NG Insertion and Removal

S

Step 1

Check provider’s order and institutional policy

Step 2

Obtain supplies (NG tube, suction tubing, tubing connector, anti-reflux valve, tape, blue pad, emesis basin, lubricant, cup of water, safety pin, pen light. Tear all tapes here!

Step 3

Identify client, provide privacy, explain procedure, and check allergies.

Step 4

Wash hands using proper procedure

Step 5

Attach connecting tubing to suction and necessary connector. Check and verify suction.

Step 6

Position client in high fowler’s position and place blue pad over chest. Place emesis basin within reach.

• Will probably do follow measurement of tubing

Step 7

Apply nonsterile gloves

Step 8

Measure and mark the correct distance for the insertion (tip of nares, ear lobe, xiphoid process)

Step 9

Lubricate end (“2-4”) of NG tube with lubricating gel

Step 10

Instruct client to flex head slightly backward. insert NG tube into chosen nostril until it reaches the pharynx (client may begin gagging).

Step 11

Instruct client to flex head forward and touch their chin to their chest. Encourage client to swallow as tube is advanced. Sips of water may be given unless contraindicated.

Step 12

Continue advancing the tube carefully while coordinating with swallows, stopping when the client breathes. Advance tube until marking tape reaches the nare.

Step 13

Discontinue the procedure and remove the tube if there is gagging, coughing, cyanosis, or resistance!

Step 14

Secure the tube to the patient’s nose

Step 15

Secure tube to gown at shoulder level ensuring the air vent (blue tube) is above stomach level.

Step 16

Attach anti-reflux valve to air vent on NG tube

Step 17

Verify placement using 2 methods according to institutional policy: x-ray & measurement of the pH. MUST obtain x-ray before administering fluids or meds.

Step 18

Attach NG tube to suction and set to prescribed level

Step 19

Perform exit procedures: position client in a safe and comfortable position with the call light in reach, dispose of supplies per institutional policy, remove gloves, and wash hands using proper procedure. DOCUMENT!

Step 20

Provide oral hygiene every 2-4 hours

Step 21

Lubricate lips and nare generously as needed

Step 22

Verify placement of NG tube every 8 hours

Step 23

Perform abdominal assessment every 8 hours

Step 24

Monitor and document NG output. Report output >100 mL/hr

Step 25

Verbalize method for volume-to-volume replacement.

• Replace fluids via IV

Step 26

Verbalize method for administering medications via an NG tube

• crush medication and insert with water + 60 mL syringe (unless enteric or long-release)

Step 27

Check provider’s order/institutional policy

Step 28

Obtain supplies (blue pad, nonsterile gloves)

Step 29

Identify the client, provide privacy, explain the procedure, allergies

Step 30

Wash hands using proper procedure

Step 31

Apply nonsterile gloves

Step 32

Turn off suction and perform key abdominal assessments

• inspection, palpation, auscultation

Step 33

Assist client to a 30-45 degree position and place blue pad over chest

Step 34

Remove tubing from the gown. Gently remove tape from the nose.

Step 35

Disconnect NG tube from suction connector tubing. Hold NG tubing upright at this point.

Step 36

Insert 60 mL syringe into NG tube and inject 30-50 mL of air to clear the tube. Close tubing.

Step 37

instruct client to take deep breath and HOLD

Step 38

Quickly remove NG tube gathering into the blue pad.

• NOTE THE TIP for integrity

Step 39

Dispose of NG tube and container with secretions per institutional policy.

• NOTE AMOUNT OF SECRETIONS FOR DOCUMENTATION

Step 40

Perform exit procedures: position client in a safe and comfortable position with the call light in reach, dispose of supplies per institution policy, remove gloves and wash hands using proper procedure, document.