{"id":3635,"date":"2015-06-18T15:19:06","date_gmt":"2015-06-18T15:19:06","guid":{"rendered":"http:\/\/opentextbc.ca\/clinicalskills\/?post_type=chapter&#038;p=3635"},"modified":"2021-05-26T21:12:42","modified_gmt":"2021-05-26T21:12:42","slug":"10-2-nasogastric-tubes","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/clinicalskills\/chapter\/10-2-nasogastric-tubes\/","title":{"raw":"10.3 Nasogastric Tubes","rendered":"10.3 Nasogastric Tubes"},"content":{"raw":"<h2>Using a Nasogastric Tube<\/h2>\r\nA <strong>nasogastric (NG) tube<\/strong> is a flexible plastic tube inserted through the nostrils, down the nasopharynx, and into the stomach or the upper portion of the small intestine. Placement of NG tubes is always confirmed with an X-ray prior to use (Perry, Potter, &amp; Ostendorf, 2014).\r\n\r\nNG tubes are used to:\r\n<ul>\r\n \t<li>Deliver nutrients to the patient\u00a0via\u00a0a feeding pump<\/li>\r\n \t<li>Remove gastric contents<\/li>\r\n<\/ul>\r\nAn NG tube used for feeding should be labelled. The tube is used to feed patients who may have swallowing difficulties or require additional nutritional supplements. These tubes are narrower and smaller bored than a Salem sump or Levine\u00a0tube.\r\n\r\nAn NG tube can also remove gastric content, either draining the stomach by gravity or by being connected to a suction pump. In these situations, the NG tube is used to prevent nausea, vomiting, or gastric distension, or to wash the stomach of\u00a0toxins.\r\n\r\nThe NG tube is fastened to the patient using a nose clip, and is taped and pinned to the patient\u2019s gown to prevent accidental removal of the tube and\u00a0to prevent the tube from slipping from the stomach area into the lungs.\r\n\r\nWhen working with people who have nasogastric tubes, remember the following care measures:\r\n<ul>\r\n \t<li>Maintain and promote comfort. The tube constantly irritates the nasal mucosa, causing a great deal of discomfort. Ensure that the tube is securely\u00a0anchored to the patient's\u00a0nose to prevent excess tube movement, and is pinned to the gown to avoid excessive pulling or dragging.<\/li>\r\n \t<li>Because one nostril is blocked, patients tend to mouth breathe. This causes dehydration of the nasal and oral mucosa, and patients will complain of thirst, but they are usually NPO (<em>nil per os<\/em> or nothing by mouth). Mouth care will help to relieve the dryness. This can include rinsing the mouth with cold water or mouthwash as long as the patient does\u00a0not swallow. Some patients\u00a0may be allowed to suck on ice chips.<\/li>\r\n \t<li>If the patient complains of abdominal pain, discomfort, or nausea, or begins to vomit, report it immediately. The drainage flow is probably obstructed and the tube will need to be irrigated.<\/li>\r\n \t<li>These patients\u00a0should <em>never <\/em>be allowed to lie completely flat. Lying flat increases the patient's risk of aspirating stomach contents. Patients with an NG tube are at risk for aspiration. The head of bed should always be raised 30 degrees or higher.<\/li>\r\n<\/ul>\r\nChecklist 78 outlines the steps for inserting a nasogastric tube.\r\n<table style=\"border-color: #000000; height: 4175px;\" border=\"1px solid rgb(0, 0, 0)\" width=\"100%\"><caption><a id=\"checklist78\"><\/a>Checklist 78: Inserting a Nasogastric tube<\/caption>\r\n<tbody>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 75px; text-align: center;\" colspan=\"4\">\r\n<h5 style=\"text-align: center;\"><span style=\"color: #000000;\">Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 75px;\" colspan=\"4\">\r\n<h5><span style=\"color: #333333;\">Safety considerations:\u00a0<\/span><\/h5>\r\n<ul>\r\n \t<li>Perform hand hygiene.<\/li>\r\n \t<li><span style=\"color: #333333;\">Check room for additional precautions.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Introduce yourself to patient.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Explain process to patient;\u00a0offer analgesia, bathroom, etc.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Listen and attend to patient cues.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Ensure patient's privacy and dignity.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Assess ABCCS\/suction\/oxygen\/safety.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Apply principles of asepsis and safety.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Check vital signs.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Complete necessary focused assessments.<\/span><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px; text-align: center;\" colspan=\"2\">\r\n<h4 style=\"text-align: center;\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px; text-align: center;\" colspan=\"2\">\r\n<h4 style=\"text-align: center;\">\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">1. Perform hand hygiene and gather supplies.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This\u00a0prevents the transmission of microorganisms.\r\n\r\n[caption id=\"attachment_5642\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1715.jpg\"><img class=\"wp-image-5642 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1715-150x150.jpg\" alt=\"Gather supplies \" width=\"150\" height=\"150\" \/><\/a> Gather supplies[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">2. Visually inspect condition of patient's nasal and oral cavities.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Check for\u00a0signs of infection or skin breakdown.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">3.\u00a0Assess for the best nostril before you begin.\r\n\r\nDo this by occluding one side and asking the patient to sniff.\u00a0Ask the patient about previous injuries or history of a deviated septum.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">If either nostril is equally suitable, select the nostril closest to the suction.\r\n\r\n[caption id=\"attachment_5627\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1687.jpg\"><img class=\"wp-image-5627 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1687-150x150.jpg\" alt=\"Assess for most patent nostril\" width=\"150\" height=\"150\" \/><\/a> Assess for most patent nostril[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">4. Palpate patient's abdomen for distension, pain, and\/or rigidity.\r\n\r\nAuscultate for bowel sounds.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Document assessment findings and determine appropriateness of NG tube insertion related to reason for insertion and patient's physical assessment.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">5. Assess patient's level of consciousness and understanding of procedure.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Patient must be able to follow instructions related to NG\u00a0insertion to allow for passage of tube through nasal and gastrointestinal tracts.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">6. Check doctor's orders for type of NG tube to be placed and reason for placement.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Check\u00a0appropriate orders relevant to patient safety.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">7. Check doctor's orders to determine whether the NG tube is to be attached to suction or a drainage bag.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This should be commensurate with the reason for the NG tube.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">8. Position patient sitting up at 45 to 90 degrees (unless contraindicated by the patient's condition), with a pillow under the head and shoulders.