{"id":1043,"date":"2015-06-18T15:19:06","date_gmt":"2015-06-18T19:19:06","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/10-2-nasogastric-tubes\/"},"modified":"2019-09-30T14:35:30","modified_gmt":"2019-09-30T18:35:30","slug":"10-3-nasogastric-tubes","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/10-3-nasogastric-tubes\/","title":{"raw":"10.3 Nasogastric Tubes","rendered":"10.3 Nasogastric Tubes"},"content":{"raw":"<h2>Using a Nasogastric Tube<\/h2>\r\nA nasogastric (NG) tube is a hollow flexible plastic or silicone tube inserted through a nare, past the nasopharynx, oropharynx and into the stomach or the upper portion of the small intestine (the later referred to as naso-jejunum). NG tubes are used for feeding, gastric decompression, or gastric lavage.\r\n\r\n<strong>An NG tube used for feeding<\/strong> is usually softer and has a smaller lumen than tubes used for gastric suctioning \/ decompression. NG feeding tubes are used for patients who may have swallowing difficulties or require additional nutritional supplements. Placement of blindly inserted enteral tubes must be verified by x-ray before initial use for feedings or medication administration (Bourgault et al., 2014).\u00a0Blindly inserted means there has not been direct visualization that the tube in the correct position.\r\n\r\nSometimes normal peristalsis is interrupted (i.e., post op, in association with certain conditions). In these situations a <strong>naso gastric tube is used for gastric decompression<\/strong>. Removal of gastric contents can be done either by gravity or by being connected to a suction pump. In these situations, the NG tube is used to relieve gastric distention and in doing so prevent nausea and vomiting. In the event a patient swallows toxic substances, a nasogastric tube can be inserted and used to lavage or wash the stomach of\u00a0its contents. NG tubes for these purposes generally have a larger lumen than tubes used for feeding purposes (Perry et al., 2018). Sometimes referred to as a Salem Sump or Levin, these tubes are double lumen. The main lumen is attached to suction, the second lumen acts as an air vent which prevents suctioning of gastric mucosa when the stomach is empty.\r\n\r\nWhen working with people who have nasogastric tubes, remember the following care measures:\r\n<ul>\r\n \t<li>There is potential for pressure injury at the nares and in the mucosa. The tube constantly irritates the nasal mucosa. Ensure that the tube is securely\u00a0anchored to the patient's\u00a0nose to prevent excess tube movement, and is secured to the gown to avoid excessive pulling or dragging.<\/li>\r\n \t<li>There is potential for nasal and mouth dryness and discomfort. Because one nostril is blocked, patients tend to mouth breathe. This can cause drying of the nasal and oral mucosa, and patients will complain of thirst, but they are usually NPO (<em>nil per os<\/em>, or nothing by mouth). Provide mouth care frequently. This can include rinsing the mouth with cold water or mouthwash as long as the patient does\u00a0not swallow. Silicone based mouth care products are helpful for some. Some patients\u00a0may be allowed to suck on ice chips.<\/li>\r\n \t<li>Potential for tube obstruction resulting in abdominal pain, discomfort, nausea, or vomiting. In such cases the nurse must investigate complaints of these things immediately, ensuring the drainage flow is not obstructed and to determine if the tube needs to be irrigated.<\/li>\r\n \t<li>Risk of aspiration. Persons with these tubes should <em>never <\/em>be allowed to lie completely flat. Lying flat increases the patient's risk of aspirating stomach contents. The head of bed should always be raised 30 degrees or higher (consult agency policy).<\/li>\r\n \t<li>Potential for tube migration. Ensure tape is secure on the tube and nose or face. Measure and record the external length and compare to previous measurements.<\/li>\r\n \t<li>If used for decompression, assess GI function including secretion volume, character, and pH (Perry et al., 2018).<\/li>\r\n \t<li>NG tubes used for decompression: Set suction as ordered or low if not specifically ordered<\/li>\r\n \t<li>Tubes that appear plugged from medications or tube feed may require declogging (consult agency guidelines).<\/li>\r\n<\/ul>\r\n<ul>\r\n \t<li>Check agency policy for checking tube placement, which may include:<\/li>\r\n<\/ul>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li>X-ray. This is the gold standard for NG tube verification (Stewart, 2014).<\/li>\r\n \t<li>Gentle aspiration with a syringe to observe gastric contents for amount, colour, and quality. Gastric contents can be green, off white, tan, bloody, brown, or yellow.<\/li>\r\n \t<li>Use pH paper to measure pH of aspirate. Keep in mind that certain medications can alter gastric pH making this part of the assessment unreliable\u00a0 for some patients (Lilley et al., 2016). pH alone cannot accurately distinguish between gastric and respiratory placement. Radiographic confirmation may still be necessary (Perry et al., 2018).<\/li>\r\n \t<li>External length when recorded, assessed frequently and compared with current readings helps to establish tube migration.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<ul>\r\n \t<li>Know the patient\u2019s history: Persons with recent gastric surgery cannot have NG tubes inserted or reinserted blindly.<\/li>\r\n<\/ul>\r\nChecklist 80 outlines the steps for inserting a nasogastric tube.