Summary
Highlights
Before inserting a nasogastric tube, assess the patient for a history of nasal surgery, deviated septum, patency of nares, gag reflex, and mental status. Gather all necessary equipment including the tube, syringe, lubricant, facial tissues, stethoscope, and water. Identify the patient, explain the procedure, and obtain consent. Assess the nostrils for obstructions and determine the best nostril for insertion. Measure the tube length from the tip of the nose to the earlobe, then to the xiphoid process. Lubricate the tube and insert it into the selected nostril, guiding it gently. If resistance is met, re-lubricate or try the other nostril. Once the tube reaches the pharynx, ask the patient to tilt their head forward and swallow as the tube is advanced. Verify placement by aspirating stomach contents, checking pH, and listening for a whooshing sound over the epigastrium with injected air. Secure the tube with tape.
Before starting nasogastric tube feeding, assess the patient for dehydration, malnutrition, food allergies, and bowel sounds. Determine the feeding type, amount, and frequency. Position the patient in a Fowler's or slightly elevated right side-lying position. Perform hand hygiene. Attach a syringe to the tube, aspirate, and check the pH of residual stomach contents. If the residual volume is significant, consult the charge nurse or agency policy. Warm the feeding solution to room temperature. Connect the syringe to the tube and slowly instill the feeding, adjusting the flow rate as needed. Flush the tubing with water. Clamp or stopper the tube and ensure the patient remains upright for at least 30 minutes. Document all relevant information, including the amount and type of feeding, duration, and patient assessment.
Before removing the nasogastric tube, assess for bowel sounds and the absence of nausea or vomiting when the tube is clamped. Assemble equipment, including a disposable pad, tissues, clean gloves, and a plastic trash bag. Confirm the primary care provider's order for removal. Position the patient upright and inform them about the procedure, asking them to use tissues for their nose and mouth afterward. Instill 50ml of air into the tube. Ask the patient to take a deep breath and hold it. Pinch the tube with a gloved hand and smoothly withdraw it. Place the tube in a plastic bag and observe its intactness. Provide mouth care and encourage the patient to blow their nose. Dispose of used equipment properly and document the removal, including any drainage and client assessment.