Policies And Procedures For the Insertion
and Management of Fine Bore Naso-gastric
(N/G) Tubes in Adults
Co-ordinator Dorothy Barber
Nutrition Nurse Specialist
Reviewer:
Approver: Dr A McKinlay
Consultant Gastro-enterologist
Signature
Signature
Signature
Identifier
Review Date:
Date
UNCONTROLLED WHEN PRINTED
VERSION 1
Title:
Policies and Procedures for the Insertion and Management of
Fine Bore Naso-Gastric (N/G) Feeding Tubes in Adults
Policy Ref:
Across NHS
Boards
Organisation
Wide
Directorate
Clinical Service
Sub
Department
Area
Yes
This controlled document shall not be copied in part or whole without the express
permission of the author or the author’s representative.
Review date:
July 2007
Author:
Dorothy Barber Nutrition Nurse Specialist (Adults)
Policy application:
NHS Grampian
Purpose:
To give all staff guidance on the management and care of fine
bore N/G tubes
Responsibilities for implementation:
Organisational:
Clinical group:
Corporate:
Departmental:
Area:
Review:
This policy will be reviewed every 2 years
Approved by:
Date:
Signature:
Designation:
2
Introduction
Nasogastric (n/g) feeding is the most suitable route for patients requiring short term
feeding, (up to 4weeks) or for patients awaiting procedures to provide longer term
access e.g. gastrostomy tube.
The nasogastric route is used for the provision of nutrients directly into the
stomach. It is many years since the advantages of fine bore tubes (12fg) was
first recognised (Macatear et al 1999). Bastow (1986) stated that problems such
as nasopharyngeal discomfort, oesophagitis, ulceration, gastric erosions,
excessive gagging and sinusitis were caused by the rigidity of the larger bore
PVC tubes. Taylor (1988) described the benefits of the fine bore tubes having
the advantage of flexibility, nasal comfort and allowing normal swallowing where
appropriate. They also reduce the lower oesophageal incompetence and
subsequent increased risk of reflux and aspiration which may occur with large
bore tubes.
There are a variety of materials used for fine bore tubes, PVC, polyurethane and
silicone. PVC is a harder material which is not tissue compatible and therefore
has a lifespan of approximately 10 days. It is useful as a cheap short-term tube
where the patient is either on bolus feeding and removing the tube between
feeds or the patient is anxious or confused and accidentally removing the tube
regularly. Silicone is the most expensive material and rarely used because of
this. It has a lifespan of many months. Polyurethane is the most commonly used
material in n/g tubes, as it is tissue compatible with a thin wall allowing maximum
internal diameter. Manufacturers will give guidelines on how long these tubes
can remain insitu.
The use of fine bore n/g tubes for enteral nutrition and hydration is becoming
more common. It is vital that they are passed safely into the stomach and
that there position is confirmed on initial placement and on subsequent
use. Poorly positioned tubes leave vulnerable patients open to the risks of
regurgitation and aspiration. Colagiovanni (1999) noted that it was the
nurse’s responsibility to verify correct placement prior to any use of the n/g
tube. See appendices 1 & 2
Bockus (1991) found that the smaller the syringe the greater the pressure
created therefore it is recommended that a 20ml syringe should be the smallest
used to prevent tube rupture. A 50ml syringe is preferred.
3
Documentation
It is important that the following information is documented for the patient receiving
enteral nutrition via the n/g tube route to allow member of the team caring for the
patient to give optimum care.
1. Consent
2. Type of tube
3. How tube position confirmed
4. When due changed
It is important that the fact the patient is on n/g nutrition support is also
documented on the medicine kardex. Naysmith (1998) reported potential
problems with inappropriate drug administration where it had not been
highlighted that the n/g route was being used.
4
General Directions
Pre Procedure
The following are a set of general instructions to be observed prior to commencing
any procedure.
Procedure
Rationale
1. Wash and dry hands.
1. To minimise the risk of cross
infection.
2. Clean trolley/tray/flat surface as
per NHS Grampian Cleaning,
Disinfection and Sterilisation
Policy.
2. To minimise the risk of infection
3. Prepare and assemble all
3. Procedure can be completed
equipment required for procedure.
without interruption.
4. Reassure and explain the
procedure to the patient/relative in
terms that can be understood and
gain verbal consent.