\r\n<table style=\"border-color: #000000\">\r\n<tbody>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"4\">\r\n<h3 style=\"text-align: center\"><a id=\"checklist80\"><\/a>Checklist 80: Inserting a Nasogastric Tube\u2014Adult<\/h3>\r\n<h5 style=\"text-align: center\"><em><span style=\"color: #000000\">Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 837.906px\" colspan=\"4\">\r\n<h5><span style=\"color: #333333\">Safety considerations:\u00a0<\/span><\/h5>\r\n<ul>\r\n \t<li>Perform\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-3-hand-hygiene-and-non-sterile-gloves\/\">hand hygiene<\/a>.<\/li>\r\n \t<li><span style=\"color: #333333\">Check room for <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-4-additional-precautions-and-personal-protective-equipment-ppe\/\">additional precautions.<\/a><\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Introduce yourself to patient.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\r\n \t<li>Know the patient history for nasal problems, facial trauma, anticoagulant therapy, basilar skull fracture, conditions involving the esophagus (varices, strictures, surgery).<\/li>\r\n \t<li>Know the rationale for the NG.<\/li>\r\n \t<li><span style=\"color: #333333\">Explain process to patient;\u00a0offer analgesia, bathroom, etc.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Listen and attend to patient cues.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Ensure patient's privacy and dignity.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Complete <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-13-quick-priority-assessment-qpa\/\">QPA<\/a> including safety<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Apply <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-5-principles-of-surgical-asepsis\/\">principles of\u00a0asepsis<\/a>\u00a0<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Check\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-4-vital-signs\/\">vital signs.<\/a><\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Complete\u00a0necessary\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-5-head-to-toe-systems-approach-to-assessment\/\">focused assessments<\/a>.<\/span><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 50%;text-align: center\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000;width: 50%;text-align: center\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">1. Perform <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-3-hand-hygiene-and-non-sterile-gloves\/\">hand hygiene<\/a>. Check prescriber's orders for type of NG tube to be placed and reason for placement. Gather supplies.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This\u00a0prevents the transmission of microorganisms. Check\u00a0appropriate orders relevant to patient safety.\r\n\r\nSupplies include NG tube, lubricant, towel, tape securement device, catheter tip syringe, cup of water with straw.\r\n\r\nIf no specific order for NG tube size, use your nursing judgment: large lumens\u2192decompression; small lumens\u2192feeding.\r\n\r\n[caption id=\"attachment_5642\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1715.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1715-150x150.jpg\" alt=\"Gather supplies \" class=\"wp-image-5642 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Gather supplies[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">2. Assess patient's level of consciousness and understanding of procedure.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">Patient must be able to follow instructions related to NG\u00a0insertion to allow for passage of tube through nasal and gastrointestinal tracts.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">3.\u00a0Visually inspect condition of patient's nasal and oral cavities.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">Check for\u00a0signs of infection or skin breakdown. If the patient is at risk for intracranial passage of the tube (i.e., basilar skull fracture) avoid the nasal route. Consult prescriber for alternate route.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">4.\u00a0Palpate patient's abdomen for distension, pain, and\/or rigidity. Auscultate for bowel sounds.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">Document assessment findings and determine appropriateness of NG tube insertion related to reason for insertion and patient's physical assessment.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">5. Apply clean gloves. Assess for the best nostril before you begin. Do this by occluding one side and asking the patient to sniff.\u00a0Ask the patient about previous injuries or history of a deviated septum.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">If either nostril is equally suitable, select the nostril closest to the suction.\r\n\r\n[caption id=\"attachment_5627\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1687.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1687-150x150.jpg\" alt=\"Assess for most patent nostril\" class=\"wp-image-5627 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Assess for most patent nostril[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">6. Position patient sitting up at 45 to 90 degrees (unless contraindicated by the patient's condition), with a pillow under the head and shoulders.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This position allows the NG tube to pass more easily through the nasopharynx and into the stomach.