles
Minutes  PREPARATION OF LIQUID OR SYRUP Demonstration tray Method of
process of
preparing
preparing liquid or
 Thoroughly shake bottle and mix the medicine in liquid / syrup
syrup medication
the bottle. for
medication
through NG
 Remove the cap and take medicine in to it. tube

 Hold the bottle so that label is next to palm and

pour the medication away from the palm to prevent
spoilage of the label.

 Hold the medication cup at the eye level and fill it

to desired level for accurate measurement.

 Use syringe for measuring medication if the dose is

in fraction to ensure efficacy.

 Wipe mouth of the bottle with cotton and label

‘will not be soiled with spilled liquid’

 Spread mackintosh / small towel o the chest of the

patient to protect the child and bed linens from any
spills with medicine or vomit.

 Administration of drug through nasogastric tube.

S. Specific Time Content Method AV Aids Evaluation
No. Objectives of
teaching

 Do not leave the drug unattended.

 Assess the patient's abdomen for bowel sounds and

distention, check abdominal girth before each feed.

 Perform necessary pre-administration assessment for

specific medication i.e. vital signs

 Elevate the bed to semi or high Fowler's position to

promote digestion.

 Check tube patency and positions (aspirate stomach

contents).

 Withhold feeding/medication, if residual volume is

greater than the required amount of feed.

 Hold the nasogastric tube somewhat above the level of

the patient's nose.

14 3  Check the aspirate before procedure. Lab Articles

To demonstrate the Minutes Demonstration tray and
steps of NG tube  ADMINISTRATION OF DRUG THROUGH RT lab
dummy Procedure of NG
feeding or tube feeding and
medication  Identify child by comparing name on medicine card
with the name child gives when asking third check of drug
label to reduce errors. administration
( Return
 Remove the plunger from the syringe and connect it to Demonstration
pinched or kinked feeding tube.
S. Specific Time Content Method of AV Aids Evaluation
No. Objectives teaching

Pinching of tube prevents air to enter into the tube.

 Pinch the feeding tube and fill with 5 mL of water

into the syringe barrel before administering the
first medication. It prevents the interaction of
medication with the previous feed of medicine
content in the tube.

 Hold the tube with one hand , release the tubing

and elevate the syringe barrel to allow liquid to
flow by gravity.

 Then liquid or dissolve medication into syringe

barrel and allow to flow by gravity into enteral
tube.

 To prevent air entering in the tube and child’s

stomach never allow to the syringe to empty
completely .Always administer a tube feeding
slowly tube feeding slowly.

 If you are administering several medication then

administer each one separately and flush with at
least 5 mL of water between each medication (if
fluid restriction is not there) to prevent the drug
interaction.

 After administering the appropriate amount of

feed/medications, flush the tube with 5-10 mL of
water and close the tube. If child is on continuous
aspiration clamp the tube for 20-30 minutes after
giving medication for absorption.
S. Specific Time Content Method of AV Aids Evaluation
No. Objectives teaching

 Document the medication/amount of feeding given

and how tolerated on child's treatment chart and
intake-output chart .
15 To explain the 2 Lab ------ Steps to do
Minutes  POSTPROCEDURAL STEPS Demonstration after
steps have to
completing
follow after exact
 Return intake out out chart /medication chart to NG tube
procedure of NG
appropriate folder for next time use. feeding or
tube feeding or medication
medication through through NG
 Take all the articles to treatment room. Wash and
it tube
dry all the articles and replace them in the students
cupboard.

 Wash hands, clean work area.

 Return to the patient to check for any expected or

unexpected reactions after administration of food
specially medication.
 SUMMARY

Nasogastric tube insertion means insertion of tube from nares to oropharynx to stomach for different purposes for example feeding an
unconscious child , child with swallowing difficulty ,unhealthy newborn , medication purpose , analysis of gastric contents etc.
alot of articles are needed for NG tube insertion and feeding . NG tubes of different size comes for different age group of the child.
Various preprocedural , Intraprocedural and post procedural steps we are suppose to do for NG tube insertion and NG tube feeding.
While doing the procedure we need to ensure that the tube goes easily through nares to oropharynx to stomach with use of any extra
force. In case child is showing any contraindication immediate action need to be taken for that.Proper documentation of the procedure
should be done for future referene of the same procedure.
 CONCLUSION

NG tube insertion and NG Tube feeding and NG tube insertion has come out to be one of the most effective method of provding
nutrition and medication to a newborn or child who is unable to take it through oral route . Appropriate size of NG tube must be
us to avoid any contraindication of the procedure.Maintaining clean technique ensures prevention of crossi nfection.
Doing this procedure in right way can bring a lot of improvement in the health status of the child while doing significant errors
might bring serious complication in the condition of the child.So being a professional health care provider we have to be very
much skilled in doing the procedure with minimal or no significant mistakes.
In such a way we can fulfill the actual goal of this procedure.
 BIBLIOGRAPHY

• Rana kaur avinash , et al ‘ CLINICAL NURSING PROCEDURES ’ 2 nd edition , CBS publishers pvt .ltd .
Pp 926-929 ,976-978

• https://medlineplus.gov/ency/patientinstructions/000182.htm

• https://youtu.be/k8aH0TyJYhc.