NG (Nasogastric) Tube: Insertion

■ Explain procedure to Pt and offer reassurance.

■ Auscultate abdomen for positive bowel sounds if NG tube is to be used for administration of feedings or medication.

■ Position Pt upright in high-Fowler’s position. Instruct Pt to keep chin-tochest posture during insertion. This helps to prevent accidental insertion into trachea.

■ Measure tube from tip of nose to earlobe, then down to the xiphoid. Mark this point on tube with tape.

■ Lubricate tube by applying water-soluble lubricant to tube. Never use petroleum-based jelly, which degrades PVC tubing.

■ Insert tube through nostril until you reach previously marked point on tube. Instruct Pt to take small sips of water during insertion to help facilitate passing of tube.

■ Secure tube to Pt’s nose using tape. Be careful not to block 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 degrees 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 also to check pH.

■ Dip litmus paper into gastric aspirate. A reading of a pH of 1–3 suggests placement in stomach.

■ An alternative, but less reliable, method is to inject 20 mL of air into tube while auscultating the abdomen. Hearing loud gurgle of air suggests placement in stomach. If no bubbling is heard, remove tube and reattempt. Withdraw tube immediately if Pt becomes cyanotic or develops breathing problems.

■ An inability to speak also suggests intubation of trachea instead of stomach.

■ *Note: small-bore NI (nasointestinal) tubes (i.e., Dobhoff) may collapse under pressure, and initial confirmation of placement is obtained by xray.

■ Assemble equipment (wall suction, feeding pump, etc.) per manufacturer guidelines.

■ Document type and size of NG tube, which nostril, and how Pt tolerated procedure. Document how tube placement was confirmed and whether tubing was left clamped or attached to feeding pump or suction.