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">7. Raise bed to a comfortable working height.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This helps prevent biomechanical injury to the healthcare provider.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">8. Explain the procedure to the patient. Agree on a signal the patient can use if they wish you to pause during the procedure.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This procedure can be anxiety-provoking and uncomfortable for many patients. Providing a means for the patient to communicate discomfort and a desire to pause during the procedure helps alleviate anxiety.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">9. Place a towel on\u00a0the patient's chest and provide facial tissues and an emesis basin.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">Nasal and oral secretions may be evident during the procedure.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">10. Provide patient with drinking water and a straw if the patient is not fluid restricted and can hold the cup.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">Sipping water through a straw helps to\u00a0initiate the swallowing reflex and facilitate passing of NG tube.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">11. Stand on patient's right side if you are right-handed and the left side if you are left-handed.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">You will use your dominant hand to insert the tube.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">12. Measure distance of the tube from:\r\n<ul>\r\n \t<li>The tip of the nose, to...<\/li>\r\n \t<li>The earlobe, to...<\/li>\r\n \t<li>The xiphoid process,<\/li>\r\n<\/ul>\r\n<p style=\"padding-left: 30px\">and then mark the tube at this point.<\/p>\r\n<strong>Note:<\/strong> Add 20 to 30 cm for an NJ tube.\r\n\r\n&nbsp;<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This determines the appropriate length of NG tube to be inserted.\r\n\r\n[caption id=\"attachment_6404\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2210.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_2210-150x150.jpg\" alt=\"Measure from tip of nose to earlobe\" class=\"wp-image-6404 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Measure from tip of nose to earlobe[\/caption]\r\n\r\n[caption id=\"attachment_6405\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2211.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_2211-150x150.jpg\" alt=\"Measure from earlobe to xiphoid process\" class=\"wp-image-6405 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Measure from earlobe to xiphoid process[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">13. Curve 10 to 15 cm of the end of the NG tube around your gloved finger, and then release it.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">Curling the NG tube around your finger helps it conform to the normal curve\u00a0of the nasopharynx.\r\n\r\n<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2123.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_2123-150x150.jpg\" alt=\"Curl the NG tube around your finger to help it conform to the normal curve of the nasopharynx\" class=\"aligncenter wp-image-6387 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">14. Lubricate NG tube tip according to your agency policy (often approx 10 cm).\r\n\r\nIf inserting a weighted feeding tube with a stylet or guidewire, follow manufacturer's instructions for lubrication (often involves injecting water into in)\r\n\r\nPrepare securement device.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">\r\n\r\n[caption id=\"attachment_5633\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1697.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1697-150x150.jpg\" alt=\"Lubricate tip of tube as per agency policy\" class=\"wp-image-5633 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Lubricate tip of tube as per agency policy[\/caption]\r\n\r\nNever use non-water-soluble lubricant (e.g., Vaseline), as it will not dissolve and may cause respiratory complications if it enters the lungs.\r\n\r\nAgency policy might restrict who can insert a weighted feeding tube.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">15. Have patient drop head forward\u00a0and breathe through the mouth.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">Dropping the head forward closes the trachea and opens the esophagus, which\u00a0allows the NG tube to pass more easily through the nasopharynx and into the stomach.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">16. Insert NG tube tip slowly into\u00a0the patient's nostril and advance it steadily, in a downward direction, along the bottom of the nasal passage, with the curved end pointing downward\u00a0in the direction of the ear on the same side as the nostril.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This follows the natural anatomical alignment of the nasopharynx.\r\n\r\n[caption id=\"attachment_5634\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1700.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1700-150x150.jpg\" alt=\"Insert nasogastric tube slowly into patient's nostril\" class=\"wp-image-5634 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Insert nasogastric tube slowly into patient's nostril[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">17. You may feel slight resistance as you advance along the nasal passage. Twist the tube slightly, apply downward pressure, and continue trying to advance the tube. If significant resistance is felt, remove the tube and allow the patient to rest before trying again in the other nostril.