2. Stacy McClelland University of South Florida

3. Objectives Explain the objective(s) of the procedure. Identify equipment needed for the procedure. Describe the steps of a nasogastric tube insertion. Describe how to verify placement.

4. Planning & Preparation Verify order Understand purpose or use Verify correct patient Discuss procedure Gather equipment

5. Equipment Large-bore nasogastric tube 50 mL catheter tip syringe Water soluble lubricant Glass of water with straw Tape and permanent marker pH chemstrip or Gastroccult testcard and developer

6. Insertion Prior to procedure have patient hold ice chips in mouth. Prepare tube with ice or warm water. Position patient in high Fowler’s. Check patency of nares. Measure distance needed for tube placement. Lubricate tube tip.

7. Insertion Continued With patient’s head lifted insert tube down and back into nasal passage. Have patient position chin to chest and continue swallowing until marked length is reached. View position of tube by using tongue blade and penlight Inject air into tube to note sound of air in the upper left abdominal quadrant. Attach syringe to end of tube to aspirate a small amount of stomach contents. Clamp tube and secure placement then to suction.

8. Insertion Continued (adapted from Smith, Duell, and Martin, 2008, p.654). (adapted from Smith, Duell, and Martin, 2008, p. 655).

9. Documentation Type of tube inserted Methods used for placement verification Type of suction and setting Gastrointestinal findings Patient’s tolerance of procedure

10. Clinical Pearls Oral hygiene Saline for flushing Altered appearance (adapted from Smith, Duell, and Martin, 2008, p. 656).

11. Learner Evaluation Performed by instructor Simulation lab Written and/or oral explanation

12. References McQuaid, K. R. (2011). Gastrointestinal disorders. In S. J. McPhee, M. A. Papadakis, & M. W. Rabow (Eds.), 2011 Current medical diagnosis & treatment (50 th ed). (pp. 540- 638). New York, NY: McGraw Hill. Rabow, M. W., & Pantilat, S. Z. (2011). Palliative care and pain management. In S. J. McPhee, M. A. Papadakis, & M. W. Rabow (Eds.), 2011 Current medical diagnosis & treatment (50 th ed). (pp. 76-94). New York, NY: McGraw Hill.

13. References Continued Smith, S. F., Duell, D. J., & Martin, B. C. (2008). Clinical nursing skills: Basic to Advanced skills (7 th ed.). Upper Saddle River, NJ: Pearson Prentice Hall. Tampa General Hospital (2011, October). GI Intubation. [Employee Policies and Procedures]. Copy in possession of author, internal document not accessible by hyperlink.