Inserting a Nasogastric (NG) Tube

Goal: The tube is passed into the patient's stomach without any complications.

1. Verify the medical order for insertion of an NG tube.

2. Perform hand hygiene and put on PPE, if indicated.

3. Identify the patient.

4. Explain the procedure to the patient and provide the rationale as to why the tube is needed. Discuss the associated discomforts that may be experienced and possible
interventions that may allay this discomfort. Answer any questions as needed.

5. Gather equipment, including selection of the appropriate NG tube.

6. Close the patient’s bedside curtain or door. Raise bed to a comfortable working position; usually elbow height of the caregiver (VISN 8, 2009). Assist the patient to high Fowler’s position or elevate the head of the bed 45 degrees if the patient is unable to maintain upright position. Drape chest with bath towel or disposable pad. Have emesis basin and tissues handy.

7. Measure the distance to insert tube by placing tip of tube at patient’s nostril and extending to tip of earlobe and then to tip of xiphoid process. Mark tube with an indelible marker.

8. Put on gloves. Lubricate tip of tube (at least 2 –4 ) with water-soluble lubricant. Apply topical anesthetic to nostril and oropharynx, as appropriate.

9. After selecting the appropriate nostril, ask patient to slightly flex head back against the pillow. Gently insert the tube into the nostril while directing the tube upward and backward along the floor of the nose. Patient may gag when tube reaches pharynx. Provide tissues for tearing or watering of eyes. Offer comfort and reassurance to the patient.

10. When pharynx is reached, instruct patient to touch chin to chest. Encourage patient to sip water through a straw or swallow even if no fluids are permitted. Advance tube in downward and backward direction when patient swallows. Stop when patient breathes. If gagging and coughing persist, stop advancing the tube and check placement of tube with tongue blade and flashlight. If tube is curled, straighten the tube and attempt to advance again. Keep advancing tube until pen marking is reached. Do not use force. Rotate tube if it meets resistance.

11. Discontinue procedure and remove tube if there are signs of distress, such as gasping, coughing, cyanosis, and inability to speak or hum.

12. Secure the tube loosely to the nose or cheek until it is determined that the tube is in the patient’s stomach:
a. Attach syringe to end of tube and aspirate a small amount of stomach contents.
b. Measure the pH of aspirated fluid using pH paper or a meter. Place a drop of gastric secretions onto pH paper or place small amount in plastic cup and dip the pH
paper into it. Within 30 seconds, compare the color on the paper with the chart supplied by the manufacturer.
c. Visualize aspirated contents, checking for color and consistency.
d. Obtain radiograph (x-ray) of placement of tube, based on facility policy (and ordered by physician).

13. Apply skin barrier to tip and end of nose and allow to dry. Remove gloves and secure tube with a commercially prepared device (follow manufacturer’s directions) or tape to patient’s nose. To secure with tape:
a. Cut a 4 piece of tape and split bottom 2 or use packaged nose tape for NG tubes.
b. Place unsplit end over bridge of patient’s nose.
c. Wrap split ends under tubing and up and over onto nose. Be careful not to pull tube too tightly against nose.

14. Put on gloves. Clamp tube and remove the syringe. Cap the tube or attach tube to suction according to the medical orders.

15. Measure length of exposed tube. Reinforce marking on tube at nostril with indelible ink. Ask the patient to turn their head to the side opposite the nostril the tube is inserted. Secure tube to patient’s gown by using rubber band or tape and safety pin. For additional support, tube can be taped onto patient’s cheek using a piece of tape. If a double-lumen tube (e.g., Salem sump) is used, secure vent above stomach level. Attach at shoulder level.

16. Assist with or provide oral hygiene at 2- to 4-hour intervals. Lubricate the lips generously and clean nares and lubricate as needed. Offer analgesic throat lozenges or anesthetic spray for throat irritation if needed.

17. Remove equipment and return patient to a position of comfort. Remove gloves. Raise side rail and lower bed.

18. Remove additional PPE, if used. Perform hand hygiene.