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This allows the NG tube to pass more easily through the nasopharynx and into the stomach.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">9. Raise bed to a comfortable working height.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This helps prevent biomechanical injury to the health care provider.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">10. Agree on a signal the patient can use if they wish you to pause during the procedure.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This procedure can be anxiety-provoking and uncomfortable for many patients. Providing a means for the patient to communicate discomfort and a desire to pause during the procedure helps alleviate anxiety.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">11. Place a towel on\u00a0the patient's chest and provide facial tissues and an emesis basin.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Nasal and oral secretions may be evident during the procedure.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">12. Provide patient with drinking water and a straw if the patient is not fluid restricted.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Sipping water through a straw helps to\u00a0initiate the swallowing reflex and facilitate passing of NG tube.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">13. Stand on patient's right side if you are right-handed and the left side if you are left-handed.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">You will use your dominant hand to insert the tube.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">14. Measure distance of the tube from\r\n<ul>\r\n \t<li>The tip of the nose, to...<\/li>\r\n \t<li>The earlobe, to...<\/li>\r\n \t<li>The xiphoid process<\/li>\r\n<\/ul>\r\nand then mark the tube at this point.\r\n\r\n&nbsp;<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This determines the appropriate length of NG tube to be inserted.\r\n\r\n[caption id=\"attachment_6404\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2210.jpg\"><img class=\"wp-image-6404 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2210-150x150.jpg\" alt=\"Measure from tip of nose to earlobe\" width=\"150\" height=\"150\" \/><\/a> Measure from tip of nose to earlobe[\/caption]\r\n\r\n[caption id=\"attachment_6405\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2211.jpg\"><img class=\"wp-image-6405 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2211-150x150.jpg\" alt=\"Measure from earlobe to xiphoid process\" width=\"150\" height=\"150\" \/><\/a> Measure from earlobe to xiphoid process[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">15. Lubricate NG tube tip according to your agency policy.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Tube may be lubricated internally using tap water or externally using water-soluble lubricating jelly. Agency policy varies and should be checked.\r\n\r\n[caption id=\"attachment_5633\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1697.jpg\"><img class=\"wp-image-5633 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1697-150x150.jpg\" alt=\"Lubricate tip of tube as per agency policy\" width=\"150\" height=\"150\" \/><\/a> Lubricate tip of tube as per agency policy[\/caption]\r\n\r\nNever use non-water-soluble lubricant (e.g., Vaseline), as it will not dissolve and may cause respiratory complications if it enters the lungs.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">16. Apply clean non-sterile\u00a0gloves.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Using gloves decreases the transfer of microorganisms.\r\n\r\n[caption id=\"attachment_5561\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1516.jpg\"><img class=\"wp-image-5561 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1516-150x150.jpg\" alt=\"Apply clean disposable gloves\" width=\"150\" height=\"150\" \/><\/a> Apply clean non-sterile\u00a0gloves[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">17. Curve 10 to 15 cm of the end of the NG tube around your gloved finger, and then release it.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Curling the NG tube around your finger helps it conform to the normal curve\u00a0of the nasopharynx.\r\n\r\n[caption id=\"attachment_6387\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2123.jpg\"><img class=\"wp-image-6387 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2123-150x150.jpg\" alt=\"Curl the NG tube around your finger to help it conform to the normal curve of the nasopharynx\" width=\"150\" height=\"150\" \/><\/a> Curl the NG tube around your finger[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">18. Have patient drop head forward\u00a0and breathe through the mouth.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Dropping the head forward closes the trachea and opens the esophagus, which\u00a0allows the NG tube to pass more easily through the nasopharynx and into the stomach.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">19. Insert NG tube tip slowly into\u00a0the patient's nostril and advance it steadily, in a downward direction, along the bottom of the nasal passage, with the curved end pointing downward\u00a0in the direction of the ear on the same side as the nostril.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This follows the natural anatomical alignment of the nasopharynx.\r\n\r\n[caption id=\"attachment_5634\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1700.jpg\"><img class=\"wp-image-5634 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1700-150x150.jpg\" alt=\"Insert nasogastric tube slowly into patient's nostril\" width=\"150\" height=\"150\" \/><\/a> Insert nasogastric tube slowly into patient's nostril[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">20. You may feel slight resistance as you advance along the nasal passage. Twist the tube slightly, apply downward pressure, and continue trying to advance the tube. If significant resistance is felt, remove the tube and allow the patient to rest before trying again in the other nostril.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">It is common for the patient to feel discomfort, and this may be expressed with light coughing and gagging. More aggressive coughing and gagging may indicate that the tube has entered the airways, in which case\u00a0you should withdraw the NG tube.\r\n\r\n[caption id=\"attachment_5635\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1702.jpg\"><img class=\"wp-image-5635 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1702-150x150.jpg\" alt=\"Advance the tube gently\" width=\"150\" height=\"150\" \/><\/a> Advance the tube gently[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">21. If there is difficulty in passing the NG tube, you may ask the patient to sip water slowly through a straw unless oral\u00a0fluids are contraindicated. If oral fluids are not allowed, ask the patient to try dry swallowing while you advance the tube.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">If patient continues to gag or cough, check that the tube is not coiled\u00a0in the back of the mouth, using a tongue blade and a flashlight to check the back of the mouth. If tube is coiled, withdraw the tube until only the tip of the tube is seen in the back of the mouth. Then try advancing the tube again while patient tries to swallow.