4. To have a patient/relative who is
knowledgeable of the procedure
and a healthcare worker who has
been given the authority to
proceed.
5. Ensure privacy during the
procedure, do not expose the
patient unnecessarily and avoid
draughts.
5. To avoid unnecessary
embarrassment to the patient and
minimise airborne contamination.
6. Provide adequate lighting.
6. To enable clear observation.
7. Wear clean disposable white
apron.
7. To lessen the possibility of
uniform contamination.
5
Post Procedure
The following are a set of general instructions to be observed when a procedure
has been completed.
Procedure
Rationale
1. W ash and dry hands.
1. To minimise the risk of cross
infection.
2. Leave the patient comfortable and
the area clean and tidy.
2. To ensure patients comfort.
3. Clean equipment according to
NHS Grampian Cleaning,
Disinfection and Sterilisation
Policy.
3. To minimise the risk of cross
infection.
4. Return all opened Sterile Services
Department (SSD) items for
reprocessing, protecting sharp
instruments.
4. For cleaning and reprocessing.
5. Dispose of clinical waste as per
NHS Grampian Waste Disposal
Policy.
5. To comply with the Environmental
Protection Act and Duty Of Care
Legislation.
6. Document the procedure in the
appropriate records.
6. Accurate records of the patients
care journey are available.
6
Passing a Fine Bore Naso-Gastric (N/G) Tube
Definition
The passage of a tube into the stomach via the naso-pharynx.
Indications
1.
To facilitate a naso-gastric feeding regime.
2.
To administer medications
Relative Contra-indications
1.
Oesophageal / Pharyngeal Stricture
2.
Oesophageal Varices
3.
Paralytic Ileus
4.
Non functioning G.I. Tract
Note:
1.
PVC tube used for up to 10 days
2.
Polyurethane tube used for up to 28 days.
Requirements
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Naso-gastric tube - adult 6 FG - 9 FG
Syringe 50ml (catheter tip or luer slip to fit end of tube)
Disposable cup 3/4 full with tap water – to lubricate n/g tube
Cotton buds/tissues
Universal pH indicator paper/strips
Disposable gloves - non-sterile
Adhesive tape
Denture bowl - where required
Disposable paper sheet
Glass of iced water if not contraindicated
Note - The unconscious or dense hemiplegic patient should be placed flat in
bed with one pillow under the head. Positioning the patient’s chin towards
the knees will ease the passage of the tube.
Procedure
Rationale
1. Follow Pre Procedure General
Directions.
1. See Pre Procedure General Directions.
7
2. Request/assist the patient to sit in a
semi-upright position in the bed or chair.
Support the patient’s head with a pillow.
2. To allow for easier passage of the tube.
This position enables easy swallowing
and ensures that the epiglottis is not
obstructing the oesophagus.
3. Clean patient’s nostrils, if required.
4. Request patient to/or remove their
dentures (if appropriate) and place in
denture bowl.
5. Wash and dry hands
5. To minimise the risk of cross infection.
6. Protect patient’s clothing with a
disposable paper sheet.
7. Put on gloves
7. To protect nurse’s hands.
8. Holding the n/g tube estimate the
distance from the patient’s ear lobe to
the bridge of the nose and then to the
lower end of the xiphisternum, without
making contact with the skin or patient’s
clothing.
8. To provide an indication of the length of
tube required to reach the patient’s
stomach.
9. Follow manufacturer’s instructions
regarding visual checks and
recommendations re the guide wire.
9. To ensure safe effective use of the
equipment.
10. Dip the tube in water.
10. To activate the external lubricant thus
reducing friction between the mucous
membrane and the tube.
11. Gently insert the tube through the nostril 11. To facilitate passage of the tube by
and slowly advance it along the nasal
following the natural anatomy of the
passage. If an obstruction is felt,
nose.
withdraw slightly then advance the tube
again at a slightly different angle. Gentle
rotation of the tube can be helpful.
12. (a) As the tube is passed through the
nasopharynx request the patient to
bend the head forward.
(b) Request the patient to swallow as
the tube is advanced. Sips of iced
water may be offered to facilitate this
unless contra-indicated.
8
12. (a) To facilitate closure of the epiglottis
enabling the tube to pass into the
oesophagus.
13. Continue to advance the tube until the
length required has been passed. If an
obstruction is felt do not force, withdraw
the tube slightly and attempt to reinsert
or withdraw completely and repass.
