Nasogastric Tube Insertion

NG Insertion: Measuring

Measure from tip of nose to earlobe to xiphoid process
 

Equipment needed for NG tube insertion:

(per Elkin, Perry and Potter  -  N 170 required textbook)  

  1. 14 to 15 Fr. N/G tube  (smaller-lumen catheters are not used for compression in adults because they are not able to remove thick secretions)
  2. Water-soluble lubricating jelly
  3. Tongue blade
  4. Flashlight
  5. 60 ml catheter tip syringe
  6. Tape one inch wide (hypoallergenic tape is recommended silk tape is good) or commercial fixation device
  7. Safety pin and rubber band
  8. Clamp, drainage bag or suction machine
  9. Emesis basin
  10. Towel
  11. Glass of water with straw
  12. Facial tissues
  13. Tincture of benzoin (optional)
  14. Suction equipment!
  15. Clean disposable gloves

Steps for NG tube insertion:

(per Elkin, Perry and Potter  -  N 170 required textbook)

  1. See Standard Protocol (inside front cover)  
  2. Prepare equipment at bedside.  Cut piece of tape about 4 inches and split one half in two pieces to form a or have  NG tube fixator device available.
  3. Place in high-Fowler's position.  Is height of bed comfortable for you?
  4. Place towel over client's chest give facial tissue to client.
  5. Instruct client to relax and breathe normally while occluding one nare.  Repeat with other nare.  Select nostril with greater airflow.
  6. Stand on side of patient with your dominant hand. 
  7. Measure distance to insert tube:
    1. Measure distance from tip of nose to earlobe to xiphoid process see illustration and mark tube at this measurement
    2. Mark 50-cm point on tube, then do traditional measurement above. Insert tube to marked site. Tube is usually placed midway between the two points. Mark with piece of tape or indelible marker
  8. Curve 4 to 6 inches of end of tube tightly around index finger and then release (this decreases tube stiffness)
  9. Lubricate 3 to 4 inches of the distal end with water-soluble lubricant.
  10. Tell client  insertion will begin and ask client to extend neck back against pillow
  11. Insert tube slowly through nare with CURVED end pointing downward.  Continue to insert along floor of nasal passage aiming down toward opposite ear.  (IF resistance is met, apply gentle downward pressure to advance tube. Do NOT force past resistance.)
  12. IF resistance is met, try to rotate the tube and see if it will advance if still resistant withdraw tube, allow client to rest, relubricate tube, and insert into other nare.
  13. Continue insertion of tube until just past nasopharynx by gently rotating it toward the opposite nostril  (up towards septum and down) towards oropharynx.
  14. Stop tube advancement allow client to relax and provide tissues.
  15. Explain to client that the next step will require them to swallow. Give client glass of water with straw (unless contraindicated)
  16. With tube just above oropharynz. Instruct client to flex head forward and swallow small sips of water and advance tube 1 to 2 inches with each swallow.
  17. If client begins to cough, gag or choke, withdraw slightly and stop advancement instruct client to breathe easily and take sips of water.
  18. Check back of oropharynx (throat) using a tongue blade to compress tongue.  If coiled, withdraw until tip of catheter can be seen.   Continue to advance tube while swallowing until tape or mark is reached.
  19. ask client to speak.
  20. Inspect posterior pharynx for presence of coiled tube.
  21. Draw up 30 ml of air into syringe. Attach the catheter-tipped syringe to end of tube, flush tube with 30 ml of air before aspirating and listen for air movement in stomach; then aspirate gently back on syringe to obtain gastric contents, observing color. (Measure pH, if done, in your hospital)
  22. Verify tube placement follow agency policy for preferred methods for checking NG tube placement.
  23. Anchor tube tape tube to nose using the two split ends of tape or use tube fixation device.
  24. Fasten rubber band to end of N/G tube in a slip knot and pin rubber band to client's gown allow for enough slack for movement of head.
  25. Place a mark, either a red mark or tape, on the tube to indicate where the tube exits the nare or measure tube length form nare to connector and document in record.
  26. Keep head of bed elevated at least 30 degrees unless ordered otherwise.
  27. Client's response, length, size and type of gastric tube inserted and which nostril used and placement validation.
  28. Palpate client's abdomen for distention and pain,
  29. Auscultate for bowel sounds any change?
  30. Comfort rate (explain the sensation of tube should decrease somewhat with time)
  31. Observe color of gastric secretions and patency of N/G tube
  32. Observe client's oral and nasal mucosa may c/o of sore throat offer throat lozenges or suck on ice chips if allowed.
  33. Once placement of tube is confirmed:
  34. Provide regular oral hygiene every 2 to 4 hours.
  35. Document 

 

NG Drainage Replacement:

Example order:
Measure NG drainage q4h and replace volume with Lactated Ringers IV ml for ml.

Procedure:
1. Measure NG Drainage and mark cannister

2. Calculate how many ml of fluid loss need to be replaced with the ordered IV infusion
3. Fill Soluset with appropriate volume of IV fluid

(so if measured NG drainage was 120 ml, you will administer 120 ml of Lactated Ringers IV over the next 4 hours)

4. Put timing strip on Soluset

(an RN judgment is how rapidly to administer the fluid; over 1 hour or up to 4 hours).

5. Set correct rate