NASOGASTRIC TUBE

Purposes
1. To decompress stomach by removing fluids and/or gas to
promote abdominal comfort
2. To allow surgical anastamoses to heal without distention
3. To decrease risk of aspiration
4. To administer medications to clients who are unable to
swallow
5. To provide nutrition by acting as a temporary feeding
tube
6. To irrigate the stomach and remove toxic substances,
such as poisoning
 Place patient in a High Fowlers position
Measure: NEX (usually 22-26 inches for adults) plus 2 inches for tall
patients.
I Lubricate with water soluble
Ask the client to hyperextend the neck, advancing the tube toward the
N nasopharynx
S Instruct client to tilt the head forward when the tube is felt in the
oropharynx(throat)
E Offer small sips of water from a glass with straw and encourage to swallow

R Stop if the patient gags, wait for few min. before proceeding
Withdraw if gagging continues
T Assess for correct placement by:
Check pH: should be less than 4.0
I Inserting 5-10 ml of air into a stethoscope placed over the stomach and
O listen for a swooshing sound
Taking X-ray: MOST RELIABLE METHOD
N Secure tube to the bridge of the nose with tape and to the gown
Key points
Usually up to 2 weeks use only (short term)
Clean but not sterile procedure
Mouth care needed
Report coffee ground material
(digested blood)
Check for placement and patency
Clamp tube when ambulating
Hold feeding if >50% residual from previous hour
(adults) or >25% (children)
Flush tube with water before and after feeding
Use pump to control rate of tube feeding
Administer fluid at room temperature
Change bag Q8 hours for continuous feeding
Elevate head of bed while feeding is running
Check patency Q4 hours
Good mouth care
Nasogastric Tubes:

Linton-Nachlas
—4-lumen, used for bleeding esophageal varices

Keofeed/Dobhoff
—soft silicone, used for long-term feedings
 Purpose Example Key Points
of Use
LEVIN TUBE  Inserted into  Any abdominal  Low
stomach to or other sx after intermittent
- Single lumen decompress by which peristalsis is suction
removing gastric absent for a few  Irrigate prn
contents and air days with NSS
 Used for  GI hemorrhage
feeding when  CA of the
unable to swallow esophagus
 Early post-op
for pt who had
laryngectomy or
radical neck
dissection
 Purpose Example of Use Key Points
SALEM – SUMP Gastric Same as levin •With
decompression tube continuous
- Double lumen with continuous suction
air vented tube suction (25mmHg)
to provide •If leak occurs
constant inflow in the vent (blue
of athmos- tubing), instill
pheric air, and 30 ml air into
to protect vent and irrigate
gastric mucosa main with NSS.
from trauma of •Do not clamp
suctioning vent
NG Irrigation Tubing:
Verify placement of tube
Insert 30-50 cc of normal saline into tube
If feel resistance, change patient position, check for kinks
Withdraw solution or record amount as input
NG removal:
Clamp tube
Remove tape
Instruct patient to exhale
Remove tube with smooth, continuous pull
 LAVAGE TUBES

Purpose Example of Use Key Points

LAVACUATOR • Orogastric w/ Ingestion of • Continuous

large suction poison suction
lumen and • Irrigation
smaller lavage solution enters
vent the lavage lumen
• Removes toxic while stomach
substances from contents are
stomach removed through
the suction lumen
What is the position of the patient when
inserting the NGT?
Low Fowler’s position
Semi-Fowler’s position
Trendelenberg position
High Fowler’s position
What is the position of the patient when
inserting the NGT?
Low Fowler’s position
Semi-Fowler’s position
Trendelenberg position
High Fowler’s position

Rationale: D – Nurse Quick Check Skills 320

How do you measure the length of the NGT before inserting it
to the patient?
From the earlobe to the xiphoid process to the tip of the
nose
From the xiphoid process to the tip of the nose to the
earlobe
From the tip of the nose to the xiphoid process to the
earlobe
From the tip of the nose to the earlobe to the xiphoid
process
How do you measure the length of the NGT before inserting it to the
patient?
From the earlobe to the xiphoid process to the tip of the nose
From the xiphoid process to the tip of the nose to the earlobe
From the tip of the nose to the xiphoid process to the earlobe
From the tip of the nose to the earlobe to the xiphoid process

