PROCEDURE CHECKLIST
Chapter 26: Inserting Nasogastric and Nasoenteric Tubes
Check (9) Yes or No
PROCEDURE STEPS
Yes
1. Prepares the tube.
a. Plastic tube: Places in basin of warm water for 10
minutes.
b. Rubber tube: Places in basin of ice for 10 minutes.
c. Small-bore tube: Inserts stylet or guidewire and
secures into position according to agency policy. (Small
bore tubes may come with the guidewire in them.
Leaves the wire in place until tube is positioned and
placement checked on x-ray. Once wire is removed,
does not reinsert it.)
2. Assists patient into a high Fowler’s position.
Variations:
a. If the patient is comatose, places the patient into a
semi-Fowler’s position. Has a coworker help position
the patient’s head for insertion.
b. If the patient is confused and combative, asks a
coworker to assist with insertion.
3. Measures tube length correctly.
a. Nasogastric tube: Measures from the tip of the nose
to the earlobe, and from the earlobe to the xiphoid
process. Marks the length with tape or indelible ink on
the NG tube.
b. Nasoenteric tube: Adds 8–10 cm (3–4 inches) to NG
measurement and marks with tape.
4. Drapes a linen saver pad over the patient’s chest and
hands him an emesis basin.
5. Cuts a 4-inch (10 cm) piece of hypoallergenic tape.
6. Dons procedure gloves, if not done previously.
7. Lubricates the distal 4 inches (10 cm) of the tube with a
water-soluble lubricant.
8. If the patient is awake, alert, and able to swallow, hands
him a glass of water with a straw.
9a. Gently inserts the tip of the tube into the nostril. Has the
patient hyperextend his neck and advances the tube slowly,
aiming downward and toward the ear.
9b. If resistance is felt when the tube reaches the
nasopharynx, uses gentle pressure, but does not force the
tube to advance.
9c. Provides tissues if the patient’s eyes tear.
10. After the tube passes through the nasopharynx, has the
No
COMMENTS
Copyright © 2007, F. A. Davis Company, Wilkinson & Van Leuven/Procedure Checklists for Fundamentals of Nursing
patient flex his head toward the chest.
11. Rotates the tube 180°.
12. Directs patient to sip and swallow the water while
slowly advancing the tube.
13. Advances tube 2–4 inches (5–10 cm) with each
swallow until marked length is reached.
14a. If patient gags, stops advancing the tube and has
patient take deep breaths and drink a few sips of water.
14b. If gagging continues, uses a tongue blade and penlight
to check tube position in the back of the throat.
14c. If the tube is coiled in the back of the throat, the
patient coughs excessively during insertion, the tube does
not advance with each swallow, or the patient develops
respiratory distress, withdraws the tube and allow the
patient to rest before reinserting.
14d. Variation: To Advance the Tube Into the
Duodenum:
After the tube is in the stomach, positions patient on his
right side; advances the tube 5 to 7.5 cm (2 to 3 inches)
hourly, over several hours (up to 24 hours) until
radiography confirms placement.
15. When tube is in place, secures it temporarily with one
piece of tape so it does not move while confirming
placement.
16. Verifies tube placement at the bedside by:
a. Aspirating stomach contents and measuring pH.
b. Confirms “a” by injecting air into the NG tube and
auscultating, or asking patient to speak. (See Technique
28-4 in Volume 2.)
17. After confirming placement, secures tube with tape
or a tube fixation device.
Tape:
a. Applies skin adhesive to patient’s nose and allows it
to dry.
b. Removes gloves and tears one end of the
hypoallergenic tape lengthwise for 2 inches (5cm)
c. Applies the intact end of the tape to the patient’s nose.
d. Wraps the 2-inch (5 cm) strips around the tube where
it exits the nose.
e. Alternatively, uses 1-inch tape; applies one end to
patient’s nose, wraps the middle around the tube, and
secures the other end to the opposite side of the nose.
Alternative: Uses Fixation device: Places the wide end of
the pad over the bridge of the nose; positions the connector
around the tube where it exits the nose.
18. Ties a slipknot around the tube with a rubber band.
Copyright © 2007, F. A. Davis Company, Wilkinson & Van Leuven/Procedure Checklists for Fundamentals of Nursing
Secures the rubber band (or tape) to the patient’s gown
with a safety pin.
Recommendation: Pass ______ Needs more practice ______
Student:
Date:
Instructor:
Date:
Copyright © 2007, F. A. Davis Company, Wilkinson & Van Leuven/Procedure Checklists for Fundamentals of Nursing