Checklist: Inserting Nasogastric (NG) TUBE

1 Hand hygiene / Gather equipment

Introduce self and explain procedure, Explain that the client will need to swallow
2 and ask the client raise his hand if he is distress.
3 HOB 45 degree or higher
-clean nose with alcohol and let dry
-examine nostrils and select the most patent nostril (the one the client can
4 breathe out of easily)
-check chart to see if the client has had previous nasal surgery
5 Prepare tape and the put on clean gloves
Measure NG tube from tip of client`s nose to earlobe to ziphoid process and mark
6 with small piece of tape or marker
-Place towel and emesis basin over the client`s chest
7 -give tissue to the client
-coil end of tube over fingers to soften the tube
8 Lubricate the tube 10 cm
-Extend the client`s head back
-carefully insert the tube. Aim tube toward the ear on the same side and
9 downward. Rotate to help the tube pass the bridge of the nose. Do not force the
tube
-when pas the nasopharynx, have the client flex head forward ( chin touching
chest)
10 -Have the client take sips of water from a straw and ask the client to swallow
-continue advancing the tube when the client swallows, until your reach the mark
made with the tape or markers
-When reaching the place marked by tape or marker, tape the tube to the client`s
nose on one side.
11 -Hold on to the tube with one hand at all times, until the tube is taped at least
on one side
-check the placement to ensure it is in the stomach by 4 methods:-
1th ──── Using the tongue depressor and light, look in the client`s mouth to make
12 sure it is not coiled there. Ask if the patient an talk. If the patient can talk the is
not in the airway
2nd ──── Auscultate bolus of air (30cc) with stethoscope over epigastric region (just
13 below ziphoid process)
14 3rd ────Aspirate contents and observe for color
4th ────Check the pH with test trips. If pH is 5 or less the NG is in stomach. If the
15 pH is 6-6.9 the NG is in the small bowel. If the pH is greater than 6.9 the NG tube
may also be in the lung
-Connect the tube to the drainage bag or to low intermittent suction
16 -Tape the tube securely to the nose
-Mark the tube again at the client`s nostril (this way you will know if the tube
17 moves)
-Fix the tube with a safety pin and rubber band to the client`s gown

18 REMOVE: check the chart—Assess bowel sounds to make sure they are positive
in all 4 quadrants
Explain the procedure to the client (explain that is it less uncomfortable than
19 insertion). HOB should be elevated 45 degree or greater
-Check placement of NG tube by auscultation and aspiration (check color only)
20 -Flush NG tube with sterile saline, 20 mls to clear tube of gastric content and
prevent aspiration
-Loosen tape, pinch tube at naris
21 -Have the client take a deep breath and HOLD IT while you withdraw the tube.
This will prevent aspiration
22 Coil the tube in your hand and remove the gloves over the tube and discard
Offer oral and nasal hygiene (give the client water, tissue and clean above his nose
23 with alcohol to remove tape)
24 Dispose of all things and wash hands with germX
Answer these questions
-If the client begins to cough, choke or vomit. What should you do?
25 - What should you document after placement?
- What should you document after removal?