Patient Care
J OB A ID
Developed by: CNS Med/Surg
Formulated: August 2006
Materials:
Revised:
Approved by CPC 2/12
Task/Process:
Ref Policy #
Reviewed: 2/12
VIII-A-25 Page 1 of 3
Nasogastric tube - Water-soluble lubricant - Suction equipment if ordered - Stethoscope
Personal protective equipment - Glass of water with straw or ice - Tincture of benzoin
Normal saline Irrigating syringe (60-ml catheter-tip) - Suction tube attachment device or tape -
Emesis basin - Towel or linen saver - Tongue blade - Penlight
NOTE: Purposes of NGT insertion:
1. Remove fluids and gas from stomach (decompression).
2. Prevent or relieve nausea and vomiting after surgery or traumatic events by decompressing stomach.
3. Irrigate the stomach (lavage) for active bleeding or poisoning.
4. Treat mechanical obstruction.
5. Administer medications and feeding (gavage) directly into the GI tract.
6. Obtain a specimen of gastric contents for laboratory studies.
WARNING: Ask the patient if he/she has ever had nasal surgery, trauma, a deviated septum, or bleeding disorder. NGTs may be contraindicated in patients with nasopharyngeal or esophageal obstruction, severe uncontrolled coagulopathy, or severe maxillofacial trauma.
Implementation FOR ALL PATIENT CARE PROCEDURES, BE SURE TO DO THE FOLLOWING:
Verify or secure order, verify informed consent, introduce yourself and identify the patient per policy, explain procedure, wash hands and use appropriate PPE as required for procedure.
Prior to NGT Insertion NOTE: Explain how mouth breathing and swallowing will help in passing the tube.
Procedure
1. Provide privacy
2. Assemble equipment
3. Determine with patient what sign he/she might use, such as raising the index finger, to indicate “wait a few moments” because of gagging or discomfort.
1. Position patient in a sitting or highFowler’s position; place towel across chest.
2. Remove dentures; place emesis basin and tissues within th e patient’s reach.
3. Inspect the tube for defects; look for partially closed holes or rough edges.
4. Determine length of tube to be inserted by placing the tip on the patient’s nose, extending the tube to the earlobe and then extending to the xyphoid process.
Mark length with tape or permanent marker.
Obtaining the NEX
(nose, earlobe, xiphoid) measurement:
5. Have patient blow nose to clear nostrils.
6. Inspect the nostrils with a penlight, observing for any obstruction.
NOTE: Occlude each nostril, and have the patient breathe. This will help determine which nostril is more patent .
7. Coil the first 7-10cm (3-4 inches) of the tube around your fingers.
8. Lubricate the coiled portion of the tube with water-soluble lubricant.
9. Tilt back the patient’s head and gently pass the tube into the posterior nasophargynx, directing downward and backward toward the ear.
10. When tube reaches the pharynx, the patient may gag; allow patient to rest for a few moments.
11. Have patient tilt head slightly forward. Offer several sips of water through a straw, or permit patient to suck on ice chips. Advance tube as patient swallows.

WARNING
Documentation
12. Gently rotate the tube 180 degrees to redirect the curve.
13. Continue to advance tube gently each time the patient swallows until the tape mark reaches the patient’s nostril.
ALERT: Coughing and choking are normal responses for some patients; however, choking and coughing plus cyanosis or inability to speak indicate respiratory distress and that the tube may be in the airway. Remove immediately and allow the patient a few moments of rest and try again.
14. To check whether the tube is in the stomach: a. Ask the patient to talk b. Use the tongue blade and penlight to examine the patient’s mouth— especially unconscious patient. c. Attach a syringe to the end of the NGT. Place a stethoscope over the left upper quadrant of the abdomen, and inject 10-20 cc of air while auscultating the abdomen. d. Aspirate contents of stomach with a 60-ml catheter tip syringe. Reinstill stomach contents and flush with water. e. X-rays may be done to confirm tube placement.
15. Apply tincture of benzoin to nose.
16. Anchor the tube with a suction tube attachment device or tape.
17. Plug end of tube, or connect tube to suction device or feeding administration set.
19. Wash hands after removing gloves
Never place the end of the tube in water while checking placement. If the tube is in the trachea, the patient could aspirate.
Record the time, type, and size of tube inserted. Document placement checks after each assessment, along with amount, color, consistency of drainage.
PATIENT EDUCATION Assure the patient that most discomfort he/she feels will lessen as he/she gets used to the tube.
Care of NGT
Nasogastric Tube
Removal
1.
Cleanse nares and provide mouth care every shift.
2.
Apply petrolatum to nostrils as needed, and assess for skin irritation or breakdown.
3.
Keep head of bed elevated at least 30 degrees.
4.
Confirm placement with auscultation of air bolus with each assessment and as needed, as well as aspiration of gastric contents.
5.
To irrigate, place towel underneath tube and disconnect tube from suction. Determine tube placement by auscultation and aspiration of secretions. Draw up 20 to 30 ml of normal saline, or prescribed fluid, and gently instill into NGT. Reconnect tube to suction, or reclamp if suction is not used. Document amount instilled on I&O record.
6.
If the tube is a Salem sump, it will require periodic placing of 10-20ml of air through the vent port (blue port or smaller lumen). Do not instill water into the vent, and, if the vent is draining fluid, instill air to clear it.
1.
Verify physician order.
2.
Place a towel across the patient’s chest, and inform him/her that the tube is to be withdrawn.
3.
Wash hands and don clean gloves.
4.
Turn off suction; disconnect and clamp tube.
5.
Remove the tape from the patient’s nose.
6.
Instruct the patient to take a deep breath and hold it.
7.
Slowly, but evenly, withdraw tubing and cover it with a towel as it emerges. (As the tube reaches the nasopharynx, you can pull it quickly.)
8.
Provide the patient with materials for oral care and lubricant for nasal dryness.
9.
Discard tube in red biohazard trash bag.

10.
Remove gloves and wash hands.
11.
Document time of tube removal and the patient’s reaction.
12.
Document type and size of tube and color, consistency, and amount of drainage in suction canister.
13.
Continue to monitor the patient for signs of GI difficulties.