Rationale: D – Nurse Quick Check Skills 320

What is the initial thing to do when administering a drug
to a client with NGT?
Wash your hands
Put on gloves
Verify the order
Explain the procedure the client
What is the initial thing to do when administering a drug to a
client with NGT?
Wash your hands
Put on gloves
Verify the order
Explain the procedure the client

Rationale: C – Nurse Quick Check Skills 318

What is the important thing that you should advice a
client when inserting the NGT?
Don’t move
Hold your breathe
Swallow
Cough
What is the important thing that you should advice a client
when inserting the NGT?
Don’t move
Hold your breathe
Swallow
Cough

Rationale: C – Nurse Quick Check Skills 320

To minimize esophageal reflux what is the recommended
position of the client?
Flat in bed with head slightly elevated
Right lateral position with head slightly elevated
Left lateral position with head slightly elevated
High fowler’s position
To minimize esophageal reflux what is the recommended
position of the client?
Flat in bed with head slightly elevated
Right lateral position with head slightly elevated
Left lateral position with head slightly elevated
High fowler’s position

Rationale: B – Nurse Quick Check Skills 319

What is the best way to verify the position of the NGT?
Auscultating air
Aspirate gastric content
X-ray
Place the end of the tube in the container with
water.
What is the best way to verify the position of the NGT?
Auscultating air
Aspirate gastric content
X-ray
Place the end of the tube in the container with water.

Rationale: C – Nurse Quick Check Skills 321

What is the measurement of the NGT to a child or to an
infant?
14 to 18 French
5 to 10 French
21 to 25 French
11 to 13 French
What is the measurement of the NGT to a child or to an
infant?
14 to 18 French
5 to 10 French
21 to 25 French
11 to 13 French
Rationale: B – Delmar’s Fundamentals and Advance
Nursing Skills Second Edition 715
A 70 year old client with a Nasogastric tube (NGT) was
given a continuous feeding. What position will the
nurse place the client at all times?
Side Lying
Semi Fowler’s
High Fowler’s
Prone
A 70 year old client with a Nasogastric tube (NGT) was
given a continuous feeding. What position will the
nurse place the client at all times?
Side Lying
Semi Fowler’s
High Fowler’s
Prone
Answer: B –Saunders 4th Edition Pg.252
A client asks the nurse what is the purpose of having a
Nasogastric tube. The nurse knows that the purpose of
NGT is: prioritize
To irrigate the stomach
To decrease the risk for aspiration
To provide nutrition
To decompress the stomach
Order the above according to prioritization:
A client asks the nurse what is the purpose of having a
Nasogastric tube. The nurse knows that the purpose of
NGT is: prioritize
1. To decompress the stomach
2. To provide nutrition
3. To decrease the risk for aspiration
4. To irrigate the stomach
Order the above according to prioritization:
Answer: DCBA – Saunders 4th Edition Pg.252
While assessing the client’s double-lumen NGT the nurse
noticed a leakage through the air vent. What should
the nurse initially do?
Clamp the lumen
Call the physician
Irrigate the main lumen with tap water
Instill 30 ml of water into the air vent
While assessing the client’s double-lumen NGT the nurse
noticed a leakage through the air vent. What should the
nurse initially do?
Clamp the lumen
Call the physician
Irrigate the main lumen with tap water
Instill 30 ml of water into the air vent
Answer: D – Saunders 4th Edition Pg.252
Which of the following action/s is/are correct in NGT
irrigation:
Instill 20-30mL of water or NS with an irrigation syringe
Instill 30-50mL of water or NS with an irrigation syringe
Perform irrigation every 8 hours to assess patency of the
tube
Pull back on the syringe plunger to withdraw fluid, repeat if
the tube flow is sluggish
Which of the following action/s is/are correct in NGT irrigation:
Instill 20-30mL of water or NS with an irrigation syringe
Perform Instill 30-50mL of water or NS with an irrigation
syringe
irrigation every 8 hours to assess patency of the tube
---every 4 hours
Pull back on the syringe plunger to withdraw fluid, repeat if
the tube flow is sluggish
Answer: BD – Saunders 4th Edition Pg.252
The nurse is about to give a bolus feeding to a client,
what will indicate the nurse to withhold the feeding?
Residual amount of 100mL
Residual amount of 120mL
pH measuring 3.5
pH measuring 2.5
The nurse is about to give a bolus feeding to a client,
what will indicate the nurse to withhold the feeding?
Residual amount of 100mL
Residual amount of 120mL
pH measuring 3.5
pH measuring 2.5

