1. Samantha Soto University of Central Florida
Nasogastric Tube Placement, Removal, and Maintenance for the Bedside Nurse
Samantha Soto
University of Central Florida
Figure 1 Retrieved from Microsoft clip art software on 11/22/11
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Figure 1

2. Objectives articulate the anatomy of the upper gastrointestinal tract
Figure 2
After a two hour class including a PowerPoint presentation, handout, and demonstration of nasogastric tube placement, security, and removal on a mannequin, the nurse will perform the following correctly:
articulate the anatomy of the upper gastrointestinal tract
describe two types of nasogastric tubes and their uses
verbalize three conditions where a nasogastric tube would be indicated
perform a return demonstration of patient assessment prior to nasogastric tube placement
verbalize the supplies and equipment necessary for nasogastric tube placement
Figure 2 retrieved from Microsoft clip art software on 11/22/11
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3. Objectives cont. demonstrate a suction set up
perform a return demonstration of patient education on nasogastric tube placement
perform a return demonstration of nasogastric tube insertion, security, and removal
list two methods to verify correct nasogastric tube placement
describe maintenance of the nasogastric tube
list three documentation methods
list two expected and two unexpected outcomes for the course of nasogastric tube placement
Figure 29
Figure 29 Retrieved from Microsoft clip art program on 11/23/11.
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4. Anatomy of the Upper Gastrointestinal Tract
Figure 3 anatomy of upper gastrointestinal tract. Retrieved from on 11/22/11
Figure 3
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5. Nasogastric Tubes Figure 6 Figure 5 Figure 4 Figure 7 Figure 8
Figure 4 Retrieved from healthmad.com on 11/22/11. Figure 5 Retrieved from allegromedical.com on 11/22/11
Figure 6 Retrieved from on 11/22/11. Figure 7 Retrieved from radiographicceu.com on 11/21/11
Figure 8 Retrieved from studentrntiffany.wordpress.com on 11/22/11.
Figure 7
Figure 8
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6. Conditions requiring Nasogastric Tube Placement
Stomach decompression for small bowel obstruction such as an ileus
Gastric contents evacuation such as overdose or hemorrhage
Gastric lavage
Sampling of gastric contents for analysis, medications, and fluids
Feedings
(McHale Wiegand & Carlson, 2005)
Figure 9
Figure 9 Retrieved from medicaldevicenow.com on 11/22/11. Figure 32 retrieved from Microsoft clipart program on 11/23/11.
Figure 32
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7. Patient Assessment prior to Nasogastric Tube Placement
If possible ask patient for information regarding their past medical history, be sure to include questions about:
ingestion of drugs or toxins
nasal deformities
epistaxis
facial surgery
trauma-facial or head
sinusitis
transphenoidal pituitary resection
history of basilar skull fracture
varicies
recent esophageal or gastric surgeries
(McHale Wiegand & Carlson, 2005)
Figure 10 Retrieved from Microsoft clipart software on 11/22/11.
Figure 10
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8. Patient Assessment prior to Nasogastric Tube Placement
Please note signs and symptoms such as:
Abdominal distention
Nausea
Vomiting
Absence of bowel sounds
(McHale Wiegand & Carlson, 2005)
Absence of bowel movements
Note last bowel movement and type
Figure 11 Retrieved from Microsoft clip art program on 11/22/11.
Figure 11
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9. Orders
Orders
Nasogastric tube placement requires physician orders whether verbal or written. Do not forget to write them.
Figure 12 Retrieved from cardinalhealth.com on 11/22/11. Figure 13 Retrieved from surgical-products.salvin.com on 11/22/11. Figure 14 Retrieved from covidien.com on 11/22/11.
Figure 12
Figure 13
Figure 14
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10. Supplies and Equipment supplies may include:
Figure 15
Nasogastric tube
Water soluble lubricant
Gloves
Cup of water
Irrigation kit, fill with tap water
Stethoscope
Nasogastric tube holder
towel
Suction tubing x2
Suction regulator
Suction canister
Silk tape and safety pin
Antireflux valve if no suction is needed
Figure 15 Retrieved from Microsoft clip art program on 11/22/11. Figure 16 Retrieved from studentrntiffany.wordpress.com on 11/22/11.
Figure 16
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11. Supplies and Equipment supplies may include:
Figure 17
Figure 19
Figure 20
Figure 18
Figure 17 Retrieved from Microsoft clip art program on 11/22/11. Figure 18 Retrieved from pstdental.com on 11/22/11. Figure 19 Retrieved from sci.rutgers.edu on 11/22/11. Figure 20 Retrieved from Microsoft clip art program on 11/22/11. Figure 21 Retrieved from penncare.net on 11/22/11. Figure 22 Retrieved from hellotrade.com on 11/22/11. Figure 23 Retrieved from gomedsource.com on 11/22/11.
