Inserting a nasointestinal tube

Introduction

• This document serves as a checklist for evaluating competency in the skill of inserting a nasointestinal tube as part of nursing fundamentals.

Pre-Insertion Preparation

• Instructions are provided for assessing competency in numerous steps, requiring evaluators to mark each as Satisfactory (S) or Unsatisfactory (U).

• Key actions prior to tube insertion include:

  • **Documentation of relevant information: **

  • Amount of insulin administered

  • Injection site

  • Client assessment in the medical record

  • Privacy: Ensure patient privacy as needed.

  • Introduction: Introduce yourself to the client clearly.

  • Hand Hygiene: Perform hand hygiene and put on appropriate Personal Protective Equipment (PPE) if indicated.

  • Identification: Verify the client’s identification.

  • Allergy Check: Determine whether the client has any allergies.

  • Prescription Verification: Verify the provider's prescription for tube insertion.

  • Client Education: Provide education to the client about the procedure.

Equipment and Positioning

• Gathering Equipment:

  • Gather all necessary equipment for the insertion of a nasointestinal tube.

• Client Positioning:

  • Ensure a quiet environment, providing privacy.

  • Place the client on their right side to assist in the optimal placement of the tube during insertion.

• Measuring Tubing:

  • Measure the necessary length of the tubing

  • Place the tip of the tubing near the client’s nose.

  • Extend to the earlobe, measure down to the xiphoid process, and then add 8 to 10 inches.

  • Mark this measurement with a marker for reference during insertion.

• Flexing Head:

  • Have the client flex their head forward to facilitate tube passage into the nasopharynx.

• Client Reassurance:

  • Provide reassurance to the client throughout the procedure.

  • Acknowledge that gagging may occur upon reaching the pharynx.

  • If the client is not NPO (nothing by mouth), encourage them to sip through a straw during the process to aid swallowing.

Tube Insertion Procedure

• Advancement of Tube:

  • Continue to advance the tube while the client swallows.

  • Monitor the client for any excessive gagging or coughing, which may indicate improper placement.

• Reaching Measurement Mark:

  • Continue advancing the tube until the previously measured mark is reached.

• Securing the Tube:

  • Once reached, secure the tube loosely with tape.

  • Allow the tube to move into the intestines through peristalsis.

• Consult Agency Policy:

  • Refer to agency policy for the required amount of time for the tube to remain in place.

• Guidewire Management:

  • Leave the guidewire in place until the placement is confirmed using two methods.

  • Once assured of correct placement, remove the guidewire and secure the tube following agency policy.

Post-Insertion Care

• Oral Hygiene:

  • Perform oral hygiene for the client after completion of the procedure.

• Hand Hygiene:

  • Remove gloves and perform hand hygiene afterward.

• Client Safety:

  • Ensure that the client is in a safe position prior to leaving and that they have the call light within reach for assistance.

References

• Taylor, C., Lynn, P., and Bartlett, J. (2019). Fundamentals of nursing (9th ed.). Philadelphia: Wolters Kluwer.

Introduction

• This document serves as a checklist for evaluating competency in the skill of inserting a nasointestinal tube as part of nursing fundamentals.

Pre-Insertion Preparation

• Instructions are provided for assessing competency in numerous steps, requiring evaluators to mark each as Satisfactory (S) or Unsatisfactory (U).

• Key actions prior to tube insertion include:

  • **Documentation of relevant information: **

  • Amount of insulin administered

  • Injection site

  • Client assessment in the medical record

  • Privacy: Ensure patient privacy as needed.

  • Introduction: Introduce yourself to the client clearly.

  • Hand Hygiene: Perform hand hygiene and put on appropriate Personal Protective Equipment (PPE) if indicated.

  • Identification: Verify the client’s identification.

  • Allergy Check: Determine whether the client has any allergies.

  • Prescription Verification: Verify the provider's prescription for tube insertion.

  • Client Education: Provide education to the client about the procedure.

Equipment and Positioning

• Gathering Equipment:

  • Gather all necessary equipment for the insertion of a nasointestinal tube.

• Client Positioning:

  • Ensure a quiet environment, providing privacy.

  • Place the client on their right side to assist in the optimal placement of the tube during insertion.

• Measuring Tubing:

  • Measure the necessary length of the tubing

  • Place the tip of the tubing near the client’s nose.

  • Extend to the earlobe, measure down to the xiphoid process, and then add 8 to 10 inches.

  • Mark this measurement with a marker for reference during insertion.

• Flexing Head:

  • Have the client flex their head forward to facilitate tube passage into the nasopharynx.

• Client Reassurance:

  • Provide reassurance to the client throughout the procedure.

  • Acknowledge that gagging may occur upon reaching the pharynx.

  • If the client is not NPO (nothing by mouth), encourage them to sip through a straw during the process to aid swallowing.

Tube Insertion Procedure

• Advancement of Tube:

  • Continue to advance the tube while the client swallows.

  • Monitor the client for any excessive gagging or coughing, which may indicate improper placement.

• Reaching Measurement Mark:

  • Continue advancing the tube until the previously measured mark is reached.

• Securing the Tube:

  • Once reached, secure the tube loosely with tape.

  • Allow the tube to move into the intestines through peristalsis.

• Consult Agency Policy:

  • Refer to agency policy for the required amount of time for the tube to remain in place.

• Guidewire Management:

  • Leave the guidewire in place until the placement is confirmed using two methods.

  • Once assured of correct placement, remove the guidewire and secure the tube following agency policy.

Post-Insertion Care

• Oral Hygiene:

  • Perform oral hygiene for the client after completion of the procedure.

• Hand Hygiene:

  • Remove gloves and perform hand hygiene afterward.

• Client Safety:

  • Ensure that the client is in a safe position prior to leaving and that they have the call light within reach for assistance.

References

• Taylor, C., Lynn, P., and Bartlett, J. (2019). Fundamentals of nursing (9th ed.). Philadelphia: Wolters Kluwer.