Inserting a Nasogastric Tube Procedure

Purposes
- To administer tube feedings and medications to clients unable to eat by mouth or swallow a sufficient diet without aspirating food or fluid into the lungs
- To establish a means for suctioning stomach contents to prevent gastric distention, and vomiting.
- To remove laboratory contents for laboratory analysis
- To lavage (wash) the stomach in case of poisoning or overdose of medication

Equipment
- Large or small bore tube (plastic or rubber)
- Solution basin filled with warm water (if plastic tube is used) or ice (if rubber tube is used)
- Adhesive tape (2.5 cm wide)
- Disposable gloves
- Water soluble lubricants
- Facial tissues
- Glass of water and drinking straw or medication cup with water
- 20 to 50 ml syringe with an adaptor
- Basin
- Stetoscope
- Clamp (optional)
- Suction apparatus (if required)
- Gauze square or plastic specimen bag and elastic band
- Safety pin and elastic band
- Infant seat, towel, or pillow
- Restrain or hand mitts (for infants and young children)
- 5-mL or 12 mL, syringes

Procedure
1. Explain the procedure to the patient. The passage of tube is not painful but is unpleasant.

2. Position the patient in a high fowlers position, if health permits to support head on pillow.

3. In infant, place in infant seat or with rolled towel or pillow under the head and shoulders.

4. Place the towel across the chest. A diaper can be used for an infant.

5. Ask the client to hyperextend the head, and using a flash light observe the intactness of the tissue of the nostrils.

6. Examine the nares for any obstructions or deformities by asking the client to breath through one nostril while occluding of the other.

7. Select the nostril that has the greater airflow.

8. Obstruct one of the infant’s nares, and feel for air passage from the other.

9. If a rubber tube is being used, place it on ice. This stiffens the tube, facilitating the insertion. If a plastic tube is being used, place it in warm water. This makes the tube more flexible.

10. Determine how far to insert
- Use the tube to mark off the distance from the tip of the client’s nose to the tip of the ear lobe and from the tip of the ear lobe to the tip of the sternum. This length approximate the distance from the nares to stomach.
- For infants and young children, measure from the nose to the tip of the ear lobe and then to the xiphoid process.
- Mark this length with adhesive tape, if the tube does not have marking.

11. Lubricate the tip of the tube well with water solution lubricant or water to ease insertion.

12. Insert the tube with its natural curve toward the client in to the selected nostril. Ask the client to hyper extend the neck, and gently advance the tube toward the nasopharynx. Do not hyper-extend or hyper -flex an infant neck

13. Direct the tube along the floor of the nostril and toward the ear on that side.

14. If the tube meets resistance, withdraw it, rubricate it and insert it in the other nostril. (The tube should never be forced against resistance)

15. Once the tube reaches the oropharynix (throat) the client will feel the tube in the throat and may gag or retch. Ask the client to tilt the head forward and encourage the client to drink and swallow. If the client gags, stop passing the tube momentary. Have the client rest, take a few breaths, and take sips of water to calm the gag reflex.

16. In the cooperation with the client, pass the tube 5 to 10 cm (2 to 4 in) with each swallow, until the indicated length is inserted.

17. If the client continuous to gag and the tube does not advance with each swallow, with draw it slightly, and inspect the throat by looking through the mouth. (The tube may be coiled in the throat. If so withdraw it until it is straight, and try again to insert it).

18. As certain correct placement of the tube:
- Aspirate stomach content, and check their acidity.
- Ascultate air insufflation’s
- If the signs do not indicate placement in the stomach, advance the tube 5 cm, and repeat the test
- For the tube that are to be placed in to the duodenum or jejunum, advance the tube 5 to 7.5 cm per hour until xray study confirms its placement.

19. Secure the tube by taping it to the bridge of the client’s nose
- Cut 7.5 cm of tape, and split it length wise at one end, leaving 2.5 cm tab at the end
- Place the tape over the bridge of the client’ nose and bring the split ends under the tubing and backup over the nose.
- For infants or small children, tape the tube to the area between the end of the nares and the upper lip, as well as to the cheek.

20. Attach the tube to the suction source or feeding apparatus as ordered, or clamp the end of the tubing.

21. Secure the tube to the client’s gown. Loop an elastic band around the end of the tubing, and attach the elastic band to the gown with a safety pin or attach a piece of adhesive tape to the tube, and pin the tape to the gown.

22. Document relevant information, means by which correct placement was determined and client responses.

23. Establish a plan for providing daily nasogastric tube care
- Inspect the nostril for discharge and irritation
- Clean the nostril and tube with moistened cotton tipped applicators
- Apply water-soluble lubricant to the nostril if it appears dry or encrusted.
- Change the adhesive tape ad required
- Give frequent mouth care

24. If suction is applied, ensure that the patency of both the nasogastric and suction tubes in maintained

25. Document all relevant information:
- Type of tube inserted
- Data and time of tube insertion
- Type of suction used
- Color and amount of gastric contents
- Client tolerance of the procedure