\r\n\r\n[caption id=\"attachment_5636\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1704.jpg\"><img class=\"wp-image-5636 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1704-150x150.jpg\" alt=\"Patient may sip water slowly through a straw\" width=\"150\" height=\"150\" \/><\/a> Patient may sip water slowly through a straw[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">22. Continue to advance NG tube until you reach the mark\/tape you had placed for measurement.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This ensures accurate placement.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">23. Temporarily anchor the tube to patient's cheek with a piece of tape until you can check for correct placement.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This prevents displacement of the NG tube while checking placement.\r\n\r\n[caption id=\"attachment_5617\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1668.jpg\"><img class=\"wp-image-5617 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1668-150x150.jpg\" alt=\"Anchor tube\" width=\"150\" height=\"150\" \/><\/a> Anchor tube[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">24. Verify tube placement according to agency policy.\r\n\r\nColour-coded pH paper is usually used,\u00a0as an initial and interim check, to confirm that acidic contents are present. Then an X-ray is taken to confirm placement prior to using NG tube for feeding.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">The contents aspirated from the tube should be acidic with a pH &lt;5. If the pH is more than 6, it\u00a0may indicate the presence of respiratory fluids or small bowel content, and the tube should be removed.\r\n\r\n[caption id=\"attachment_5640\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1711.jpg\"><img class=\"wp-image-5640 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1711-150x150.jpg\" alt=\"Verify tube placement using pH paper\" width=\"150\" height=\"150\" \/><\/a> Verify tube placement using pH paper[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">25. Once the tube placement has been confirmed, mark (with a permanent marker) and record the length of tubing extending from the nose to the outer end of the tube.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This aids in timely recognition and identification of tube displacement or migration.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">26. Secure the tube to the patient's gown with a safety pin, allowing enough tube length for comfortable head movement.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This keeps the NG tube in place.\r\n\r\n[caption id=\"attachment_5639\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1708.jpg\"><img class=\"wp-image-5639 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1708-150x150.jpg\" alt=\"Secure the tube to the patient's gown with a safety pin\" width=\"150\" height=\"150\" \/><\/a> Secure the tube to the patient's gown with a safety pin[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">27. Document the procedure according to\u00a0agency policy, and report any unexpected findings to the appropriate health care provider.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Timely and accurate documentation promotes patient safety.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"4\">Data source: ATI, 2015a; BCIT, 2015c; Berman &amp; Snyder, 2016<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h5>Special considerations with NG tubes:<\/h5>\r\n<ul>\r\n \t<li>Always assess correct placement of the NG tube prior to infusing any fluids or tube feeds as per agency policy. Check location of external markings on the tube and colour of the PH of fluid aspirated from the tube. Routine evaluation will ensure the correct placement of the tube and reduce the risk of aspiration. Do not instill air to test location of tube.<\/li>\r\n \t<li>Do not give the patient anything to eat or drink without knowing that the patient has passed a swallowing assessment.<\/li>\r\n \t<li>If changing the gown or repositioning the patient, take care not to pull on the NG tube. Remember to unpin the tube from the gown and repin the tube.<\/li>\r\n \t<li>If the NG tube falls out of the patient, it\u00a0is not an emergency. <em>But<\/em> be sure to\u00a0assess your patient. How are the ABCCS? Notify the RN in charge of the patient.<\/li>\r\n \t<li>A patient who appears to be in respiratory distress\u00a0should be considered an emergency, and emergency procedures should be followed. Respiratory distress may present as\u00a0coughing, choking, or reduced oxygen saturation.<\/li>\r\n<\/ul>\r\n<h3><a id=\"video10.1\"><\/a>Video 10.1<\/h3>\r\n<div class=\"textbox shaded\" style=\"text-align: center;\">Watch the video\u00a0<a href=\"https:\/\/barabus.tru.ca\/nursing\/nasogastric_tube_insertion.html\"><em>Nasogastric tube insertion<\/em><\/a> by\u00a0<a href=\"\/clinicalskills\/back-matter\/appendix-3\/\">Ren\u00e9e Anderson &amp; Wendy McKenzie<\/a>, Thompson Rivers University.<\/div>\r\n<h2>Removing an NG Tube<\/h2>\r\nAn NG tube should be removed if it is no longer required. The process of removal is usually very quick. Prior to removing an NG tube, verify physician orders. If the NG tube was ordered to remove gastric content, the physician's order may state to \"trial\" clamping the tube for a number of hours to see if the patient tolerates its removal. During the trial, the patient should not experience any nausea, vomiting, or abdominal distension.\r\n\r\nTo review how to remove an NG tube, refer to\u00a0Checklist 79.\r\n<table style=\"border-color: #000000; height: 1547px;\" border=\"1px solid rgb(0, 0, 0)\" width=\"100%\"><caption><a id=\"checklist79\"><\/a>Checklist 79: Removal of an NG Tube<\/caption>\r\n<tbody>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 75px; text-align: center;\" colspan=\"4\">\r\n<h5 style=\"text-align: center;\"><span style=\"color: #000000;\">Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 75px;\" colspan=\"4\">\r\n<h5><span style=\"color: #333333;\">Safety considerations:\u00a0<\/span><\/h5>\r\n<ul>\r\n \t<li>Perform hand hygiene.<\/li>\r\n \t<li><span style=\"color: #333333;\">Check room for additional precautions.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Introduce yourself to patient.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Explain process to patient;\u00a0offer analgesia, bathroom, etc.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Listen and attend to patient cues.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Ensure patient's privacy and dignity.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Assess ABCCS\/suction\/oxygen\/safety.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Apply principles of asepsis and safety.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Check vital signs.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Complete necessary focused assessments.<\/span><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px; text-align: center;\" colspan=\"2\">\r\n<h4 style=\"text-align: center;\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px; text-align: center;\" colspan=\"2\">\r\n<h4 style=\"text-align: center;\">\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">1. Verify health care provider's orders to remove NG tube.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">An order is required to remove an NG tube.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">2. Collect supplies.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Supplies include waterproof pads, 20 ml syringe, tissues, non-sterile gloves, and garbage bag.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">3. Verify patient using two identifiers. Explain procedure to patient and place patient in high Fowler's position.