Equipment
■ NG tube (commonly 16 or 18 Fr for adults) or NE (small bowel) tube (8, 10, or 12 Fr).
■ Stylet or guidewire (for small-bore tubes), according to agency policy.
■ Procedure gloves.
■ Linen-saver pad or towel.
■ Water-soluble lubricant.
■ 50- to 60-mL catheter-tip syringe or bulb syringe for Salem sump tubes.
■ 30-mL Luer-Lok syringe for small-bore feeding tubes.
■ Hypoallergenic tape (2.5 cm [1 in.] wide) or tube fixation device.
■ Indelible marker.
■ Skin adhesive.
■ Stethoscope.
■ Basin of warm water (for plastic tube) or ice (for rubber tube).
■ Glass of water with a straw; penlight; tongue blade; pH test strip.
■ Tissues.
■ Safety pin.
■ Gauze square or small plastic bag.
■ Rubber band.
■ Suction equipment (if tube is being connected to suction).
Assessment
■ Verify:
■ The medical prescription for type of tube and whether it is to be attached to suction or drainage.
■ The patient’s need for NG or NE intubation (e.g., surgery involving the GI tract, impaired swallowing, or decreased level of consciousness).
■ Check medical history for:
■ Anticoagulant therapy.
■ Coagulopathy.
■ Nasal trauma.
■ Nasal surgery.
■ Epistaxis.
■ Deviated septum.
■ Assess each naris for deviated septum and skin breakdown.
■ Ask the patient to close each nostril alternately and breathe; select the nostril with the greatest air flow.
■ Assess the level of consciousness and ability to follow instructions.
■ Ask the patient to blow her nose, if not contraindicated.
■ Be Safe! Assess for a gag reflex, using a tongue blade. Absence of gag reflex increases the risk for aspiration.
■ Be Smart! Contraindications to NG insertion by a nurse include:
■ Maxillofacial disorders, surgery, or trauma.
■ Esophageal tumors or surgery.
■ Laryngectomy.
■ Skull fracture.
■ Unstable high cervical spinal injuries.
■ Esophageal varices. Post-Procedure Reassessment
■ Assess the patient’s tolerance of the procedure (e.g., discomfort, gagging, coughing, respiratory status) and whether she is comfortable.
■ Note the color, consistency, and pH of NG or NE aspirate.
Key Points
■ Place the patient in a sitting or high-Fowler’s position.
■ Measure the length of the tube.
■ NG tubes: Measure from tip of the nose to earlobe and from earlobe to xiphoid process.
■ NE tubes: Add 8 to 10 cm (3 to 4 in.) to the NG measurement, as directed.
■ Lubricate the tube with water-soluble lubricant.
■ Have the patient hyperextend her neck and breathe through her mouth.
■ Insert the tube gently through the nostril and advance the tube as the patient swallows.
■ Instruct the patient to tilt her head forward, drink water, and swallow.
■ Be Safe! Withdraw the tube immediately if respiratory distress occurs during or immediately after insertion.
■ Be Safe! Confirm tube placement initially by x-ray. Always reconfirm tube placement with a combination of bedside methods before giving feedings or medicine.
■ Be Smart! Secure the tube to the nose and to the patient’s gown.
Documentation
■ Chart:
■ Date and time of insertion.
■ Size and type of the NG or NE tube.
■ Insertion site (which naris).
■ Length of tube from tip of the nose to the end of the tube.
■ Tolerance of the procedure.
■ Any abnormal findings.
■ Methods for confirming tube placement.
■ Description of gastric contents.
■ Respiratory status.
■ You will document NG or NE tube insertion in progress notes and flowsheets in most agencies.
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| Measure from tip of nose to earlobe, then to the xiphoid process |
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| Apply tape to the patient’s nose |
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