Nasogastric or orogastric tube insertion
Verify the order.
Review the patient's medical record for contraindications.
Gather and prepare the equipment and supplies.
Perform hand hygiene.
Confirm the patient's identity.
Provide privacy.
Explain the procedure.
Ask whether the patient has a history of epistaxis or sinusitis. If so, ask whether one naris is more
susceptible.
Agree on a signal that the patient can use to stop the procedure.
Raise the bed to waist level.
Perform hand hygiene.
Assess the patient's GI status.
Unless contraindicated, position the patient with the head of bed elevated at least 30 degrees.
Perform hand hygiene.
Put on necessary personal protective equipment.
Assess the patient's nares to determine the best choice for nasogastric (NG) tube insertion.
Determine the insertion length of the tube.
Place a fluid-impermeable pad or towel over the patient's chest.
Administer an anesthetic agent, if ordered.
Lubricate the distal tip of the tube with water-soluble lubricant.
For NG tube insertion, grasp the tube with the distal end pointing down, curve it (if needed), and insert it
carefully into the more patent nostril. Instruct the patient to flex the head forward (if not contraindicated)
and tuck the chin. Guide the NG tube through the nose at an angle parallel to the floor of the nasal canal
and then down toward the distal pharynx. Unless contraindicated, after the tube reaches the oropharynx,
have the patient sip water through a straw as you slowly advance the tube.
For orogastric (OG) tube insertion, grasp the OG tube with the distal end pointing down, curve it (if needed),
and insert it carefully into the oral cavity. Guide the tube down toward the esophagus. Instruct the patient to
tuck the chin (if not contraindicated. If you meet resistance, rotate the tube to guide it toward the
esophagus. If resistance persists, stop the procedure and assess for barriers to tube advancement.
As you advance the tube, monitor for cues that may indicate that the tube entered the respiratory tract or
the tube is kinked or coiled in the oral cavity. Stop the procedure immediately and remove the tube if you
suspect respiratory intubation. Allow the patient to rest. Then resume the insertion procedure as indicated.
Continue to advance the tube to the predetermined length.
Use at least two bedside methods to confirm tube placement in the stomach.
Arrange for an X-ray, if ordered.
Secure the tube with a securement device, tape, or a transparent semipermeable dressing.
Mark the tube at the patient's naris or corner of the mouth with indelible marker. Measure the external tube
length or note the incremental marking on the tube where it exits the patient's nose or mouth. Document
the external tube length in the patient's medical record.
Trace the tubing. Then attach it to suction equipment, if ordered, and verify the designated suction pressure.
Route the tubing toward the patient's feet. If different access sites are used, label each tube at the distal and
proximal ends.
Provide oral care and do so regularly.
Remove and discard the fluid-impermeable pad or towel.
Unless contraindicated, keep the head of the bed elevated at least 30 degrees.
Return the bed to the lowest position.
Discard used supplies appropriately.
Remove and discard your personal protective equipment.
Perform hand hygiene.
Disinfect your stethoscope.
Perform hand hygiene.
Document the procedure.
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