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Follow agency policy for proper patient identification.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">4. Perform hand hygiene. Place waterproof pad on patient's chest.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This reduces the transmission of microorganisms.\r\n\r\n[caption id=\"attachment_5083\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/08\/DSC_1100.jpg\"><img class=\"wp-image-5083 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/08\/DSC_1100-150x150.jpg\" alt=\"Perform hand hygiene\" width=\"150\" height=\"150\" \/><\/a> Perform hand hygiene[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">5. Disconnect tube from feed if present.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This prevents risk of aspiration of tube feed.\r\n\r\n[caption id=\"attachment_5615\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1664.jpg\"><img class=\"wp-image-5615 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1664-150x150.jpg\" alt=\"Disconnect tube from feed or suction\" width=\"150\" height=\"150\" \/><\/a> Disconnect tube from feed or suction[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">6. Remove tape or securement device from nose.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This allows for the tube to be easily removed.\r\n\r\n[caption id=\"attachment_5618\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1669.jpg\"><img class=\"wp-image-5618 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1669-150x150.jpg\" alt=\"Remove tape or securement device from nose\" width=\"150\" height=\"150\" \/><\/a> Remove tape or securement device from nose[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">7. Unclip NG tube from patient's gown.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This allows for tube to be easily removed.\r\n\r\n[caption id=\"attachment_5614\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1663.jpg\"><img class=\"wp-image-5614 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1663-150x150.jpg\" alt=\"Unclip NG tube from patient's gown\" width=\"150\" height=\"150\" \/><\/a> Unclip NG tube from patient's gown[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">8. Clear NG tube by inserting 10 to 20 ml of air into tube.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This prevents aspiration of tube feed falling out of tube.\r\n\r\n[caption id=\"attachment_5616\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1667.jpg\"><img class=\"wp-image-5616 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1667-150x150.jpg\" alt=\"Insert 10-20 mL of air into NG tube\" width=\"150\" height=\"150\" \/><\/a> Insert 10 to 20 ml of air into NG tube[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">9. Instruct patient to take a deep breath and hold it.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This\u00a0prevents aspiration; holding the breath closes the glottis.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">10. Kink the NG tube near the naris and gently pull out tube in a swift, steady motion, wrapping it in your hand as it is being pulled out. Dispose of tube in garbage bag.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This prevents any residual feed from flowing out of tube upon removal.\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1672.jpg\"><img class=\"wp-image-5619 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1672-150x150.jpg\" alt=\"Pull out tube in a swift, steady motion\" width=\"150\" height=\"150\" \/><\/a> Pull out tube in a swift, steady motion[\/caption]\r\n\r\n&nbsp;\r\n\r\n[caption id=\"attachment_5626\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1684.jpg\"><img class=\"wp-image-5626 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1684-150x150.jpg\" alt=\"Wrap tube in glove and dispose as per agency policy\" width=\"150\" height=\"150\" \/><\/a> Wrap tube in glove and dispose as per agency policy[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">11. Offer tissue or clean the nares for the patient and offer mouth care as required.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This clears the nares\/nasal passages of any remaining secretions.\r\n\r\n[caption id=\"attachment_5627\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1687.jpg\"><img class=\"wp-image-5627 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1687-150x150.jpg\" alt=\"Offer tissue or clean the nares for the patient \" width=\"150\" height=\"150\" \/><\/a> Offer tissue or clean the nares for the patient[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">12. Remove gloves and place patient in a comfortable position. Assess patient's level of comfort. Perform hand hygiene.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This promotes patient comfort and reduces the transmission of microorganisms.\r\n\r\n[caption id=\"attachment_5575\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1581.jpg\"><img class=\"wp-image-5575 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1581-150x150.jpg\" alt=\"Hand hygiene with ABHR\" width=\"150\" height=\"150\" \/><\/a> Hand hygiene with ABHR[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">13. Document procedure according to\u00a0agency policy<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Document removal of NG tube and patient response to the removal.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"4\">Data source:\u00a0ATI, 2015a; BCIT, 2015b; Perry et al., 2014<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\">Critical Thinking Exercises<\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<ol>\r\n \t<li>You are inserting a nasogastric tube and the tube is not advancing. Explain your next steps, with rationale.<\/li>\r\n \t<li>Your patient has a nasogastric tube and is requesting water because her throat feels dry. Describe your next actions.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>","rendered":"<h2>Using a Nasogastric Tube<\/h2>\n<p>A <strong>nasogastric (NG) tube<\/strong> is a flexible plastic tube inserted through the nostrils, down the nasopharynx, and into the stomach or the upper portion of the small intestine. Placement of NG tubes is always confirmed with an X-ray prior to use (Perry, Potter, &amp; Ostendorf, 2014).<\/p>\n<p>NG tubes are used to:<\/p>\n<ul>\n<li>Deliver nutrients to the patient\u00a0via\u00a0a feeding pump<\/li>\n<li>Remove gastric contents<\/li>\n<\/ul>\n<p>An NG tube used for feeding should be labelled. The tube is used to feed patients who may have swallowing difficulties or require additional nutritional supplements. These tubes are narrower and smaller bored than a Salem sump or Levine\u00a0tube.<\/p>\n<p>An NG tube can also remove gastric content, either draining the stomach by gravity or by being connected to a suction pump. In these situations, the NG tube is used to prevent nausea, vomiting, or gastric distension, or to wash the stomach of\u00a0toxins.<\/p>\n<p>The NG tube is fastened to the patient using a nose clip, and is taped and pinned to the patient\u2019s gown to prevent accidental removal of the tube and\u00a0to prevent the tube from slipping from the stomach area into the lungs.<\/p>\n<p>When working with people who have nasogastric tubes, remember the following care measures:<\/p>\n<ul>\n<li>Maintain and promote comfort. The tube constantly irritates the nasal mucosa, causing a great deal of discomfort. Ensure that the tube is securely\u00a0anchored to the patient&#8217;s\u00a0nose to prevent excess tube movement, and is pinned to the gown to avoid excessive pulling or dragging.