1.

Nasogastric Tube (NGT) Inserting

Purposes:
 To enable administering of tube feedings to clients unable to eat by
mouth or swallow without aspiration
 For means of decompression or suctioning gastric contents to prevent
gastric distention, nausea, and vomiting
 For diagnostic procedures where gastric contents will be used as
specimen
 To lavage or wash the stomach in case of poisoning or overdose of
medication

Preparation:
 Review the physician’s order to ensure client safety. Review the type,
size, and purpose of the NG tube. Size appropriately vary according to
the client’s age.
 Gather the needed equipment. This is to make sure that the equipment
is functioning properly before using it on the client.
 Gloves
 Nasogastric tube
 Water-soluble substance (K-Y jelly)
 Protective towel covering for client
 Emesis basin
 Tape for marking placement and securing tube
 Stethoscope
 60-mL catheter tip syringe
 Rubber band and safety pin
 Suction equipment or tube feeding equipment
 Glass of water (if allowed)
 Straw for glass of water
 Observe proper hand washing and don non-sterile gloves to prevent the
transmission of microorganisms. Clean, not sterile, technique is
necessary because the gastrointestinal (GI) tract is not sterile.

Before
1. Introduce yourself to patient.
2. Identify the client. Just like in administering medications, it is very
important to be sure that the procedure is being carried out on the right
client.
3. Briefly explain the procedure to the client and assess his capability to
understand and participate. It is not advisable to explain the procedure too
far in advance because the client’s anxiety about the procedure may
interfere with its success. It is important that the client relax, swallow, and
cooperate during the procedure.
4. Perform necessary assssments:
 Assess the condition of client’s nasal and oral cavities. Check for
signs of infection or skin breakdown, and check for history of nasal
surgery or deviated septum as well.
 Determine the presence of gag reflex
  Assess mental status, level of consciousness, or ability to
participate in the procedure
 Palpate client’s abdomen for distension, pain, and/or rigidity
 Auscultate for bowel sounds

During
1. Position client upright or in full Fowler’s position, if possible, and place a
clean towel over the client’s chest. Full Fowler’s position allows the NG tube
to pass more easily through the nasopharynx and into the stomach. A towel
is used as a covering to protect bed linens and the client’s gown.
2. Wipe the client’s face and nose with a wet towel or an alcohol swab. The
NG tube will stay more secure if taped on a clean, non oily nose. This will
also prevent the tube from moving in the throat—causing gagging or
discomfort later.
3. Examine nostrils for deformity or obstruction by closing one nostril and
then the other and asking the client to breathe through the nose for each
attempt. If the client has difficulty breathing out of one nostril, try to insert
the NG tube in that one. The client may breathe more comfortably if the
“good” nostril remains patent. If either nostril is equally suitable, select the
nostril closest to the suction.
4. Provide patient with drinking water and a straw if the patient is not fluid
restricted. Sipping water through a straw helps to initiate the swallowing
reflex and facilitate passing of NG tube.
5. Measure distance of the tube from the tip of the nose, to the earlobe,
then to the xiphoid process, and then mark the tube at this point. This
determines the appropriate length of NG tube to be inserted. Each client will
have a slightly different terminal insertion point. Measurements must be
made for each individual’s anatomy.
6. Lubricate 4 to 8 inches of the tub with a water-soluble lubricant. with a
small piece of temporary tape or note the distance. The NG intubation is
very uncomfortable for many clients, so will help alleviate the discomfort
since it facilitates the progression of the tube.
7. Curve 10 to 15 cm of the end of the NG tube around your gloved finger,
and then release it. Curling the NG tube around your finger helps it conform
to the normal curve of the nasopharynx.
8. Flex the client’s head forward, tilt the tip of the nose upward and insert
the NG tube tip slowly into the patient’s nostril and advance it steadily, in a
downward direction, along the bottom of the nasal passage, with the curved
end pointing downward in the direction of the ear on the same side as the
nostril. Once the tube reaches the nasopharynx, allow the client lower his
head slightly. This follows the natural anatomical alignment of the
nasopharynx.
9. Instruct the client to swallow as the tube advances. Advance the tube
until the correct marked position on the tube is reached. Encourage the
client to breathe through his mouth. Swallowing of small sips of water may
enhance passage of tube into the stomach rather than the trachea. If oral
fluids are not allowed, ask the patient to try dry swallowing while you
advance the tube.
10. If patient continues to aggressively gag or cough, check that the tube is
not coiled in the back of the mouth, using a tongue blade and a flashlight to
check the back of the mouth. If tube is coiled, withdraw the tube until only
the tip of the tube is seen in the back of the mouth. Then try advancing the
tube again while patient tries to swallow.
11. If obstruction is felt, pull out the tube and try the other nostril. The
client’s nostril may deflect the NG into an inappropriate position. Let the
client rest a moment and retry on the other side.
12. Continue advancing the tube as far as the marked insertion point. Place
a temporary piece of tape across the nose and tube. The tube may move
out of position if not secured before checking for placement.
13. Check tube placement with these methods. Check the tube for correct
placement by at least two and preferably three of the following methods:
A. Aspirate stomach contents. Stomach aspirate will appear cloudy,
green, tan, off-white, bloody, or brown. It is not always visually possible
to distinguish between stomach and respiratory aspirates.
B. Check pH of aspirate. Measuring the pH of stomach aspirate is
considered more accurate than visual inspection. Stomach aspirate
generally has a pH range of 0 to 4, commonly less than 4. The aspirate
of respiratory contents is generally more alkaline, with a pH of 7 or
more.
C. Inject 30 mL of air into the stomach and listen with the stethoscope
for the “whoosh” of air into the stomach. The small diameter of some NG
tubes may make it difficult to hear air entering the stomach.
D. Confirm by x-ray placement. X-ray visualization is the only method
that is considered positive.

After
1. Secure the tube with tape or commercially prepared tube holder once
stomach placement has been confirmed. It is very important to ensure that
the NG tube is in its correct place within the stomach because, if by
accident the NG is within the trachea, serious complications in relation to
the lungs would appear. Securing the tube in place will prevent peristaltic
movement from advancing the tube or from the tube unintentionally being
pulled out. It is also important to allow enough tube length for comfortable
head movement.
2. Once the tube placement has been confirmed, mark (with a permanent
marker) and record the length of tubing extending from the nose to the outer
end of the tube. This aids in timely recognition and identification of tube
displacement or migration.
3. Document the procedure according to agency policy, and report any
unexpected findings to the appropriate health care provider. Timely and
accurate documentation promotes client safety.

Maintaining Integrity
 Wash your hands before and after touching the tube. You may be
directed to wear gloves. This will help keep bacteria away from your
tube.
 Keep the outside tubing above the level of your stomach. This will help
prevent fluid from backing up into your NG tube.
 Make sure that the tube is pinned to your clothes. This may help prevent
discomfort and pulling on the tube.
 The tape that attaches the NG tube to your nose or cheek may need to
be changed every day. The tape will also be changed if it gets wet or
dirty. You will need check the skin on your nose for any inflammation.
 Placement of the tube will need to be checked several times during the
day. Healthcare providers will teach you how to remove and test
stomach fluid to confirm placement.
 Your NG tube will need to be flushed before and after feedings or
medicines are put in the tube. Your NG tube may also need to be
flushed if the tube becomes blocked. Follow your healthcare provider's
instructions on how to flush your tube.