Figure 21
Figure 22
Figure 23
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12. Patient Education Explain the procedure to your patient
Let the patient know that they have an important role as well
Explain that discomfort will be felt briefly and that the gag reflex may be elicited
(McHale Wiegand & Carlson, 2005)
Explain to the patient that you may have someone help you with a few things
Figure 24
Figure 24 Retrieved from sjbhealth.org on 11/22/11.
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13. Nasogastric Tube Preparation
Figure 25
You may want to review your facility’s policy and procedure first
Place patient in a high Fowler’s position if awake and alert
Place patient with the head down on the left side if they are comatose or sedated
Place a towel on the patient’s chest
(McHale Wiegand & Carlson, 2005)
Figure 25 Retrieved from medtrng.com on 11/23/11. Figure 26 Retrieved from paramedicine.com on 11/23/11.
Figure 26
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14. Nasogastric Tube Preparation cont.
Figure 27
Measure the tube from the bridge of the nose to the earlobe to the tip of the xiphoid process and mark the tube
Have your supplies and equipment ready
Setup suction if necessary(remember that suction for nasogastric tubes is almost always low and intermittent)
Have patient close a nare and breath through the other to assess which is the most patent
(McHale Wiegand & Carlson, 2005)
Figure 27 Retrieved from med.uottawa.ca on 11/23/11.
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15. Nasogastric Tube Insertion and Security
Wash hands
Place gloves
Lubricate 6-10cm of the nasogastric tube
Insert the tube through the nare directing it slightly upward first then down and back
You may rotate the tube with a twisting motion if resistance is met, but do not force it
(McHale Wiegand & Carlson, 2005)
Figure 28
Figure 28 Retrieved from isisthescientist.com on 11/22/11.
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16. Nasogastric Tube Insertion and Security cont.
Figure 22
Continue to advance the tube and have patient drink a few sips of water while advancing
If the patient gags or coughs, stop and let the patient rest
Confirm the tube placement
Secure tube with nasogastric tube holder or tape and safety pin to gown with tape
If the physician has requested suction then the end of the tube will attach to the suction tubing coming from the suction container
(McHale Wiegand & Carlson, 2005)
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17. Placement Verification
Figure 30
Nasogastric tube placement can be confirmed by injecting air into the distal end of the tube via a syringe or chest x-ray.
Most facilities require that nasogastric tube placement be confirmed via chest x-ray prior to its use
Figure 30 Retrieved from csee.usf.edu on 11/23/11. Figure 31 Retrieved from patientsafetyauthority.org on 11/23/11.
Figure 31
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18. Maintenance of the Nasogastric Tube
Every facility or hospital will have a policy for maintenance of the nasogastric tube, however here are a few tips.
Check for patency every 4 hours
Monitor output for amount, color, type
Perform oral care
Monitor nare/insertion site for redness, swelling, drainage, bleeding, or breakdown
Irrigate nasogastric tube if necessary
Maintain tube to suction if ordered so
Monitor vital signs and assess respiratory and gastrointestinal
Reposition and retape tube if necessary
(McHale Wiegand & Carlson, 2005)
Figure 33 Retrieved from Microsoft clipart program on 11/23/11.
Figure 33
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19. Nasogastric Tube removal
Wash hands and place gloves
Cover patient with a towel
Have a red biohazard bag prepared
Gently remove the tape or holder from nose
Withdraw tube gently and in one fluid motion
Place tube in red bag
Provide nasal care if necessary
Place powder for gelatin in container of gastric secretions and also place in red bag
Dispose of red bags appropriately
(McHale Wiegand & Carlson, 2005)
Figure 34
Figure 34 Retrieved from Microsoft clipart program on 11/23/11.
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20. Documentation Patient education
placement and patient’s tolerance to procedure
type and size of tube
proof of placement
removal
nasogastric tube output in I/O charting
What the output appears like and amount
Nasal care
Unexpected outcomes
Any nursing interventions
(McHale Wiegand & Carlson, 2005)
Figure 35 Retrieved from Microsoft clipart program on 11/23/11.
Figure 35
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21. Expected Unexpected Outcomes Outcomes
“Decompression of the stomach
Evacuation of the stomach and proximal small intestine
Instillation of fluid, medications, or feedings
Tube placement in to trachea, bronchus or esophagus
Bleeding from nose, mouth, stomach, esophagus
Vagal response
Skin ulceration, sinusitis, esophageal-tracheal fistula, gastric ulceration, infection
Vomiting
Aspiration”
Figure 36 and 37 Retrieved from Microsoft clipart program on 11/23/11.
Figure 36
(McHale Wiegand & Carlson, 2005)
Figure 37
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22. References
Mchale Wiegand, D., Carlson, K. (2005). AACN Procedure Manual for Critical Care-Nasogastric Tube Insertion, Care, and Removal(5th ed.). St. Louis, MO: Elsevier Saunders.
2/17/2019