<\/li>\n<li>Because one nostril is blocked, patients tend to mouth breathe. This causes dehydration of the nasal and oral mucosa, and patients will complain of thirst, but they are usually NPO (<em>nil per os<\/em> or nothing by mouth). Mouth care will help to relieve the dryness. This can include rinsing the mouth with cold water or mouthwash as long as the patient does\u00a0not swallow. Some patients\u00a0may be allowed to suck on ice chips.<\/li>\n<li>If the patient complains of abdominal pain, discomfort, or nausea, or begins to vomit, report it immediately. The drainage flow is probably obstructed and the tube will need to be irrigated.<\/li>\n<li>These patients\u00a0should <em>never <\/em>be allowed to lie completely flat. Lying flat increases the patient&#8217;s risk of aspirating stomach contents. Patients with an NG tube are at risk for aspiration. The head of bed should always be raised 30 degrees or higher.<\/li>\n<\/ul>\n<p>Checklist 78 outlines the steps for inserting a nasogastric tube.<\/p>\n<table style=\"border-color: #000000; height: 4175px; width: 100%;\">\n<caption><a id=\"checklist78\"><\/a>Checklist 78: Inserting a Nasogastric tube<\/caption>\n<tbody>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 75px; text-align: center;\" colspan=\"4\">\n<h5 style=\"text-align: center;\"><span style=\"color: #000000;\">Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 75px;\" colspan=\"4\">\n<h5><span style=\"color: #333333;\">Safety considerations:\u00a0<\/span><\/h5>\n<ul>\n<li>Perform hand hygiene.<\/li>\n<li><span style=\"color: #333333;\">Check room for additional precautions.<\/span><\/li>\n<li><span style=\"color: #333333;\">Introduce yourself to patient.<\/span><\/li>\n<li><span style=\"color: #333333;\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\n<li><span style=\"color: #333333;\">Explain process to patient;\u00a0offer analgesia, bathroom, etc.<\/span><\/li>\n<li><span style=\"color: #333333;\">Listen and attend to patient cues.<\/span><\/li>\n<li><span style=\"color: #333333;\">Ensure patient&#8217;s privacy and dignity.<\/span><\/li>\n<li><span style=\"color: #333333;\">Assess ABCCS\/suction\/oxygen\/safety.<\/span><\/li>\n<li><span style=\"color: #333333;\">Apply principles of asepsis and safety.<\/span><\/li>\n<li><span style=\"color: #333333;\">Check vital signs.<\/span><\/li>\n<li><span style=\"color: #333333;\">Complete necessary focused assessments.<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px; text-align: center;\" colspan=\"2\">\n<h4 style=\"text-align: center;\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000; width: 250px; text-align: center;\" colspan=\"2\">\n<h4 style=\"text-align: center;\">\u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">1. Perform hand hygiene and gather supplies.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This\u00a0prevents the transmission of microorganisms.<\/p>\n<figure id=\"attachment_5642\" aria-describedby=\"caption-attachment-5642\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1715.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5642 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1715-150x150.jpg\" alt=\"Gather supplies\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5642\" class=\"wp-caption-text\">Gather supplies<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">2. Visually inspect condition of patient&#8217;s nasal and oral cavities.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Check for\u00a0signs of infection or skin breakdown.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">3.\u00a0Assess for the best nostril before you begin.<\/p>\n<p>Do this by occluding one side and asking the patient to sniff.\u00a0Ask the patient about previous injuries or history of a deviated septum.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">If either nostril is equally suitable, select the nostril closest to the suction.<\/p>\n<figure id=\"attachment_5627\" aria-describedby=\"caption-attachment-5627\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1687.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5627 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1687-150x150.jpg\" alt=\"Assess for most patent nostril\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5627\" class=\"wp-caption-text\">Assess for most patent nostril<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">4. Palpate patient&#8217;s abdomen for distension, pain, and\/or rigidity.<\/p>\n<p>Auscultate for bowel sounds.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Document assessment findings and determine appropriateness of NG tube insertion related to reason for insertion and patient&#8217;s physical assessment.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">5. Assess patient&#8217;s level of consciousness and understanding of procedure.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Patient must be able to follow instructions related to NG\u00a0insertion to allow for passage of tube through nasal and gastrointestinal tracts.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">6. Check doctor&#8217;s orders for type of NG tube to be placed and reason for placement.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Check\u00a0appropriate orders relevant to patient safety.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">7. Check doctor&#8217;s orders to determine whether the NG tube is to be attached to suction or a drainage bag.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This should be commensurate with the reason for the NG tube.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">8. Position patient sitting up at 45 to 90 degrees (unless contraindicated by the patient&#8217;s condition), with a pillow under the head and shoulders.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This allows the NG tube to pass more easily through the nasopharynx and into the stomach.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">9. Raise bed to a comfortable working height.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This helps prevent biomechanical injury to the health care provider.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">10. Agree on a signal the patient can use if they wish you to pause during the procedure.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This procedure can be anxiety-provoking and uncomfortable for many patients. Providing a means for the patient to communicate discomfort and a desire to pause during the procedure helps alleviate anxiety.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">11. Place a towel on\u00a0the patient&#8217;s chest and provide facial tissues and an emesis basin.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Nasal and oral secretions may be evident during the procedure.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">12. Provide patient with drinking water and a straw if the patient is not fluid restricted.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Sipping water through a straw helps to\u00a0initiate the swallowing reflex and facilitate passing of NG tube.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">13. Stand on patient&#8217;s right side if you are right-handed and the left side if you are left-handed.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">You will use your dominant hand to insert the tube.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">14. Measure distance of the tube from<\/p>\n<ul>\n<li>The tip of the nose, to&#8230;<\/li>\n<li>The earlobe, to&#8230;<\/li>\n<li>The xiphoid process<\/li>\n<\/ul>\n<p>and then mark the tube at this point.