Even though you’ll have gloves on, you should still wash your hands with warm water and antibacterial soap to further reduce the risk of introducing germs into the nasogastric tube.
Talking the patient through the procedure before you perform it can allow you to gain his or her trust while also calming the patient down.
If the patient has a difficult time holding his or her head up, you may need someone to assist you by holding the patient’s head forward. You can also use stiff pillows to hold the head steady. When placing an NG tube in a baby, you can lay the baby back instead of holding him or her in an upright sitting position. The baby’s face should be up, and the chin should be slightly raised.
You will need to insert the tube into whichever nostril appears clearest. If necessary, use a small flashlight or similar light to look into the nostrils.
Start at the bridge of the nose, then draw the tube across the face to the earlobe. From the earlobe, draw the tube down to the xiphisternum, which lies halfway between the end of the sternum and the navel. This point lies at the center front of the body, where the lower ribs meet. For an infant, this point will be roughly one finger-width beneath the chest bone. For a child, measure two finger-widths. The distance can vary more dramatically for teenagers and adults depending on height. Write down the proper measurement on the tube using permanent marker.
This procedure can be uncomfortable for many patients, and the use of throat spray can minimize discomfort and reduce gagging. It is not strictly necessary, however.
Using a lubricant containing 2-percent Xylocaine or a similar anesthetic can further reduce irritation and discomfort.
The patient must continue looking straight at you. Direct the tube down and toward the ear on that side of the head. Do not allow the tube to feed upward and into the brain. Stop if you feel resistance. Pull the tube out and try the other nostril. Never force the tube inward.
For patients who were not treated with throat spray, opening the mouth might be too painful. Instead, you should simply ask the patient to indicate when he or she feels the tube at the back of the throat. As soon as the tube hits the top of the throat, guide the patient’s head so that the chin touches the chest. This can help encourage the tube into the esophagus, rather than into the trachea.
If the patient is unable to drink water for any reason, you should still encourage him or her to dry swallow as you feed the tube into the throat. For infants, give the patient a pacifier to encourage him or her to suck and swallow during the process.
If you meet resistance further into the throat, slowly rotate the tube as you advance it. This should help. If the tube still gives considerable resistance, pull it out and try again. Never force it in. Stop immediately and remove the tube if you notice a change in the patient’s respiratory status. This can include choking, coughing, or difficulty breathing. A change in respiratory status suggests that the tube has been inserted into the trachea by mistake. [8] X Research source You should also remove the tube if it comes out of the patient’s mouth.
Draw back the plunger of the syringe to collect 3 ml of air, then attach the syringe to the open end of the tube. Place a stethoscope over the patient’s stomach, just below the ribs and toward the left side of the body. Quickly depress the plunger to insert the air into the tube. You should hear a gurgling or popping sound through the stethoscope if the tube has been positioned correctly. Remove the tube if you suspect improper placement.
Attach an empty syringe toe the adapter at the free end of the tube. Lift the plunger to draw 2 ml of stomach contents into the tube. Wet the pH indicator paper with the collected sample and compare the color on the strip to its corresponding color chart. The pH should usually be between 1 and 5. 5 Remove the tube if the pH is too high or if you otherwise suspect improper placement. [10] X Research source
Attach one piece of tape to the patient’s nose, then wrap the ends of that piece around the tube. Place a separate piece of tape across the tube and over the patient’s cheek, as well. The tube must not be able to move around as the patient moves his or her head naturally.
Help the patient ease into a comfortable resting position. Make sure that the tube is not cut off or strained. Once the patient is comfortable, you should be able to remove your gloves and wash your hands. Throw the gloves away in a clinical waste bin, and use warm water and antibacterial soap to wash your hands.
Do this before using the tube to deliver food or medications. The x-ray technician should promptly deliver the x-ray results, and proper placement can then be confirmed by a doctor or nurse.
You’ll need to attach a bile bag to the end of the tube if you want to drain out digestive waste fluids. Alternatively, you may need to attach the end of the tube to a suction machine. Set the machine suction and pressure as indicated for that patient’s specific needs. If you need to use the NG tube for feeding or medication, you might need to remove the guide wire from inside before inserting anything into the stomach. Flush 1 to 2 ml of water through the tube before carefully pulling the guide wire straight out. Clean the wire, dry it, and store it in a safe, sterile location for later use. Regardless of what the tube is used for, you should document its usage closely. Write down the reason for its insertion, the type and size of the tube, and all other medical details dealing with the usage of the tube. [13] X Research source