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">It is common for the patient to feel discomfort, and this may be expressed with light coughing and gagging. More aggressive coughing and gagging may indicate that the tube has entered the airways, in which case\u00a0you should STOP and wait for the coughing to stop. If it doesn't stop, withdraw the NG tube.\r\n\r\n[caption id=\"attachment_5635\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1702.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1702-150x150.jpg\" alt=\"Advance the tube gently\" class=\"wp-image-5635 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Advance the tube gently[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">18. If the patient has difficulty in passing the NG tube, you may ask the patient to sip water slowly through a straw unless oral\u00a0fluids are contraindicated. If oral fluids are not allowed, ask the patient to try dry swallowing while you advance the tube.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">If patient continues to gag or cough, check that the tube is not coiled\u00a0in the back of the mouth, using a tongue blade and a flashlight to check the back of the mouth. If tube is coiled, withdraw the tube until only the tip of the tube is seen in the back of the mouth. Then try advancing the tube again while the\u00a0 patient tries to swallow.\r\n\r\n[caption id=\"attachment_5636\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1704.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1704-150x150.jpg\" alt=\"Patient may sip water slowly through a straw\" class=\"wp-image-5636 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Patient may sip water slowly through a straw[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">19. Continue to advance NG tube until you reach the mark\/tape you had placed for measurement.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This ensures accurate placement.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">20. Temporarily anchor the tube to patient's cheek with a piece of tape until you can check for correct placement.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This prevents displacement of the NG tube while checking placement.\r\n\r\n[caption id=\"attachment_5617\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1668.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1668-150x150.jpg\" alt=\"Anchor tube\" class=\"wp-image-5617 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Anchor tube[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">21. Verify tube placement according to agency policy. This may include\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li>X-ray (gold standard)<\/li>\r\n \t<li>Gentle aspiration with a syringe to observe gastric contents for amount, color, and quality. Gastric contents can be green, off white, tan, bloody, brown, or yellow.<\/li>\r\n \t<li>Use pH paper to measure pH of aspirate.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\nColor-coded pH paper is usually used,\u00a0as an initial and interim check, to confirm that acidic contents are present. Then an X-ray is taken to confirm placement prior to using NG tube for feeding.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">The contents aspirated from the tube should be acidic with a pH &lt; 5. If the pH is more than 6, it\u00a0may indicate the presence of respiratory fluids or small bowel content, and the tube should be removed. Note: some medications alter gastric pH thus making this method of assessing placement NOT 100% reliable.\r\n\r\n[caption id=\"attachment_5640\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1711.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1711-150x150.jpg\" alt=\"Verify tube placement using pH paper\" class=\"wp-image-5640 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Verify tube placement using pH paper[\/caption]\r\n\r\nAuscultation of air being injected into the stomach is not a reliable means to determine position of a feeding tube . It cannot distinguish between gastric and small bowel placement nor if the tube tip is in the esophagus.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">22. Once the tube placement has been confirmed, secure the tube to the patient's nose with tape or a securement device.\r\n\r\nDetermine <strong>external length<\/strong> (the length of tubing extending from the nose to the outer end of the tube).<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This aids in timely recognition and identification of tube displacement or migration.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">23. Secure the tube to the patient's gown with a safety pin, allowing enough tube length for comfortable head movement.\r\n\r\n&nbsp;\r\n\r\nHelp the patient to a comfortable position.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This keeps the NG tube in place.\r\n\r\n[caption id=\"attachment_5639\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1708.