Answer: A – Saunders 4th Edition Pg.252-254

Which of the following actions are correct in NGT
insertion to a 2 year old client:
Place the infant in an infant seat or position the client
with rolled towel or pillow under the head and
shoulders
Do not hyperextend or hyper flex the patients neck
Restrain can be use during tube insertion
Tape the tube to the area between the end of the
nares and upper lip as well as to the cheek
Which of the following actions are correct in NGT insertion to
a 2 year old client:
Place the infant in an infant seat or position the client with
rolled towel or pillow under the head and shoulders
Do not hyperextend or hyper flex the patients neck
Restrain can be use during tube insertion
Tape the tube to the area between the end of the nares and
upper lip as well as to the cheek

Answer: ALL – Fundamentals of Nursing 7th Ed. Pg.1209

In NGT insertion, the neck should be:
Extended
Hyperextended
On the side
Neutral position
In NGT insertion, the neck should be:
Extended
Hyperextended
On the side
Neutral position

Answer: B – Hyperextension of the neck reduces the

curvature of the nasopharyngeal junction ---
Fundamentals of Nursing 7th Ed. Pg.1206
While inserting a Nasogastric tube to an adult client, the
client begins to have difficulty of breathing. What is the
most appropriate nursing action?
Notify the physician
Continue to insert the tube
Remove the tube and reinsert immediately
Immediately withdraw and wait until DOB subsides
While inserting a Nasogastric tube to an adult client, the
client begins to have difficulty of breathing. What is the
most appropriate nursing action?
Notify the physician
Continue to insert the tube
Remove the tube and reinsert immediately
Immediately withdraw and wait until DOB subsides

Answer: D – Saunders 4th Edition Pg.254

A prioritize nursing diagnosis to a client receiving tube
feeding is:
Risk for deficient fluid volume related to hypertonic
dehydration
Deficient knowledge about home tube feeding regimen
Imbalanced Nutrition: Less than body requirements
Risk for diarrhea related to dumping syndrome
A prioritize nursing diagnosis to a client receiving tube feeding
is:
Risk for deficient fluid volume related to hypertonic
dehydration
Deficient knowledge about home tube feeding regimen
Imbalanced Nutrition: Less than body requirements
Risk for diarrhea related to dumping syndrome

Answer: C – Brunner & Suddarth’s Medical Surgical Nursing

10th Ed. Pg.994
Which of the following action/s is/are incorrect in
providing oral and nasal hygiene to a client with NGT:
SATA
Frequent mouth care
Clean the nose with moistened cotton-tipped swabs
Cleansing the nose using water soluble lubricant
Changing nasal tapes every 3-5 days
Which of the following action/s is/are incorrect in providing
oral and nasal hygiene to a client with NGT: SATA
Frequent mouth care
Clean the nose with moistened cotton-tipped swabs
Cleansing the nose using water soluble lubricant
Changing nasal tapes every 3-5 days

Answer: D – Brunner & Suddarth’s Medical Surgical

Nursing 10th Ed. Pg.991
In removing the NGT, the nurse should instruct the client
to do which of the following action?
Exhale
Inhale then hold breath
Exhale and hold breath
Inhale and exhale quickly
In removing the NGT, the nurse should instruct the client
to do which of the following action?
Exhale
Inhale then hold breath
Exhale and hold breath
Inhale and exhale quickly

Answer: C – Fundamentals of Nursing 7th Ed. Pg.1208

Which of the following actions are incorrect in removing
a Nasogastric tube: SATA
Put on sterile gloves
Pinch the tube with the gloved hand
Slowly and smoothly withdraw the tube
Observe the intactness of the tube
Which of the following actions are incorrect in removing
a Nasogastric tube: SATA
Put on sterile gloves ---disposable
Pinch the tube with the gloved hand
Slowly and smoothly withdraw the tube --- quickly
Observe the intactness of the tube

Answer: A & C– Fundamentals of Nursing 7th Ed.

