NGT – LWS

Equipment:

  • Appropriate-sized NG tube (decompression)
  • Lubricant
  • pH strips
  • Tongue blade
  • Clean gloves
  • Flashlight
  • Emesis basin
  • Catheter-tipped syringe
  • Tape
  • Towel
  • Glass of water with straw
  • Tissues
  • Working suction equipment
  • Stethoscope
  • Pulse ox

Steps:

  1. WIIAPA:
    1. Wash hands
    2. Introduce self
    3. Identify patient (use 2 identifiers)
    4. Allergies – don’t forget food allergies
    5. Plan of care
    6. Assess patient
  1. Verify Order.
  2. Educate Patient:
    1. Explain procedure and what to expect.
    2. Encourage mouth breathing during procedure.
  3. Perform hand hygiene.
  4. Raise bed to working height and position patient in high Fowler position.
  5. Place towel over patient’s chest. Hand patient tissue and ask them to blow their nose. Place emesis basin within reach.
  6. Wash bridge of nose with soap and water or alcohol swab. Dry thoroughly.
  7. Instruct patient to relax and breath normally as you occlude one naris at a time. Select nostril with greatest airflow for insertion.
  8. Prepare NG tube/supplies:
    1. Measure length of insertion: Start at tip of nose→ earlobe → xiphoid process.  Mark length of measurement with tape.
    2. Ensure all suction equipment is present and is working.
    3. Prepare materials for tube fixation and label with date and time.
  9. Perform hand hygiene and apply clean gloves.
  10. Apply pulse ox and obtain VS. Monitor O2 sats throughout procedure.
  11. Lubricate tip of NG tube.
  12. Hand patient a cup of water with straw. Explain that you will instruct them when to swallow by taking small sips of water.
  13. Inform patient that you are about to insert the tube.
  14. Instruct patient to extend neck back toward pillow and insert tube gently through nostril. Aim back and down toward patient’s ear.
  15. Have patient then relax and flex head toward chest after tube is passed through nasopharynx.
  16. Encourage patient to swallow by taking small sips of water. Advance tube as patient swallows – rotating gently while inserting until tube reaches measured mark.
    **DO NOT advance tube during inspiration or coughing as it will likely enter the respiratory tract.**
  17. Using penlight and tongue blade, check to be sure tube is not coiled or kinked in the back of the throat.
  18. Secure tube to nose using labeled tape or a tube fixation device. Use additional tape to secure end of tube to patient gown.
  19. Verify tube placement:
    1. Follow order for confirmation x-ray.
    2. While waiting for x-ray, connect syringe and aspirate gastric content.
    3. Check pH range (1.0 – 4.0 = good indicator of gastric placement).
  20. Once placement is confirmed by x-ray, connect NG tube to suction as
  21. ordered – Low Wall Suction, 40-60 mmHg (green).
  22. Keep HOB elevated at least 30-45°.
  23. Dispose of supplies and clean patient area.
  24. Hand Hygiene
  25. Document – ex: Length, size, type of tube inserted and in which nares.Placement check, pH of aspirate, confirmation by x-ray, amount of suction applied, tolerance of procedure, patient teaching, etc.

Reference: Perry, A. G., Potter, P. A., Ostendorf, W. R., & Laplante, N. (2022). Clinical Nursing Skills & Techniques (10th ed., pp. 1038-1043). Elsevier.