How does a nurse measure the proper length for nasogastric tube insertion?
A nasogastric (NG) tube 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, & Ostendorf, 2014). NG tubes are used to:
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 tube. 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 toxins. The NG tube is fastened to the patient using a nose clip, and is taped and pinned to the patient’s gown to prevent accidental removal of the tube and to prevent the tube from slipping from the stomach area into the lungs. When working with people who have nasogastric tubes, remember the following care measures:
Checklist 78 outlines the steps for inserting a nasogastric tube. Checklist 78: Inserting a Nasogastric tubeDisclaimer: Always review and follow your hospital policy regarding this specific skill.Safety considerations:
StepsAdditional Information1. Perform hand hygiene and gather supplies.This prevents the transmission of microorganisms.Gather supplies2. Visually inspect condition of patient’s nasal and oral cavities.Check for signs of infection or skin breakdown.3. Assess for the best nostril before you begin.Do this by occluding one side and asking the patient to sniff. Ask the patient about previous injuries or history of a deviated septum. If either nostril is equally suitable, select the nostril closest to the suction.Assess for most patent nostril4. Palpate patient’s abdomen for distension, pain, and/or rigidity.Auscultate for bowel sounds.
and then mark the tube at this point. This determines the appropriate length of NG tube to be inserted.Measure from tip of nose to earlobeMeasure from earlobe to xiphoid process15. Lubricate NG tube tip according to your agency policy.Tube may be lubricated internally using tap water or externally using water-soluble lubricating jelly. Agency policy varies and should be checked.Lubricate tip of tube as per agency policyNever use non-water-soluble lubricant (e.g., Vaseline), as it will not dissolve and may cause respiratory complications if it enters the lungs. 16. Apply clean non-sterile gloves.Using gloves decreases the transfer of microorganisms.Apply clean non-sterile gloves17. Curve 10 to 15 cm of the end of the NG tube around your gloved finger, and then release it.Curling the NG tube around your finger helps it conform to the normal curve of the nasopharynx.Curl the NG tube around your finger18. Have patient drop head forward and breathe through the mouth.Dropping the head forward closes the trachea and opens the esophagus, which allows the NG tube to pass more easily through the nasopharynx and into the stomach.19. Insert NG tube tip slowly into the patient’s nostril and advance it steadily, in a downward direction, along the bottom of the nasal passage, with the curved end pointing downward in the direction of the ear on the same side as the nostril.This follows the natural anatomical alignment of the nasopharynx.Insert nasogastric tube slowly into patient’s nostril20. 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.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 you should withdraw the NG tube.Advance the tube gently21. If there is difficulty in passing the NG tube, you may ask the patient to sip water slowly through a straw unless oral fluids are contraindicated. If oral fluids are not allowed, ask the patient to try dry swallowing while you advance the tube.If patient continues to gag or cough, check that the tube is not coiled in 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.Patient may sip water slowly through a straw22. Continue to advance NG tube until you reach the mark/tape you had placed for measurement.This ensures accurate placement.23. Temporarily anchor the tube to patient’s cheek with a piece of tape until you can check for correct placement.This prevents displacement of the NG tube while checking placement.Anchor tube24. Verify tube placement according to agency policy.Colour-coded pH paper is usually used, as 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. The contents aspirated from the tube should be acidic with a pH <5. If the pH is more than 6, it may indicate the presence of respiratory fluids or small bowel content, and the tube should be removed.Verify tube placement using pH paper25. 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.This aids in timely recognition and identification of tube displacement or migration.26. Secure the tube to the patient’s gown with a safety pin, allowing enough tube length for comfortable head movement.This keeps the NG tube in place.Secure the tube to the patient’s gown with a safety pin27. Document the procedure according to agency policy, and report any unexpected findings to the appropriate health care provider.Timely and accurate documentation promotes patient safety.Data source: ATI, 2015a; BCIT, 2015c; Berman & Snyder, 2016Special considerations with NG tubes:
Video 10.1Removing an NG TubeAn 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. |