NGT Insertion

Inserting a Nasogastric Tube
Instruction: Check under Correctly Done if identified skill is correctly performed; Incorrectly
Done if skill is not performed correctly; and Not Done if the student failed to perform the
skill.
Correctly Incorrectly Not
Procedure Done Done Done
2 1 0
1. Check physician’s order for insertion of NG tube and
consider the risks associated with NG tube insertion.
2. Identify the patient.
3. Explain the procedure to the patient and provide the
rationale as to why the tube is needed. Discuss the
associated discomforts that may be experienced and
possible interventions that may allay this discomfort.
Answer any questions as needed.
4. Gather equipment including selection of the
appropriate NG polyurethane tube.
5. Perform hand hygiene. Put on nonsterile gloves.
6. Close the patient’s bedside curtain or door. Raise the
bed. Assist the patient to high Fowler’s position and
elevate the head of the bed 45 degrees. Drape chest with
bath towel or disposable pad. Have emesis basin and
tissues handy.
7. Measure the distance to insert tube by placing tip of
tube at patient’s nostril and extending to tip of ear lobe
and then to tip of xiphoid process. Mark tube with an
indelible marker.
8. Lubricate tip of tube (at least 2″–4″) with water-
soluble lubricant. Apply topical anesthetic to nostril and
oropharynx, as appropriate.
9. After selecting the appropriate nostril, ask patient to
slightly flex head back against the pillow. Gently insert
the tube into the nostril while directing the tube upward
and backward along the floor of the nose. Patient may
gag when tube reaches pharynx. Provide tissues for
tearing or watering of eyes. Offer comfort and
reassurance to the patient.
10. When pharynx is reached, instruct patient to touch
chin to chest. Encourage patient to sip water through a
straw or swallow even if no fluids are permitted. Advance
tube in downward and backward direction when patient
swallows. Stop when patient breathes. If gagging and
coughing persist, stop advancing the tube and check
placement of tube with tongue blade and flashlight. If
tube is curled, straighten the tube and attempt to
advance again. Keep advancing tube until pen marking is
reached. Do not use force. Rotate tube if it meets
resistance.
11. Discontinue procedure and remove tube if there are
signs of distress, such as gasping, coughing, cyanosis,
and inability to speak or hum.
12. While keeping one hand on tube or temporarily
securing with tape, determine that tube is in patient’s
stomach:
a. Attach syringe to end of tube and aspirate a small
amount of stomach contents.
b. Measure the pH of aspirated fluid using pH paper or a
meter. Place a drop of gastric secretions onto pH paper
or place small amount in plastic cup and dip the pH paper
into it. Within 30 seconds, compare the color on the
paper with the chart supplied by the manufacturer.
c. Visualize aspirated contents, checking for color and
consistency.
d. Obtain radiograph (x-ray) of placement of tube (as
ordered by physician).
13. Apply tincture of benzoin or other skin adhesive to tip
of nose and allow to dry. Secure tube with tape to
patient’s nose:
a. Cut a 4″ piece of tape and split bottom 2″ or use
packaged nose tape for NG tubes.
b. Place unsplit end over bridge of patient’s nose.
c. Wrap split ends under tubing and up and over onto
nose. Be careful not to pull tube too tightly against nose.
14. Clamp tube and cap or attach tube to suction
according to the physician’s orders.
15. Secure tube to patient’s gown by using rubber band
or tape and safety pin. For additional support, tube can
be taped onto patient’s cheek using a piece of tape. If
double-lumen tube (eg, Salem sump) is used, secure
vent above stomach level. Attach at shoulder level.
16. Assist with or provide oral hygiene at every 2- to 4-
hour interval. Lubricate the lips generously and clean
nares and lubricate as needed. Offer analgesic throat
lozenges or anesthetic spray for throat irritation if
needed.
17. Remove all equipment, lower the bed, and make the
patient comfortable. Remove nonsterile gloves and
perform hand hygiene.
Comment: _____________________________________________________________
Score: _____________
Name of Student: ___Date Performed: ______

(Signature Over Printed Name)
Evaluated by: Date of Evaluation: ____________

(Signature Over Printed Name)

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Inserting a Nasogastric Tube

Name of Student: _Date Performed: ____

Evaluated by: Date of Evaluation: ____________

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