<\/p>\n<p>&nbsp;<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This determines the appropriate length of NG tube to be inserted.<\/p>\n<figure id=\"attachment_6404\" aria-describedby=\"caption-attachment-6404\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2210.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6404 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2210-150x150.jpg\" alt=\"Measure from tip of nose to earlobe\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-6404\" class=\"wp-caption-text\">Measure from tip of nose to earlobe<\/figcaption><\/figure>\n<figure id=\"attachment_6405\" aria-describedby=\"caption-attachment-6405\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2211.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6405 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2211-150x150.jpg\" alt=\"Measure from earlobe to xiphoid process\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-6405\" class=\"wp-caption-text\">Measure from earlobe to xiphoid process<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">15. Lubricate NG tube tip according to your agency policy.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Tube may be lubricated internally using tap water or externally using water-soluble lubricating jelly. Agency policy varies and should be checked.<\/p>\n<figure id=\"attachment_5633\" aria-describedby=\"caption-attachment-5633\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1697.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5633 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1697-150x150.jpg\" alt=\"Lubricate tip of tube as per agency policy\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5633\" class=\"wp-caption-text\">Lubricate tip of tube as per agency policy<\/figcaption><\/figure>\n<p>Never use non-water-soluble lubricant (e.g., Vaseline), as it will not dissolve and may cause respiratory complications if it enters the lungs.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">16. Apply clean non-sterile\u00a0gloves.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Using gloves decreases the transfer of microorganisms.<\/p>\n<figure id=\"attachment_5561\" aria-describedby=\"caption-attachment-5561\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1516.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5561 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1516-150x150.jpg\" alt=\"Apply clean disposable gloves\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5561\" class=\"wp-caption-text\">Apply clean non-sterile\u00a0gloves<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">17. Curve 10 to 15 cm of the end of the NG tube around your gloved finger, and then release it.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Curling the NG tube around your finger helps it conform to the normal curve\u00a0of the nasopharynx.<\/p>\n<figure id=\"attachment_6387\" aria-describedby=\"caption-attachment-6387\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2123.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6387 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2123-150x150.jpg\" alt=\"Curl the NG tube around your finger to help it conform to the normal curve of the nasopharynx\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-6387\" class=\"wp-caption-text\">Curl the NG tube around your finger<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">18. Have patient drop head forward\u00a0and breathe through the mouth.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Dropping the head forward closes the trachea and opens the esophagus, which\u00a0allows the NG tube to pass more easily through the nasopharynx and into the stomach.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">19. Insert NG tube tip slowly into\u00a0the patient&#8217;s nostril and advance it steadily, in a downward direction, along the bottom of the nasal passage, with the curved end pointing downward\u00a0in the direction of the ear on the same side as the nostril.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This follows the natural anatomical alignment of the nasopharynx.<\/p>\n<figure id=\"attachment_5634\" aria-describedby=\"caption-attachment-5634\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1700.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5634 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1700-150x150.jpg\" alt=\"Insert nasogastric tube slowly into patient's nostril\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5634\" class=\"wp-caption-text\">Insert nasogastric tube slowly into patient&#8217;s nostril<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">20. You may feel slight resistance as you advance along the nasal passage. Twist the tube slightly, apply downward pressure, and continue trying to advance the tube. If significant resistance is felt, remove the tube and allow the patient to rest before trying again in the other nostril.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">It is common for the patient to feel discomfort, and this may be expressed with light coughing and gagging. More aggressive coughing and gagging may indicate that the tube has entered the airways, in which case\u00a0you should withdraw the NG tube.<\/p>\n<figure id=\"attachment_5635\" aria-describedby=\"caption-attachment-5635\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1702.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5635 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1702-150x150.jpg\" alt=\"Advance the tube gently\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5635\" class=\"wp-caption-text\">Advance the tube gently<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">21. If there is difficulty in passing the NG tube, you may ask the patient to sip water slowly through a straw unless oral\u00a0fluids are contraindicated. If oral fluids are not allowed, ask the patient to try dry swallowing while you advance the tube.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">If patient continues to gag or cough, check that the tube is not coiled\u00a0in the back of the mouth, using a tongue blade and a flashlight to check the back of the mouth. If tube is coiled, withdraw the tube until only the tip of the tube is seen in the back of the mouth. Then try advancing the tube again while patient tries to swallow.<\/p>\n<figure id=\"attachment_5636\" aria-describedby=\"caption-attachment-5636\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1704.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5636 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1704-150x150.jpg\" alt=\"Patient may sip water slowly through a straw\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5636\" class=\"wp-caption-text\">Patient may sip water slowly through a straw<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">22. Continue to advance NG tube until you reach the mark\/tape you had placed for measurement.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This ensures accurate placement.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">23. Temporarily anchor the tube to patient&#8217;s cheek with a piece of tape until you can check for correct placement.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This prevents displacement of the NG tube while checking placement.<\/p>\n<figure id=\"attachment_5617\" aria-describedby=\"caption-attachment-5617\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1668.