NGT PROCEDURE

PROCEDURE RATIONALE
ASSESSMENT
Health care provider’s order is needed to
1. Verified Order for type of tube and ensure proper type of tube and feeding
feeding schedule, determined if health schedule. Prokinetic agents such as
care provider wants prokinetic agent metoclopramide given before tube
given before tube placement. placement help advance tube into
intestine (Metheny, 2006).
Ensure correct patient. Complies with The
2. Identified patient using at least two
Joint Commission standards and
identifiers.
improves patent’s safety.
Encourages cooperation, reduces
3. Assessed patient’s knowledge of
anxiety, and minimizes risks. Identifies
procedure.
patient teaching needs.
Reduces transmission of microorganisms.
4. Performed hand hygiene, had patient
Sometimes nares are obstructed or
close each nostril alternately and breathe,
irritated, or a septal defect or facial
examined each naris for patency and skin
fractures are present. Place tube in most
breakdown.
patent nostril.
A history of problems may contraindicate
5. Reviewed patient’s medical history for
tube placement and require you to
problems that might affect route of
consult with health care provider to
nutritional support.
change route of nutrition support.
6. Assessed patient’s baseline height, Provides baseline information to measure
weight, hydration, electrolyte balance, nutritional improvement after enteral
caloric needs, and I&O. feedings are initiated.
These are risk factors for inadvertent
feeding tube placement into the
7. Assessed patient’s mental status,
tracheobronchial tree (Krenitsky, 2011).
presence of cough and gag reflex, ability
Patients with impaired gag reflex; their
to swallow, critical illness, presence of
risk of aspiration increases during
artificial airway.
insertion of feeding tubes and subsequent
tube feedings (Altman et al.,2013).
Absence of bowel sounds or presence of
8. Performed physical assessment of the abdominal pain, tenderness, or distention
abdomen. may indicate GI problem, contraindicating
feeding.
PLANNING
1. Identified expected outcomes.
2. Explained procedure to patient, Reduces anxiety and helps patient assist
included sensations he or she would feel. in insertion.
Helps patient assist in insertion
3. Explained how to communicate during
insertion.
IMPLEMENTATION
Reduces transmission of microorganisms.
1. Performed hand hygiene, prepared
Helps the HCP perform procedure
supplies at bedside.
smoothly
2. Stood on same side of bed as naris Allows easier manipulation of tube
chosen for insertion.
3. Applied pulse oximeter, measured vital Provides objective assessment of
signs, ensured patient stability before respiratory status during tube insertion.
inserting tube.
4. Placed bath towel over patient’s chest, Prevents soiling of gown. Insertion of tube
kept facial tissues within reach. frequently produces tearing.
5. Determined length of tube to be Length approximates distance from nose
inserted, marked location properly. to stomach.
6. Prepared NG or nasoenteric tube for
insertion:
a. Obtained order for stylet tube.
Ensures tube is patent. Activates
lubrication of tube for easier passage and
b. Injected water from syringe into the
ensure the tube is patent. Aids in
tube if tube has guidewire or stylet.
guidewire or stylet removal once the tube
is placed
c. Ensured stylet is positioned securely Improperly positioned stylet induces
within tube, injected water from syringe serious trauma. Promotes smooth
into tube. passage of tube into GI tract.
Fixation device allow the tube to float free
7. Cut hypoallergenic tape or prepared of the nares, thus reducing pressure on
other securing device. the nares and preventing device-related
pressure ulcer.
8. Applied clean gloves. Reduces transmission of microorganisms.
9. Dipped tube with surface lubricant into Activates lubricant to facilitate passage of
room temperature water or applied tube into naris to GI tract.
lubricant.
10. Handed alert patient a cup of water Swallowing water facilitates tube
with straw. passage.
11. Explained next step, inserted tube Natural contour facilitates passage of
through nostril to back of throat, aimed tube into GI tract and reduces gagging by
appropriately. patient.
12. Had patient flex toward chest at Closes off glottis and reduces risk of tube
appropriate time. entering trachea.
13. Encouraged patient to swallow with Swallowing facilitates passage of tube
small sips of water, advanced tube as past oropharynx. A tug may be felt as
patient swallowed, rotated tube while patient swallows, indicating tube is
inserting. following desired path.
Helps facilitate passage of tube and
14. Reemphasized mouth breathing and
alleviates patient’s fears during
swallowing.
procedure.
 Can cause tube to inadvertently enter
15. Did not advance tube during
patient’s airway, which will be reflected in
inspiration or coughing, monitored
changes in O2 saturation or end tidal
oximetry and capnography.
CO2.
16. Advanced tube each time patient Reduces discomfort and trauma to
swallowed, until desired length had been patient.
passed.
17. Checked for position of tube at back Tube could become coiled, kinked, or
of throat. enter the trachea.
Movement of tube stimulates gagging.
18. Anchored tube to nose temporarily Allow for assessment of tube position
before anchoring the tube securely.
Proper tube placement is essential before
19. Checked placement of tube by initiating feeding. Properly obtained pH of
aspirating stomach contents. 1.0 to 4.0 is good indication of gastric
placement (Fernandez et al., 2010)
20. Anchored tube to patient’s nose, Properly secured tube allows patient
marked exit site on tube, selected more mobility and prevents trauma to
appropriate option for anchoring nasal mucosa.
a. Applied membrane for dressing or tube Secures tube and reduces friction on
fixation device properly. nares
b. Applied tape properly. Helps tape adhere better. Protects skin.

