NG Tube

PROCEDURE CHECKLIST Chapter 26: Inserting Nasogastric and Nasoenteric Tubes Check (9) Yes or No PROCEDURE STEPS Yes
1. Prepares the tube. a. Plastic tube: Places in basin of warm water for 10 minutes. b. Rubber tube: Places in basin of ice for 10 minutes. c. Small-bore tube: Inserts stylet or guidewire and secures into position according to agency policy. (Small bore tubes may come with the guidewire in them. Leaves the wire in place until tube is positioned and placement checked on x-ray. Once wire is removed, does not reinsert it.) 2. Assists patient into a high Fowlers position. Variations: a. If the patient is comatose, places the patient into a semi-Fowlers position. Has a coworker help position the patients head for insertion. b. If the patient is confused and combative, asks a coworker to assist with insertion. 3. Measures tube length correctly. a. Nasogastric tube: Measures from the tip of the nose to the earlobe, and from the earlobe to the xiphoid process. Marks the length with tape or indelible ink on the NG tube. b. Nasoenteric tube: Adds 810 cm (34 inches) to NG measurement and marks with tape. 4. Drapes a linen saver pad over the patients chest and hands him an emesis basin. 5. Cuts a 4-inch (10 cm) piece of hypoallergenic tape. 6. Dons procedure gloves, if not done previously. 7. Lubricates the distal 4 inches (10 cm) of the tube with a water-soluble lubricant. 8. If the patient is awake, alert, and able to swallow, hands him a glass of water with a straw. 9a. Gently inserts the tip of the tube into the nostril. Has the patient hyperextend his neck and advances the tube slowly, aiming downward and toward the ear. 9b. If resistance is felt when the tube reaches the nasopharynx, uses gentle pressure, but does not force the tube to advance. 9c. Provides tissues if the patients eyes tear. 10. After the tube passes through the nasopharynx, has the No COMMENTS
Copyright 2007, F. A. Davis Company, Wilkinson & Van Leuven/Procedure Checklists for Fundamentals of Nursing
patient flex his head toward the chest. 11. Rotates the tube 180. 12. Directs patient to sip and swallow the water while slowly advancing the tube. 13. Advances tube 24 inches (510 cm) with each swallow until marked length is reached. 14a. If patient gags, stops advancing the tube and has patient take deep breaths and drink a few sips of water. 14b. If gagging continues, uses a tongue blade and penlight to check tube position in the back of the throat. 14c. If the tube is coiled in the back of the throat, the patient coughs excessively during insertion, the tube does not advance with each swallow, or the patient develops respiratory distress, withdraws the tube and allow the patient to rest before reinserting. 14d. Variation: To Advance the Tube Into the Duodenum: After the tube is in the stomach, positions patient on his right side; advances the tube 5 to 7.5 cm (2 to 3 inches) hourly, over several hours (up to 24 hours) until radiography confirms placement. 15. When tube is in place, secures it temporarily with one piece of tape so it does not move while confirming placement. 16. Verifies tube placement at the bedside by: a. Aspirating stomach contents and measuring pH. b. Confirms a by injecting air into the NG tube and auscultating, or asking patient to speak. (See Technique 28-4 in Volume 2.) 17. After confirming placement, secures tube with tape or a tube fixation device. Tape: a. Applies skin adhesive to patients nose and allows it to dry. b. Removes gloves and tears one end of the hypoallergenic tape lengthwise for 2 inches (5cm) c. Applies the intact end of the tape to the patients nose. d. Wraps the 2-inch (5 cm) strips around the tube where it exits the nose. e. Alternatively, uses 1-inch tape; applies one end to patients nose, wraps the middle around the tube, and secures the other end to the opposite side of the nose. Alternative: Uses Fixation device: Places the wide end of the pad over the bridge of the nose; positions the connector around the tube where it exits the nose. 18. Ties a slipknot around the tube with a rubber band.
Secures the rubber band (or tape) to the patients gown with a safety pin.
Recommendation: Pass ______ Needs more practice ______ Student: Instructor: Date: Date:

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What are the steps to insert a nasogastric tube?

What should be done if the patient gags during insertion?

PROCEDURE CHECKLIST Chapter 26: Inserting Nasogastric and Nasoenteric Tubes Check (9) Yes or No PROCEDURE STEPS Yes

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