14. Confirm tube is in the stomach by
withdrawing gastric content and
checking on pH indicator paper/strips.
See separate procedure.
15. (a) Fill a syringe with 10ml of tap water
and slowly flush the tube.
(b) Gently remove the guide wire from
the tube and discard.
15. (a)To facilitate the easy removal of the
guide wire from the tube.
16. Secure the tube to the cheek/nostril
using adhesive tape.
16. To maintain the tube in position.
17. Clean dentures if removed. Either
replace or leave in bowl with clean
water.
18. Follow Post Procedure General
Directions.
18. See Post Procedure General Directions.
19. Document
Note
Advice and support may be obtained from the Nutrition Nurse Specialist Ext.
52946 Bleep 2589
9
Confirmation of Position of a Fine Bore Naso-Gastric (N/G) Tube
The position of a fine bore n/g tube should always be checked:1.
After initial placement.
2.
Before commencing feed.
3.
Prior to administration of medicines if feed not in progress
4.
After vomiting, excessive coughing, prolonged hiccoughing or oropharyngeal suction.
5.
After a procedure involving movement of the patient eg physiotherapy
It is recognised that obtaining aspirate from fine bore tubes can be difficult
however Methany (1993) reported a 93% success rate using the correct syringe
size, insufflating before aspirating, changing position and patience.
Auscultation must not be used as a means of checking tube position see
appendix 1.
The method of confirming position should always be documented with the
pH obtained where appropriate.
Requirements
1.
2.
3.
4.
Clean tray
Syringe
Universal pH indicator paper/strips
Disposable gloves – non-sterile
Procedure
Rationale
1. Follow Pre Procedure General
Directions.
1. See Pre Procedure General
Directions.
2. Wash hands and put on gloves.
2. To minimise the risk of cross
infection.
3. Attach new clean syringe to n/g tube
and withdraw plunger to obtain
gastric content. Detach syringe from
n/g tube. If no aspirate obtained
insufflate 5 – 10ml air through the
tube and then gently withdraw
plunger. See flow chart
4. Put small amount of aspirate onto
pH indicator paper/strip.
10
5. Compare indicator paper to colour
code.
6. Check pH acceptable to commence
use of tube. See flow chart.
7. If unable to confirm position by
aspirate then a x-ray will be
necessary.
11
Confirmation of Position Flow Chart
Attach 50ml syringe to n/g tube and gently withdraw plunger to obtain gastric
aspirate.
Aspirate obtained
No
Yes
Insufflate 5–10ml air into the n/g tube
then gently withdraw plunger.
Aspirate obtained reads
pH 1-4 Commence
feeding.
or
Change the patient’s position
preferably onto their left side
and attempt to aspirate.
or
pH >4 consider recent food or
drink ingestion which may
alter gastric acidity. Recheck
aspirate in 30-60 minutes.
Insert the n/g tube a
further 3-5cm and
attempt to aspirate.
or
or
Aspirate obtained reads pH
>4-6 tip may be misplaced;
therefore withdraw 3-5cm,
re-aspirate and if pH reads
1-4 commence feeding.
Leave the patient and
attempt to aspirate 30 mins
later. Ensure documented
not to use tube in interim.
or
or
Aspirate obtained reads pH4-5.
Check
patient’s
medicine
kardex.
Some
medications
elevate the gastric pH. If these
medications have been given
then check with medical staff
before commencing feeding
Consider chest x
ray to ascertain
position
It is important to consider the associated risks to the patient and seek further
advice when the pH is not within the normal gastric range. A chest x-ray may be
appropriate.
If aspirate is not obtained, then a chest x-ray is required, but it is important to
consider the patient and their requirements as a x-ray should rarely be necessary
outwith daytime hours.
12
Administration Of A Naso-Gastric (N/G) Feed - Bolus Feed
A fine bore tube should be used as a large bore tube is primarily for
aspiration or gastric lavage.
Definition
Enteral feeding via naso-gastric route.
Indications
1.
Patients whose oral intake is inadequate to meet their nutritional
requirements, e.g. following surgery or the presence of swallowing
difficulties.
2.
Patients who require additional amounts of energy and protein.
Contra-indications
1.
Paralytic ileus.
2.