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5617 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1668-150x150.jpg\" alt=\"Anchor tube\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5617\" class=\"wp-caption-text\">Anchor tube<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">24. Verify tube placement according to agency policy.<\/p>\n<p>Colour-coded pH paper is usually used,\u00a0as an initial and interim check, to confirm that acidic contents are present. Then an X-ray is taken to confirm placement prior to using NG tube for feeding.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">The contents aspirated from the tube should be acidic with a pH &lt;5. If the pH is more than 6, it\u00a0may indicate the presence of respiratory fluids or small bowel content, and the tube should be removed.<\/p>\n<figure id=\"attachment_5640\" aria-describedby=\"caption-attachment-5640\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1711.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5640 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1711-150x150.jpg\" alt=\"Verify tube placement using pH paper\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5640\" class=\"wp-caption-text\">Verify tube placement using pH paper<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">25. Once the tube placement has been confirmed, mark (with a permanent marker) and record the length of tubing extending from the nose to the outer end of the tube.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This aids in timely recognition and identification of tube displacement or migration.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">26. Secure the tube to the patient&#8217;s gown with a safety pin, allowing enough tube length for comfortable head movement.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This keeps the NG tube in place.<\/p>\n<figure id=\"attachment_5639\" aria-describedby=\"caption-attachment-5639\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1708.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5639 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1708-150x150.jpg\" alt=\"Secure the tube to the patient's gown with a safety pin\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5639\" class=\"wp-caption-text\">Secure the tube to the patient&#8217;s gown with a safety pin<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">27. Document the procedure according to\u00a0agency policy, and report any unexpected findings to the appropriate health care provider.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Timely and accurate documentation promotes patient safety.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"4\">Data source: ATI, 2015a; BCIT, 2015c; Berman &amp; Snyder, 2016<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h5>Special considerations with NG tubes:<\/h5>\n<ul>\n<li>Always assess correct placement of the NG tube prior to infusing any fluids or tube feeds as per agency policy. Check location of external markings on the tube and colour of the PH of fluid aspirated from the tube. Routine evaluation will ensure the correct placement of the tube and reduce the risk of aspiration. Do not instill air to test location of tube.<\/li>\n<li>Do not give the patient anything to eat or drink without knowing that the patient has passed a swallowing assessment.<\/li>\n<li>If changing the gown or repositioning the patient, take care not to pull on the NG tube. Remember to unpin the tube from the gown and repin the tube.<\/li>\n<li>If the NG tube falls out of the patient, it\u00a0is not an emergency. <em>But<\/em> be sure to\u00a0assess your patient. How are the ABCCS? Notify the RN in charge of the patient.<\/li>\n<li>A patient who appears to be in respiratory distress\u00a0should be considered an emergency, and emergency procedures should be followed. Respiratory distress may present as\u00a0coughing, choking, or reduced oxygen saturation.<\/li>\n<\/ul>\n<h3><a id=\"video10.1\"><\/a>Video 10.1<\/h3>\n<div class=\"textbox shaded\" style=\"text-align: center;\">Watch the video\u00a0<a href=\"https:\/\/barabus.tru.ca\/nursing\/nasogastric_tube_insertion.html\"><em>Nasogastric tube insertion<\/em><\/a> by\u00a0<a href=\"\/clinicalskills\/back-matter\/appendix-3\/\">Ren\u00e9e Anderson &amp; Wendy McKenzie<\/a>, Thompson Rivers University.<\/div>\n<h2>Removing an NG Tube<\/h2>\n<p>An NG tube should be removed if it is no longer required. The process of removal is usually very quick. Prior to removing an NG tube, verify physician orders. If the NG tube was ordered to remove gastric content, the physician&#8217;s order may state to &#8220;trial&#8221; clamping the tube for a number of hours to see if the patient tolerates its removal. During the trial, the patient should not experience any nausea, vomiting, or abdominal distension.<\/p>\n<p>To review how to remove an NG tube, refer to\u00a0Checklist 79.<\/p>\n<table style=\"border-color: #000000; height: 1547px; width: 100%;\">\n<caption><a id=\"checklist79\"><\/a>Checklist 79: Removal of an NG Tube<\/caption>\n<tbody>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 75px; text-align: center;\" colspan=\"4\">\n<h5 style=\"text-align: center;\"><span style=\"color: #000000;\">Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 75px;\" colspan=\"4\">\n<h5><span style=\"color: #333333;\">Safety considerations:\u00a0<\/span><\/h5>\n<ul>\n<li>Perform hand hygiene.<\/li>\n<li><span style=\"color: #333333;\">Check room for additional precautions.<\/span><\/li>\n<li><span style=\"color: #333333;\">Introduce yourself to patient.<\/span><\/li>\n<li><span style=\"color: #333333;\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\n<li><span style=\"color: #333333;\">Explain process to patient;\u00a0offer analgesia, bathroom, etc.<\/span><\/li>\n<li><span style=\"color: #333333;\">Listen and attend to patient cues.<\/span><\/li>\n<li><span style=\"color: #333333;\">Ensure patient&#8217;s privacy and dignity.<\/span><\/li>\n<li><span style=\"color: #333333;\">Assess ABCCS\/suction\/oxygen\/safety.<\/span><\/li>\n<li><span style=\"color: #333333;\">Apply principles of asepsis and safety.<\/span><\/li>\n<li><span style=\"color: #333333;\">Check vital signs.<\/span><\/li>\n<li><span style=\"color: #333333;\">Complete necessary focused assessments.<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px; text-align: center;\" colspan=\"2\">\n<h4 style=\"text-align: center;\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000; width: 250px; text-align: center;\" colspan=\"2\">\n<h4 style=\"text-align: center;\">\u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">1. Verify health care provider&#8217;s orders to remove NG tube.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">An order is required to remove an NG tube.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">2. Collect supplies.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Supplies include waterproof pads, 20 ml syringe, tissues, non-sterile gloves, and garbage bag.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">3. Verify patient using two identifiers. Explain procedure to patient and place patient in high Fowler&#8217;s position.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Follow agency policy for proper patient identification.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">4. Perform hand hygiene. Place waterproof pad on patient&#8217;s chest.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This reduces the transmission of microorganisms.