Pg.1208
Before removing, the nurse may intermittently clamp and
unclamp the NG tube for a trial period to ensure that
the client does not experience N/V, or distention. How
long is the trial period?
12 hours
24 hours
32 hours
48 hours
Before removing, the nurse may intermittently clamp and
unclamp the NG tube for a trial period to ensure that
the client does not experience N/V, or distention. How
long is the trial period?
12 hours
24 hours
32 hours
48 hours
Answer: B – Brunner & Suddarth’s Medical Surgical
Nursing 10th Ed. Pg.991
In removing the NG tube, the tube is gently withdrawn
for:
5-10 cm
10-15 cm
15-20 cm
20-25 cm
In removing the NG tube, the tube is gently withdrawn for:
5-10 cm
10-15 cm
15-20 cm
20-25 cm

Answer: C – Brunner & Suddarth’s Medical Surgical Nursing

10th Ed. Pg.991
When inserting a NG tube, do all of the following, except:
a) Lubricate the first 3”(7.6cm) of the tube with
petroleum jelly
b) have the patient take sips of water and swallow as
you advance the tube
c) Watch for signs of respiratory distress
d) Keep an emesis basin and tissues available for the
patient
When inserting a NG tube, do all of the following, except:
a) Lubricate the first 3”(7.6cm) of the tube with
petroleum jelly
b) have the patient take sips of water and swallow as
you advance the tube
c) Watch for signs of respiratory distress
d) Keep an emesis basin and tissues available for the
patient
Lubricate the first 3”(7.6cm) of the tube with
petroleum jelly
Rationale
Only water soluble lubricants are used for NG tube insertion
because of the risk of pneumonia when it enters the respiratory
cavity
Saunders 2004
An important nursing action for a patient with a nasogastric
feeding tube is to:

a) Measure the residual contents in the stomach every

morning
b) Clean and lubricate the external nares
c) Administer the feeding over 1 to 2 hours
d) Check the patient’s blood glucose level before each
feeding
An important nursing action for a patient with a nasogastric
feeding tube is to:

a) Measure the residual contents in the stomach every

morning
b) Clean and lubricate the external nares
c) Administer the feeding over 1 to 2 hours
d) Check the patient’s blood glucose level before each
feeding
 Clean and lubricate the external nares
Rationale
 Measure the residual every before feeding, the
time 1 to 2 hours is too long for feeding and the
question doesn't state that the patient has
problems with sugar levels.
 Nurse should maintain a clean and unobstructed
nares because of the presence of tube it may
irritate the nasal lining
A nurse is preparing to administer an intermittent tube feeding
through a nasogastric tube. The nurse assesses a gastric
residual before administering the feeding to:

a) Confirm proper NGT placement

b) Determine patency of the tube
c) Assess fluid and electrolyte status
d) Evaluate absorption of the last feeding
A nurse is preparing to administer an intermittent tube feeding
through a nasogastric tube. The nurse assesses a gastric
residual before administering the feeding to:

a) Confirm proper NGT placement

b) Determine patency of the tube
c) Assess fluid and electrolyte status
d) Evaluate absorption of the last feeding
Rationale
 Aspirating the residual content
evaluates the gastrointestinal
absorption rate.
 Kozier nutrition
What is the proper technique with the gravity tube feeding?
a) Feeding bag is hung 1 foot higher than tube’s insertion
point into the client
b) Nurse administers the next feeding only if there is less
than 25 ml of residual volume from the previous feeding
c) Client is placed in the left lateral position to promote
feeding flow into the intestines
d) Feeding is administered at a refrigerated temperature to
reduce bacterial growth during feeding
What is the proper technique with the gravity tube feeding?
a) Feeding bag is hung 1 foot higher than tube’s insertion
point into the client
b) Nurse administers the next feeding only if there is less
than 25 ml of residual volume from the previous feeding
c) Client is placed in the left lateral position to promote
feeding flow into the intestines
d) Feeding is administered at a refrigerated temperature to
reduce bacterial growth during feeding
Rationale
Feeding bag is hung 1 foot higher than tube’s
insertion point into the client too low height of
feeding bottle may lead to slow feeding and high
may cause increase tube emptying
The client is admitted with anorexia nervosa. A nasogastric tube
is to be inserted. Which of the following is the best nursing
approach to prepare the client for the procedure?

a) Assist the client in sitting position

b) Explain the procedure to the client
c) If the client has a denture, make sure that they are in place in the
clients mouth
d) Have the stethoscope available to listen for the proper placement
The client is admitted with anorexia nervosa. A nasogastric tube
is to be inserted. Which of the following is the best nursing
approach to prepare the client for the procedure?