Non functioning G.I. Tract
Requirements
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Tube Feed Prescription Sheet
Prescribed feed
Syringe – 50ml catheter tip or luer slip to fit end oft tube
Disposable gloves - non-sterile
Universal pH indicator paper/strips
Glass of drinking water – for flushing tube
Bolus Adaptor – if required
Clean measuring jug - from kitchen - if required
Spigot / deadender - if required
Disposable paper sheet
Fluid Balance Chart
Procedure
Rationale
1. Follow Pre Procedure General
Directions.
1. See Pre Procedure General Directions.
2. Protect patient's clothing with a
disposable paper sheet.
13
3. Wash hands and put on gloves.
3. To minimise the risk of cross infection.
4. Check tube is in correct position see
separate procedure.
5. Attach bolus adaptor to feed container
of prescribed feed
Or
Open feed container of prescribed feed
and pour prescribed amount of feed into
measuring jug.
6. (a)Remove plunger from syringe.
(b)Connect the 50ml syringe
to the n/g tube.
8. Fill syringe with prescribed feed and
allow to flow by gravity.
9. Refill syringe until prescribed amount
has been given. Always refill the syringe
before it empties.
9. To reduce the amount of air entering the
stomach.
10. On completion tube should be flushed
with at least 20mls of tap water.
10. To maintain a patent n/g tube.
11. (a)Reinsert tube bung.
(b) Insert new spigot/deadender.
12. Record the time, volume of feed and
water on patient's Fluid Balance Chart.
12. To maintain an accurate fluid and
nutritional intake record.
13. (a) If used wash the jug thoroughly in
hot soapy water. Rinse, dry and store
inverted on a clean surface.
(b) Dispose of used syringe.
13. To minimise the risk of bacterial
contamination.
14. Follow Post Procedure General
Directions.
14. See Post Procedure General Directions.
14
Other Points









Check the patient for the following at least 2 hourly and report if present
immediately to senior nursing staff.
 altered respiratory pattern or distress
 change of skin colour
Check for feed intolerance by:
 asking the patient
or
 Observe for general discomfort, vomiting or altered bowel habit.
If there is any movement of the tube i.e. tape loose or tube position altered
accidentally. Recheck tube position as per procedure.
Once in every 24 hours adhesive tape on the cheek/nostril MUST be checked
 If tube secured to nostril change tape daily
 If tube secured to cheek change tape as required.
Advice and support may be obtained from the Nutrition Nurse Specialist.
Dietitian will assist with the management of tube feeding regime.
Patient may require assistance with mouth and nasal care.
To prevent nasal erosion it is recommended that the tube is passed into
alternate nostrils when being replaced.
When the patient is to be discharged from hospital on naso-gastric feeding, an
education program for patient/relative should be instigated as soon as possible
before discharge.
15
Administration Of A Continuous Naso-Gastric (N/G) Feed - Via
Enteral Feeding Pump
A fine bore tube should be used as a large bore tube is primarily for
aspiration or gastric lavage.
Definition
Continuous enteral feeding via the n/g route using an enteral feeding pump
Indications
1.
Patients whose oral intake is inadequate to meet their nutritional
requirements, e.g. following surgery or the presence of swallowing
difficulties.
2.
Patients who require additional amounts of energy and protein.
Contra-Indications
1.
Paralytic ileus.
2.
Non functioning G.I. Tract
Requirements
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Tube Feed Prescription Sheet
Prescribed feed
Feed container with intregal administration set - if required or
Administration set appropriate to feed container
Syringe 50ml – catheter tip or luer slip to fit end of tube
Disposable gloves - non-sterile
Universal pH indicator paper/strips
Glass of drinking water for flushing tube
Infusion stand
Enteral feeding pump
Disposable paper sheet
Fluid Balance Chart
Bottle opener - if required
Note - Prior to commencing feeding
Feeds are either bought from manufacturers or locally prepared. Manufacturers'
feeds are prepared under aseptic conditions and can remain in use for 24 hours,
but if decanted into a feed container they may only hang for 12 hours.
16
Locally made feeds are prepared under clean conditions. These feeds need to be
decanted into a feed container for administration. The hang time should not
exceed 4 hours therefore staff should estimate the volume of feed necessary to
comply with this. All locally prepared and partially used feeds must be stored in
the refrigerator and discarded if not used within 24 hours.
