Inserting an NG (Nasogastric) Tube

Purpose
1. NG tubes can be placed for many reasons:
  1. Gastric decompression
  2. Medication administration and enteral nutrition when the oral route is unavailable
    1. Aspiration
    2. Esophageal trauma

Nursing Points

General

Supplies needed
1. NG tube/salem sump – usually 14-16fr
2. 60 mL catheter tip syringe
3. Lubricant jelly
4. Cup of water with straw
5. Towel
6. Tape
7. pH strips

Assessment

Assess patient’s need for NG tube
Assess nares for patency
1. Cover one nostril at a time and ask the patient to sniff
Assess for history or presence of deviated septum
Assess client for gag reflex

Nursing Concepts

Steps and Nursing Considerations
1. Verify provider order
2. Gather supplies
3. Perform hand hygiene
4. Explain procedure to patient
5. Apply clean gloves
6. Position patient in high-fowler’s position and raise bed to comfortable working height
7. Lay towel across the patient’s chest
  1. Patients may vomit – this step is WORTH IT!
8. Measure length of tubing required
  1. Measure from nose to earlobe to xiphoid process
  2. Mark the measurement with a piece of tape or marker
9. Cut a piece of tape approximately 3 inches long.
  1. Cut a slit in the tape down the middle length-wise, about ⅔ of the way up
  2. Like a pair of pants!
10. Dip the tip of the NG tube in lubricant jelly
11. Give the patient the cup of water with a straw
12. Gently insert the NG tube into the most patent nare
  1. Should insert back and down towards the ear
  2. NOT UP!
13. When it hits the oropharynx, patient may gag – encourage them to sip and swallow repeatedly to help the tube pass correctly
14. Continue to push, twisting can help.
  1. Do NOT force against firm resistance
15. Once you reach your measurement, apply the tape to the bridge of the nose and wrap the two pieces around the tube
16. Use the 60 mL syringe to aspirate gastric contents
  1. Should be greenish or brownish
  2. May have undigested food
17. Drop gastric aspirate on a pH strip – should be less than 4 to confirm placement
18. Clamp the tubing and wait for an abdominal x-ray
  1. MUST confirm with abdominal x-ray before using
19. Secure the tubing to the patient’s gown with a piece of tape
20. Assist the client to a comfortable position
21. Discard used supplies
  1. Keep 60mL syringe at bedside
22. Remove gloves, perform hand hygiene
23. Document insertion and patient’s response / tolerance
NOTE – Using an air bolus to verify placement is NO LONGER a recommended practice
1. The gold standard for confirmation is an abdominal x-ray.

Patient Education

Purpose for NG tube
Instructions for during placement – swallow water

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Transcript

In this video we’re going to show you the correct technique for insertion of an NG tube. We’ll also give you a few tips and tricks we use.

Of course, before you get started, make sure you’ve determine which nare is more patent and that the patient doesn’t have a deviated septum.

Before you start, lay a towel across the patient’s chest – I’m telling you I’ve had patients throw up on me – this step is WORTH IT!!

Now you need to take your NG tube and measure the length you need for insertion. Measure from the tip of the nose to the earlobe, down to the xiphoid process. Then mark that spot with a piece of tape or a marker.

You also want to go ahead and prep your tape or securing device. Rip off about a 3 inch piece of tape, then cut a slit in it about ⅔ of the way up. They should look like a little pair of pants!

Go ahead and hand the patient a cup of water so they can sip and swallow while you insert the tube. Of course, our big oversized Ken doll can’t hold the cup, so just use your imagination here!

Now you want to lubricate the end of the NG tube and slowly begin inserting the tube. You should aim back and down – NOT up. UP goes to the brain, that’s not where we’re headed. Aim straight back and down.

When you feel a little bit of resistance, have the patient sip and swallow from their cup of water. You can also twist a little as you push and that should help. Don’t ever force it past firm resistance.

Once you reach your measurement, you want to secure the tube while you check placement. Apply the tape you cut to the bridge of the nose and wrap the two pieces around the tube.

Now to check placement, you’ll use the 60 mL syringe to aspirate gastric contents. They should be greenish or brownish and may have undigested food, which is normal.

Then you’re going to drop the aspirate on a pH strip. The pH should be less than 4 to confirm placement. If it’s more than that, or if at any point the patient starts choking or coughing, pull the tube out.

Now you can clamp the tube and secure it to the patient’s gown with a piece of tape. And you will wait for an abdominal x-ray. You CANNOT put anything down this tube until the x-ray confirms placement.

Make sure the client is in a comfortable position while you clean up your supplies – just make sure you keep the 60 mL syringe at bedside.

I want to point out here that for the longest time we used an air bolus to confirm placement. That practice is NO LONGER recommended because it’s not reliable. The gold standard is the abdominal x-ray.

This is a skill you don’t get to see often unless you’re in the ER, so I hope this was helpful. Now, go out and be your best self today. And, as always, happy nursing!