NASOGASTRIC TUBE INSERTION PROCEDURE

1. Inspect the condition of client’s oral cavity.
R: Determine baseline condition of the oral cavity so as to determine the need for special nursing for oral hygiene following tube placement

2. Palpate client’s abdomen.
R: To determine baseline condition of the abdomen that will later serve as comparison once the tube is inserted.

3. Check the chart for doctor’s order of nasogastric tube insertion.
R: Procedure requires physician’s order

4. Prepare necessary equipments and supplies.

5. Identify client and explain the procedure.
R: Identification of client prevents error & the explanation of procedure will gain client’s cooperation to facilitate passage of tube.

6. Positon client in high fowler’s position with pillows behind head and shoulders. Raise the head of the bed..
R: Promotes client’s ability to swallow during the procedure

7. Wash hands
R: Reduces the transmission of microorganism

8. Assemble equipments & supplies at client’s bedside.

9. Pull curtain around bed or close room’s door.
R: Provides privacy

10. Stand on client’s right side, if right handed and left side if left handed.
R: Allows easy manipulation of tubing

11. If the NGT is too pliable, place the tube in emesis basin and cover with ice.
R: Ice will stiffen the tube for easier insertion

12. Instruct client to relax & breathe normally while occluding one nostril then repeat this action to the other nostril. Select the nostril with greater airflow.
R: Tube will pass through the nostril that is more patent.

13. Measure the distance of the tube to be inserted by placing the tip of the tube at client’s nose and extending tube to the tip of ear lobe down to the xyphoid process of the sternum.
R: Tube should extend from the nares to the stomach; the distance varies with each client.

14. Mark the length of the tube to be inserted with piece of tape.
R: so that the tube to inserted will be exactly placed in the stomach

15. Lubricate 7.5 – 10 cm (3-4 in) of the end of the NGT with water soluble lubricant.
R: Lubricated tube will facilitate easy insertion

16. Instruct the client to extend the neck back against pillow, then insert tube through the nares with the end pointing downward.
R: Extending the neck facilitates initial passage of the tube through the nares and maintains clear airway.

17. Continue to pass the tube along the floor of nasal passage aiming down toward the ear.
R: Minimize discomfort if tube rub against upper nasal turbinate.

18. If resistance is met, withdraw the tube, relubricate the tube & insert it to the nares.
R: Forcing against resistance can cause trauma to the mucosa

19. Continue insertion of tube, passing through the naso-pharynx by gently rotating the tube.

20. With the tube just above the oropharynx, instruct the client to flex the head forward and to try to swallow. Advance the tube 2.5 -5 cm (1-2 in) with each act of swallowing. If the client is allowed with fluids allow to drink & advance the tube each time the client swallow water.
R: Flexed position closes upper airway to trachea and opens the esophagus. The act of swallowing closes the epiglottis and helps move the tube into the esophagus.

21. If client begins to cough, gag, or choke, stop tube advancement. If client continues to cough pull the tube back slightly.
R: Tubing may accidentally enter larynx and initiate coughing reflex & obstruct the airway.

22. If the client is relaxed, continue to advance the tube until the marked point or the desired distance