NG (Nasogastric) Tube Insertion

NG (Nasogastric) Tube Insertion

■ Explain the procedure to the Pt and offer reassurance.
■ Auscultate abdomen for positive bowel sounds if NG tube is to be used for administration of feedings or medication.
■ Position the Pt upright in high-Fowler’s position. Instruct the Pt to keep a chin-to-chest posture during insertion. This helps to prevent accidental insertion into the trachea.
■ Measure the tube from the tip of the nose to the ear lobe, then down to the xyphoid. Mark this point on the tube with tape.
■ Lubricate the tube by applying water-soluble lubricant to the tube. Never use petroleum-based jelly, which degrades PVC tubing.
■ Insert the tube through the nostril until you reach the previously marked point on the tube. Instruct the Pt to take small sips of water during insertion to help facilitate passing of the tube.
■ Secure the tube to Pt’s nose using tape. Be careful not to block the nostril. Tape tube 12–18 inches below insertion line and then pin tape to Pt’s gown. Allow slack for movement.
■ Position HOB at 30–45 to minimize risk of aspiration.
■ Confirm proper location of NG tube:
■ Pull back on plunger* of a 20-mL syringe to aspirate stomach contents. Typically, gastric aspirates are cloudy and green, or tan, off-white, bloody, or brown. Gastric aspirate can look like respiratory secretions so it is best to also check pH.
■ Dip litmus paper into gastric aspirate. A reading of a pH of 1–3 suggests placement in the stomach.
■ An alternative method, but less reliable, is to inject 20 mL of air into the tube while auscultating the abdomen. Hearing a loud gurgle of air suggests placement in the stomach. If no bubbling is heard, remove tube and reattempt. Withdraw tube immediately if the Pt becomes cyanotic or develops breathing problems.
■ An inability to speak also suggests intubation of the trachea instead of the stomach. *Note: small-bore NI (nasointestinal) tubes (e.g., Dobhoff) may collapse under pressure and initial confirmation of placement is obtained with x-ray.
■ Assemble equipment (wall suction, feeding pump, etc.) per manufacturer guidelines.
■ Document the type and size of NG tube, which nostril, and how the Pt tolerated the procedure. Document how tube placement was confirmed and whether tubing was left clamped or attached to feeding pump or suction.