a) Assist the client in sitting position

b) Explain the procedure to the client
c) If the client has a denture, make sure that they are in place in the
clients mouth
d) Have the stethoscope available to listen for the proper placement
Explain the procedure to the client

Rationale

Explaining the procedure to the client will prepare

him/her not only physically but holistically. Also the
nurse will gain cooperation when inserting the NG
tube.
A patient with cancer receives his bolus tube
feeding. Which of the following is the most
appropriate position to decrease the risk of
aspiration?
A. Sitting upright in a chair for 1 hour
B. Supine in bed with head elevated at 60 degrees for 2
hours
C. Placing on his left side with head of bed elevated at
45 degrees for 15 minutes
D. Supine with head of bed elevated to 30 degrees for
20 minutes
A patient with cancer receives his bolus tube feeding.
Which of the following is the most appropriate position
to decrease the risk of aspiration?
A. Sitting upright in a chair for 1 hour
B. Supine in bed with head elevated at 60 degrees for 2 hours
C. Placing on his left side with head of bed elevated at 45
degrees for 15 minutes
D. Supine with head of bed elevated to 30 degrees for 20
minutes
Rationale: A. As long as the patient can get out of bed, the
preferred position and time frame for preventing aspiration
after a bolus tube feeding is sitting upright out of bed for 30
to 60 minutes.
A post gastrectomy patient ask the nurse when
will his NG tube will be removed. The nurse tell
the patient
A. After the fourth post-operative day
B. Thirty-six hours after the cessation of bloody
drainage
C. When the patient already gains weight
D. When patient is able to pass flatus or stool
A post gastrectomy patient ask the nurse when
will his NG tube will be removed. The nurse tell
the patient
A. After the fourth post-operative day
B. Thirty-six hours after the cessation of bloody
drainage
C. When the patient already gains weight
D. When patient is able to pass flatus or stool
Rationale: D. NGT is removed after bowel sound is
reestablished (usually after 3 days) and after pt has
passed flatus or stool.
A patient with NGT after gastric resection
complains of severe nausea and absence of
drainage for the past 4 hours is noticed. The most
appropriate nursing action would be to
A. Repositioning the patient
B. Irrigating the tube with NSS
C. Notifying the physician
D. Giving antiemetic medication
A patient with NGT after gastric resection complains
of severe nausea and absence of drainage for the
past 4 hours is noticed. The most appropriate
nursing action would be to
A. Repositioning the patient
B. Irrigating the tube with NSS
C. Notifying the physician
D. Giving antiemetic medication
Rationale: C. N&V is not a normal observation after NGT
insertion. The most appropriate action is to notify the
physician. Positioning the tube or irrigating is not
prescribed because the NGT is placed directly in the
suture line and may cause pressure on it.
Which statement by the nurse accurately
describes the Levin tube?
A. A double lumen tube with one lumen leading to the
inflatable balloon and other luman used for aspiration.
B. A single lumen plastic or rubber tube with holes
near its tip facilitating withdrawal of fluids from the
stomach.
C. A single lumen, saline, air or water-weighted tube
approximately 6 feet long
D. A 10 foot long rubber tube with a saline, air, or water
bag at its end.
Which statement by the nurse accurately describes
the Levin tube?
A. A double lumen tube with one lumen leading to the
inflatable balloon and other luman used for aspiration.
B. A single lumen plastic or rubber tube with holes
near its tip facilitating withdrawal of fluids from the
stomach.
C. A single lumen, saline, air or water-weighted tube
approximately 6 feet long
D. A 10 foot long rubber tube with a saline, air, or water bag
at its end.
Rationale: B. Choice A refers to a Miller-Abbot tube; choice
C is a Harris tube ; and choice D is a Cantor tube used for
intestinal decompression.
Which statement accurately describes a Salem
sump tube?
A. A short double-lumen tube with small vent used for
stomach decompression
B. A double-lumen tube with an inflatable balloon
used for stomach decompression
C. A single-lumen tube used to evacuate stomach
content
D. A large-bore tube used to evacuate stomach
content.
Which statement accurately describes a Salem sump
tube?
A. A short double-lumen tube with small vent used
for stomach decompression
B. A double-lumen tube with an inflatable balloon used
for stomach decompression
C. A single-lumen tube used to evacuate stomach content
D. A large-bore tube used to evacuate stomach content.
Rationale: A. Choice B refers to a Miller-Abbot tube;
choice C is a Levin tube; and choice D is an Ewald tube.