<\/p>\n<figure id=\"attachment_5083\" aria-describedby=\"caption-attachment-5083\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/08\/DSC_1100.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5083 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/08\/DSC_1100-150x150.jpg\" alt=\"Perform hand hygiene\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5083\" class=\"wp-caption-text\">Perform hand hygiene<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">5. Disconnect tube from feed if present.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This prevents risk of aspiration of tube feed.<\/p>\n<figure id=\"attachment_5615\" aria-describedby=\"caption-attachment-5615\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1664.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5615 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1664-150x150.jpg\" alt=\"Disconnect tube from feed or suction\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5615\" class=\"wp-caption-text\">Disconnect tube from feed or suction<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">6. Remove tape or securement device from nose.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This allows for the tube to be easily removed.<\/p>\n<figure id=\"attachment_5618\" aria-describedby=\"caption-attachment-5618\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1669.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5618 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1669-150x150.jpg\" alt=\"Remove tape or securement device from nose\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5618\" class=\"wp-caption-text\">Remove tape or securement device from nose<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">7. Unclip NG tube from patient&#8217;s gown.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This allows for tube to be easily removed.<\/p>\n<figure id=\"attachment_5614\" aria-describedby=\"caption-attachment-5614\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1663.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5614 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1663-150x150.jpg\" alt=\"Unclip NG tube from patient's gown\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5614\" class=\"wp-caption-text\">Unclip NG tube from patient&#8217;s gown<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">8. Clear NG tube by inserting 10 to 20 ml of air into tube.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This prevents aspiration of tube feed falling out of tube.<\/p>\n<figure id=\"attachment_5616\" aria-describedby=\"caption-attachment-5616\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1667.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5616 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1667-150x150.jpg\" alt=\"Insert 10-20 mL of air into NG tube\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5616\" class=\"wp-caption-text\">Insert 10 to 20 ml of air into NG tube<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">9. Instruct patient to take a deep breath and hold it.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This\u00a0prevents aspiration; holding the breath closes the glottis.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">10. Kink the NG tube near the naris and gently pull out tube in a swift, steady motion, wrapping it in your hand as it is being pulled out. Dispose of tube in garbage bag.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This prevents any residual feed from flowing out of tube upon removal.<\/p>\n<figure style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1672.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5619 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1672-150x150.jpg\" alt=\"Pull out tube in a swift, steady motion\" width=\"150\" height=\"150\" \/><\/a><figcaption class=\"wp-caption-text\">Pull out tube in a swift, steady motion<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_5626\" aria-describedby=\"caption-attachment-5626\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1684.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5626 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1684-150x150.jpg\" alt=\"Wrap tube in glove and dispose as per agency policy\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5626\" class=\"wp-caption-text\">Wrap tube in glove and dispose as per agency policy<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">11. Offer tissue or clean the nares for the patient and offer mouth care as required.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This clears the nares\/nasal passages of any remaining secretions.<\/p>\n<figure id=\"attachment_5627\" aria-describedby=\"caption-attachment-5627\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1687.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5627 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1687-150x150.jpg\" alt=\"Offer tissue or clean the nares for the patient\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5627\" class=\"wp-caption-text\">Offer tissue or clean the nares for the patient<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">12. Remove gloves and place patient in a comfortable position. Assess patient&#8217;s level of comfort. Perform hand hygiene.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This promotes patient comfort and reduces the transmission of microorganisms.<\/p>\n<figure id=\"attachment_5575\" aria-describedby=\"caption-attachment-5575\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1581.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5575 size-thumbnail\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1581-150x150.jpg\" alt=\"Hand hygiene with ABHR\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5575\" class=\"wp-caption-text\">Hand hygiene with ABHR<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">13. Document procedure according to\u00a0agency policy<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Document removal of NG tube and patient response to the removal.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"4\">Data source:\u00a0ATI, 2015a; BCIT, 2015b; Perry et al., 2014<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Critical Thinking Exercises<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<ol>\n<li>You are inserting a nasogastric tube and the tube is not advancing. Explain your next steps, with rationale.<\/li>\n<li>Your patient has a nasogastric tube and is requesting water because her throat feels dry. Describe your next actions.<\/li>\n<\/ol>\n<\/div>\n<\/div>\n","protected":false},"author":5,"menu_order":3,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-3635","chapter","type-chapter","status-publish","hentry"],"part":3632,"_links":{"self":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3635","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/users\/5"}],"version-history":[{"count":29,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3635\/revisions"}],"predecessor-version":[{"id":10177,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3635\/revisions\/10177"}],"part":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/parts\/3632"}],"metadata":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3635\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/media?parent=3635"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapter-type?post=3635"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/contributor?post=3635"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/license?post=3635"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}