Liceo de Cagayan University

College of Nursing
Paseo del Rio campus, Macasandig
Cagayan de Oro City

Name: Danea Alexys A. Gomera Date: September 21, 2020

Topic: NGT Instructor: Sir Christian Villian

Definition: is a procedure in which a thin, plastic tube is inserted into the nostril, toward the esophagus,
and down into the stomach
 is used in patients suffering from dysphagia due to their inability to meet nutritional needs despite food
modifications and because of the possibility of aspiration.

Purposes:
1. to improve every patient’s nutritional intake and maintain their nutritional status.
2. deliver food and medicine to a patient when they are unable to eat or swallow.

Principles:
1. a patient may need to blow their nose and take a few sips of water (if allowed) before the
procedure.
2. Wear gloves.
3. Provide oral and skin care.
4. Face and eye protection.

Equipments:
• Gloves
• Nasogastric tube
• Water-soluble substance (K-Y jelly)
• Protective towel covering for client
• Emesis basin
• Tape for marking placement and securing tube
• Glass of water (if allowed)
• Straw for glass of water
• Stethoscope
• 60-mL catheter tip syringe
• Rubber band and safety pin
• Suction equipment or tube feeding equipment
Sources:
https://nurseslabs.com/nasogastric-intubation/

STEPS RATIONALE SCORE

1. Check doctor's order. To know ensure the right order and
to know the, type and size of the NG
tube.

2. Explain the procedure to the To promote cooperation to the

patient. patient. It is important that the client
relax, swallow, and cooperate during
the procedure.

3. Wash hands. To avoid cross contamination

4. Assemble equipment at bedside To save time and effort and this is to

and place on side of bed nearest to make sure that the equipment is
the nurse. functioning properly before using it
on the client.

5. Pull curtain around the bed or close To provide privacy and comfort
room door.

6. Stand on client's right side if right- For comfort

handed; left side if left-handed.

7. If NG tube is too pliable, place in To make the tube slightly less pliable
emesis basin and cover with ice
(optional)

8. Place bath towel over client's This is to avoid the aspirant content
chest; give facial tissues to client, to be all over the place, and tissues
for the client.

9. Offer gloves to the physician To prevent cross contamination.

10. Instruct client to relax and breathe The client may breathe more
normally while occluding one nares. comfortably if the “good” nostril
Then repeat this action for other remains patent.
nares. Select nostrils with greater air
flow.

11. Assist the physician in measuring  Each client will have a slightly
distance to insert tube by placing tip different terminal insertion point.
of tube at client's nose and extending Measurements must be made for
tube first to tip of earlobe and then each individual’s anatomy.
from earlobe down xiphoid process of
sternum.

12. Mark length of tube to be inserted To know when the physician will
with piece of tape note distance of reach the xiphoid process of the
point from next tube marking. sternum

13. Curve 4-6 inches (10-15cm) of to make sure that the tube is not
end of the tube tightly around index curled
finger then release.

14. Lubricate 3-4 inches (7.5-10cm) The NG intubation is very

of end of the tube with water soluble uncomfortable for many patients.
lubricating jelly. This is to alleviate the discomfort

15. Initially instruct client to extend his
neck back against pillow; assist the
physician in inserting the tube slowly
through nares with curves end
pointing downward
Flexing the head aids in the
anatomic insertion of the tube.The
tube is less likely to pass into the
trachea.

16. Continue to pass the tube along

floor of nasal passage aiming down
toward ear. When resistance is felt,
apply gentle downward pressure to
advance tube (do not force past
resistance)

17. If resistance is met, withdraw tube The client’s nostril may deflect the
to allow client to rest, relubricate tube NG into an inappropriate position.
and insert into other nares. Let the client rest a moment and
retry on the other side.

18. Continue insertion of tube until This is to promote client’s comfort

just past nasopharynx by gently and for the client to not experience
rotating tube toward opposite nares. respiratory distress
a. Stop tube advancement, allow
client to relax, and provide tissue
paper.
b. Explain to client that the next step
requires him to swallow.

19. With tube just above oropharynx, Swallowing water, if allowed, helps
instruct client to flex head forward and the passage of the NG tube.
dry swallow or suck in air through
straw. Advance tube 2.5-5cm (1-
2inches) with each swallow. If client
has trouble swallowing and is allowed
fluids, offer a glass of water.
Advance tube with each swallow of
water

20. If client begins to cough, gag, or The tube may be in the trachea.
choke withdraw slightly and stop tube
advancement. Instruct client to
breathe easily and take sips of water.
21. If client continues to cough during
insertion, pull tube back slightly.
22. After client relaxes, continue to
advance tube the desired distance.
Checking Tube Placement.
1. Ask client to talk
2. Check posterior pharynx for
presence of coiled tube.
3. Attach syringe to end of NG tube.
Place diaphragm of stethoscope over
upper left quadrant of abdomen just
below costal margin. Inject 10-20cc
air while auscultating abdomen.
4. Aspirate gently back on syringe to
obtain gastric contents (optional-
check pH of gastric content)
Anchoring Tube
1. After tube is properly inserted,
either clamp end or connect it to
drainage bag or suction machine.
2. Tape NG tube to client's nose;
avoid putting pressure on nares. Cut
4 inches (10cm) long piece of tape.
Place one end of tape over nose and
wrap opposite split ends around tube
as it exits nose.
Gavage
1. Warm feeding.
2. Kink tubing then connect funnel or
asepto syringe.
3. Give the fluid / feeding slowly
keeping the tube filled at all times
during the feeding. (Asepto syringe
or funnel should be at least one foot
above the edge of bed when feeding).
4. Rinse with water after feeding.
To avoid respiratory status problems
since the tube may be in the trachea
To continue the procedure
To ensure if the patient is
comfortable and it is properly placed
NG will curl up in the back of the
throat instead of passing down to the
stomach.
To check if the tube if its in the right
placement.
 Stomach aspirate will appear
cloudy, green, tan, off-white, bloody,
or brown.
To avoid air entering in the stomach
Securing the tube in place will
prevent peristaltic movement from
advancing the tube or from the tube
unintentionally being pulled out.
For easier flow of the solution and to
avoid discomfort in cooler feed
Clamping after feeding is completed
prevents air from entering the
stomach.
Controlling administration and flow
rate of feeding solution prevents air
from entering the stomach and
nausea and abdominal cramping
from developing.
Flushing clears the tube and keeps it
 patent.

5. Clamp the tube tightly until next Clamping after feeding is completed
feeding. prevents air from entering the
stomach.

6. Wash all equipments with soap and To prepare for the next use
water and return proper place.

7. Chart procedure done, calories fed, This provides accurate

amount of water usea for rinsing, and documentation and provides for
reaction of patient. comprehensive care.