Procedure
Rationale
1. Follow Pre Procedure General
Directions.
1. See Pre Procedure General Directions.
2. Protect patient’s clothing with a
disposable paper sheet.
3. Wash hands and put on gloves.
3. To minimise the risk of cross infection.
4. Check tube in correct position –see
separate procedure.
5. Ensure roller clamp on administration
set is closed.
6. (a) Attach administration set to feed
container or
(b) Fill feed container with prescribed
amount of feed and connect
administration set if necessary.
7. Suspend feed on infusion stand. Place
drip chamber into enteral feeding pump.
8. Release the roller clamp and run the
feed through the tubing. Close roller
clamp.
8. To expel air from the system.
9. Thread the tubing round the pump
mechanism.
10. Attach administration set to end of tube.
Open roller clamp.
11. Switch on pump and set the enteral
feeding pump to the prescribed rate.
12. Follow Post Procedure General
Directions.
12. See Post Procedure General Directions.
17
13. Check the flow rate hourly.
13. To ensure that the prescribed rate is
being maintained.
14. Tube should be flushed with tap water
whenever feeding is interrupted. The
amount will depend on whether the
patient is an adult, child or on a fluid
restriction.
14. To maintain a patent n/g tube.
15. Record the time, volume of feed and
water on patient’s fluid Balance Chart.
15. To maintain an accurate fluid and
nutritional intake record.
Other Points












Check the patient for the following at least 2 hourly and report, if present,
immediately to senior nursing staff - altered respiratory pattern or distress
 change of skin colour
Check for feed tolerance by:
 asking the patient
or
 observe for general discomfort, vomiting or altered bowel habit.
If there is any movement of the tube, i.e. tape loose or tube position altered
accidentally stop feed and recheck tube position as per procedure.
Reservoir and/or administration set must be changed every 24 hours.
Once in every 24 hours adhesive tape on the cheek/nostril MUST be checked –
 If tube secured to nostril change tape daily
 If tube secured to cheek change tape as required
Advice and support may be obtained for the Nutrition Nurse Specialist.
Dietitian will assist with the management of tube feeding regime.
Patient may require assistance with mouth and nasal care.
To prevent nasal erosion it is recommended that the tube is passed into
alternate nostrils.
Clean equipment according to manufacturer’s instructions.
When not in use the pump should be connected to the electricity supply.
When the patient is to be discharged from hospital on naso-gastric feeding, an
education program for patient/relative should be instigated as soon as possible
before discharge.
18
Removal of A Naso-Gastric Tube
Requirements
1.
Clean Tray
2.
Tissues
3.
Disposable gloves – non-sterile
4.
Disposable paper sheet
5.
Polythene bag
Procedure
Rationale
1. Follow Pre Procedure General
Directions.
1. See Post Procedure General
Directions.
2. Wash hands and put on gloves.
2. To minimise the risk of cross
infection.
3. Protect patient’s clothing with a
disposable paper sheet.
4. Remove tape securing tube.
5. Pinch tube and gently withdraw tube
into polythene bag.
5. To prevent spillage on removal
through oesophagus.
6. Give patient tissue to clean nasal
area/blow nose.
7. Document removal in nursing notes.
8. Follow Post Procedure General
Directions.
8. See Post Procedure General
Directions.
19
Continuing care
To ensure fine bore tube remains in position safely and causes no distress
to patient.
Nursing Procedure
Nasal Hygiene
Oral Hygiene
Rationale
To allow nostrils to remain
unblocked.
Method
Gently clean area. Encourage
patient to blow nose if
necessary.
To prevent pressure
sore.
Change position of tube exit
site ensuring tape not pulling
tube too tightly.
Patient often mouth breaths with
n/g tube insitu, mouth can quickly
become dry.
Regular oral hygiene with
mouth washes.
If patient on nil by mouth then
saliva may not be produced as
normal.
Encourage patient to brush
teeth and gums regularly.
Facial Cleansing
Area around tube often
neglected for fear of disturbing
tube.
Excess oils can be secreted
making it difficult to secure tape.
Daily removal of tape and
normal face washing,
avoiding moisturiser where
tape to be applied.
Shaving as normal for men.
Changing tape
Tape can lose its adherence
qualities.
Skin condition below tape should
be checked.
Carefully remove all old tape
before applying new.