Reduces traction on nares if tube moves.

21. Fastened end of NG tube properly to
Safety pins become unfastened and
patient’s gown.
possibly cause injury to patient.
22. Assisted patient to a comfortable
position.
23. Removed gloves, performed hand Reduces transmission of microorganisms.
hygiene.
X-ray film examination is gold standard
24. Obtained x-ray film of chest/abdomen. for verifying tube placement (Stewart,
2014).
25. Performed hand hygiene, applied Promotes patient comfort and integrity of
clean gloves, administered oral hygiene, oral mucous membranes.
cleansed tubing at nostril properly.
26. Removed gloves, disposed of Reduces transmission of microorganisms
equipment, performed hand hygiene.
27. Removed tube:
a. Verified order for tube removal.
b. Gathered equipment.
Informs patient and enhances
c. Explained procedure to patient.
cooperation.
d. Performed hand hygiene, applied Reduces transmission of microorganisms.
gloves.
 Reduce risk of aspiration in the event the
e. Positioned patient appropriately.
patient vomits.
f. Placed disposable pad over patient’s Prevents mucus and secretions from
chest. soiling patient’s gown.
g. Disconnected tube from feeding
administration.
h. Removed securement device from Allows for easy tube removal.
patient’s nose.
i.Instructed patient to take a deep breath Prevents inadvertent aspiration of gastric
and hold, kinked end of tubing, withdrew contents during tube removal.
tube appropriately.
j. Offered tissues to patient. Provides patient comfort.
k. Offered mouth care. Provides patient comfort.
l. Removed gloves, performed hand Reduces transmission of microorganisms.
hygiene.
EVALUATION
1.Observed patient’s response to tube Malposition of tube causes gagging,
placement, assessed for signs of coughing and difficulty of breathing
placement in respiratory tract.
2. Confirmed x-ray film results with Verifies position of tube before initiating
healthcare provider. enteral feeding.
3. Removed stylet after verification of
placement.
4. Routinely checked condition of nares, Routine checking ensures correct tube
location of marking on tube, and color placement and reduces the risk of
and pH of fluid aspirated from tube. aspiration.
5. Assessed patient’s LOC after removal.
6. Asked patient to explain how he or she Reflects patient’s understanding
will communicate during NG tube
instertion.
7. Identified unexpected outcomes.
RECORDING AND REPORTING
1. Recorded type and size of tube placed,
location of distal tip of tube, patient’s
tolerance of procedure, condition of naris,
and confirmation of tube position.
2. Recorded removal of tube, condition of
naris, and patient’s tolerance.
3. Reported any type of unexpected
outcome and interventions performed.
4. Documented evaluation of patient
learning.