Nasogastric Tube Insertion

By: Brunilda Illidge

Uses

Client that cant or wont eat

Clients that have increased energy needs

Clients requiring bowel rest

Burns, Trauma, CA, Sepsis

Pancreatitis

Upper GI bleed
Gastric content for study
Suspected bowel obstruction

Nasoduodenal
NGT
Nasojejunal

Benefits

Prevents aspirations
Administration of meds and nutrition
safely
Suction contents

Concerns

Aspiration
Nasal erosion
Esophagitis
Gastric ulcer

Equipment

NGT (8-12 Fr)

Levine single lumen

Salem Sump dual
lumen

60 ml syringe
Tape
Cup of water with straw
Emesis basin

Safety pin
Rubber band
Towel
Gloves
Suction equipment
Pen light
Tongue blade
Stethoscope

Procedure

Check PMD order

Understand patients need for NGT
Assess patient nares
Complete abdominal/ GI assessment/ ability to
swallow
Assess pt history

Nares, Med history

Assess for Gag reflux

Assess mental status

Procedure

Intro. Self, Identify pt.

Assess pt., Explain procedure
Discuss ways to communicate during
procedure
Position pt.
Don gloves
Assess NGT

Procedure

Determine length
Nares --- earlobe ---to xyphoid process
Mark with ink
Lubricate tube with water based lubrication
4 inches
Hand water to pt
Begin insertion aim back and down
towards ear
turn 180 degrees

Procedure

Have client flex head towards chest and

sip water

Advance tube with swallows

Instruct pt. To breath through mouth and
swallow

DO NOT FORCE TUBE

If Pt. Coughing, Choking, Cyanotic
STOP & PULL BACK

Advance to measured mark

Check placement

Ask pt. To talk

Check mouth with light and tongue blade
Secure tube
Check gastric contents/ Air auscultation
Chest/Abdomen X-ray

Documentation

Tube size and type

Time
Route (nare)
Residual
Specimen
Suction
Feeding
Patient response

Risks of Displacement

Due to

Vomiting
Suctioning
Severe coughing
Moving/transferring
THEREFORE, You MUST check placement
every single time of usage.

Removal

Check discharge order

High fowlers
Instruct to hold breath
Gently and smoothly remove
Good oral hygiene
Document

D: Pt. resting in semi fowlers position. No

gag reflex present. PMD ordered NGT for
nutrition and med. Administration.
A: Pt. teaching on NGT placement.
placement validated via air bolus.
R: Pt. tolerated procedure well. Pt. able to
speak clearly. Resp. even and unlabored.

Naso-gastric Tube Insertion

Skills Lab

PEG

PEG administration

Turn off continuous feeding

Check for gastric contents

Greater then 2X feeding HOLD meds and feeding

Return gastric contents via gravity

Flush via gravity 30cc luke warm water
Dissolve and administer one medication at a time
Flush with 15cc between meds.
Final flush of approximately 30 cc
Prevent introduction of air while administer fluid and
meds.
Turn on feeding
Maintain HOB 45 degrees

NGT Med. administration

Turn off continuous feeding

Check for placement via air bolus
Check for gastric contents

Greater then 2X feeding HOLD meds and feeding

Return gastric contents via gravity

Flush via gravity 30cc luke warm water
Dissolve and administer one medication at a time
Flush with 15cc between meds.
Final flush of approximately 30 cc
Prevent introduction of air while administer fluid and meds.
Turn on feeding
Maintain HOB 45 degrees

Prepare syringe with

30mL saline for
irrigation.

Gently instill
irrigation

Clamp suction tube

while disconnecting it
from NG tube.

Inject 10-20 cc of air

into tube.

Things to Remember

Do NOT

Mix medication with formula

Crush enteric coated, extended release,
capsules
Use oily medications
Use excessive force when administering
anything
Use cold water

DO:

Use liquid form of medication

Finely crush pills
Check NGT placement every single time
Keep HOB elevated
Follow 5 RIGHTS

If Patient Connected to Suction

Turn suction OFF

Follow previous steps.
Keep Suction OFF for at least ONE HOUR!!