Flushing for maintenance
To ensure that tube remains
patent.
Tube should be flushed
before and after use.
20
Complications
If complications occur with the tube then they should be dealt with promptly
and appropriately.
Complication
Possible reason
Failure to pass
n/g tube.
Poor patient
compliance.
Tips to avoid
recurrence
Good patient relations
and informed choices
given to encourage
compliance.
Treatment
Allow patient time to
recover and discuss
with them the
benefits of n/g
nutrition.
Ask a colleague to help.
Poor technique.
Ask a colleague for
support or the
Nutrition Nurse
Specialist.
Oesophageal
stricture.
Malposition.
Failure of tube to
advance over larynx
and down
oesophagus.
Remove tube and
change position of
patient.
Ask a colleague for
support.
Ask Nutrition Nurse
Specialist.
X ray guidance.
Nasal pressure
sores.
Tube too tight
against nostril.
No tape on nostril.
Change tape position
daily.
May require tube
change to other
nostril.
Intolerance.
Confusional state.
Poor procedure
explanation or short
term memory loss.
Good explanation and
regular re-enforcement
of benefits.
Re passing of tube
and multidisciplinary
discussions as may
require gastrostomy
or be inappropriate
for continuing
nutritional support.
21
References
Bastow, MD. (1986) Complications of enteral nutrition. Gut,27,S1,51-55. print
only
Bockus S. (1991) Trouble shooting your tube feedings. American Journal of
Nursing May 49(5):24-28 print only
Colagiovanni L. (1999) Taking the tube. Nursing Times, Vol95,No21,
Supplement. print only
McAtear CA. (1999) Current perspectives on enteral nutrition in adults. A BAPEN
working party report. ISBN; 1 899 467 300. print only
Methany N et al (1993) Effectiveness of pH measurements for predicting feeding
tube placement: an update. Nursing Research, 42:6, 324-331. print only
Naysmith MR. Nicholson J. (1998) Nasogastric drug administration. Professional
Nurse, 13(7). 424-427. print only
Taylor SJ. (1988) A guide to N/G feeding equipment. Professional Nurse, 4,2
pp91-94. print only
22
Appendix 1
Fatal Accident Inquiry
‘An inquiry in Arbroath considered the death of an elderly patient from the erroneous insertion of a
nasogastric feeding tube into the patient’s lung, There was discussion as to acceptable methods
for checking the positioning of nasogastric tubes. The test, which was used in this case, was the
‘air test’- listening for air sounds using a stethoscope once the tube has been fed. Evidence was
heard from nursing experts. There was a divergence of opinion about the most reliable method of
testing but there was concurrence about the unreliability of the ‘air test’ (1).
Auscultation of air into stomach
Determining position of nasogastric (NG) feeding tubes by auscultation of air into the stomach is
an unreliable method of checking NG tube position. Studies have confirmed that experienced
health professionals are not able to reliably predict correct tube placement. Vigorous peristalsis
can be mistaken for air entering the stomach and there has been documented evidence of air
being heard as it is injected into the lungs (2). Therefore the most reliable method of checking the
position of the NG feeding tube is with the use of radiography, this may be indicated in high risk
patients with altered consciousness, or those receiving ventilatory support.
However, routine checking by radiography is often avoided because of the following factors:

The risk to the patient of frequent exposure to X-Rays

The potential delay in administration of nutritional support

Cost and resource implications

The use of radiology can only confirm the position of the tube when the X-ray is taken
(3,4)
Therefore the most reliable bedside method available to confirm NG feeding tube placement is
aspiration of gastric acid and the use of pH paper or litmus paper (3,4).
LUHT ADVOCATE THAT THE USE OF THE AUSCULATORY METHOD OF
TESTING NG FEEDING TUBE PLACEMENT SHOULD NOT BE USED.
References:
1
Fatal Accident Inquiry into the death of Mrs Michie, Arbroath Sheriff Court
2
Metheny N et al (1990) Effectiveness of the ausculatory method in
predicting feeding tube location Nursing Research 39 (5) 262-267
3
Tait J (2001) Going nasogastric – current thinking in nasogastric tube techniques
Complete Nutrition 1 (2) 27-29
4
20.8.02
Colagiovanni L (1999) Taking the tube Nursing Times Supplement 95 (21) 63-66
Director of Nursing
23
Appendix 2
24
25