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1708-150x150.jpg\" alt=\"Secure the tube to the patient's gown with a safety pin\" class=\"wp-image-5639 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Secure the tube to the patient's gown to avoid tugging and pulling[\/caption]\r\n\r\nPersons with tube feeds require the head of bed elevated at 30 degrees (or as per agency policy) unless contraindicated to\u00a0\u2193 risk of aspiration.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">24. Document the procedure according to\u00a0agency policy, and report any unexpected findings to the appropriate healthcare provider.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">Timely and accurate documentation promotes patient safety.\r\n\r\nSample documentation: <em>date \/ time: Abdomen distended, firm. Reports ++ nausea. Frequent vomiting throughout morning. No bowel sounds. Reported to Dr GI. Orders received. #16 levine inserted right nare for 800 ml dark green returns. Attached to low suction. Tolerated well with reports of less nausea following.------RLeaf\u00a0 \u00a0RN<\/em><\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 837.906px\" colspan=\"4\">Data sources: BCIT, 2015c; Berman &amp; Snyder, 2016;\u00a0Bourgault et al., 2014; Potter et al., 2018; Simons &amp; Abdallah, 2012.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h5>Special Considerations with NG Tubes:<\/h5>\r\n<ul>\r\n \t<li>Always assess correct placement of the NG tube prior to infusing any fluids or tube feeds as per agency policy. Check external length, color and pH of the fluid aspirated from the tube. Routine evaluation of tube placement will promote patient safety by reducing risk of aspiration. Do not instill air to test location of tube.<\/li>\r\n \t<li>Do not give the patient anything to eat or drink without knowing that the patient has passed a swallowing assessment.<\/li>\r\n \t<li>If changing the gown or re-positioning the patient, take care not to pull on the NG tube. Remember to unfasten the tube from the gown and refasten the tube afterward.<\/li>\r\n \t<li>If the NG tube falls out of the patient, it\u00a0is not an emergency. <em>But<\/em> be sure to\u00a0assess your patient.<\/li>\r\n \t<li>A patient who appears to be in respiratory distress\u00a0should be considered an emergency, and emergency procedures should be followed. Respiratory distress may present as\u00a0coughing, choking, or reduced oxygen saturation.<\/li>\r\n<\/ul>\r\n<div class=\"textbox shaded\" style=\"text-align: center\">Watch the video<span>\u00a0<a href=\"https:\/\/barabus.tru.ca\/nursing\/nasogastric_tube_insertion.html\"><em>Insertion of a NG Tube<\/em><\/a> developed by Ren\u00e9e Anderson and Wendy McKenzie (2018) of Thompon Rivers University School of Nursing.\u00a0\u00a0<\/span><\/div>\r\n<h2>Removing a NG Tube<\/h2>\r\nA NG tube should be removed if it is no longer required. The process of removal is usually very quick. Prior to removing the NG tube, verify physician orders. If the NG tube is ordered to remove gastric contents, the physician's order may state to \"trial\" clamping the tube for a number of hours to see if the patient tolerates oral intake or their own accumulation of gastric secretions prior to the tube removal. During the trial, the patient should not experience any nausea, vomiting, or abdominal distension. If they do experience these things, simply reattach the NG to suction.\u00a0To review how to remove a NG tube, refer to\u00a0Checklist 81.\r\n<table style=\"border-color: #000000;height: 3050px\">\r\n<tbody>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: center;height: 204px;width: 977.4px\" colspan=\"4\">\r\n<h3 style=\"text-align: center\"><a id=\"checklist81\"><\/a>Checklist 81: Removal of a NG Tube<\/h3>\r\n<h5 style=\"text-align: center\"><em><span style=\"color: #000000\">Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;height: 472px;width: 977.4px\" colspan=\"4\">\r\n<h5><span style=\"color: #333333\">Safety considerations:\u00a0<\/span><\/h5>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li>Perform\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-3-hand-hygiene-and-non-sterile-gloves\/\">hand hygiene<\/a>.<\/li>\r\n \t<li><span style=\"color: #333333\">Check room for <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-4-additional-precautions-and-personal-protective-equipment-ppe\/\">additional precautions.<\/a><\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Introduce yourself to patient.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\r\n \t<li>Know the rationale for the NG.<\/li>\r\n \t<li><span style=\"color: #333333\">Explain process to patient;\u00a0offer comfort measures ie. bathroom, etc.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Listen and attend to patient cues.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Ensure patient's privacy and dignity.<\/span><\/li>\r\n \t<li>Complete <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-13-quick-priority-assessment-qpa\/\">QPA<\/a> including safety.<\/li>\r\n \t<li><span style=\"color: #333333\">Apply <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-5-principles-of-surgical-asepsis\/\">principles of\u00a0asepsis<\/a> and safety.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Complete\u00a0necessary\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-5-head-to-toe-systems-approach-to-assessment\/\">focused assessments<\/a>.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;text-align: center;height: 121px\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;text-align: center;height: 121px\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 19px\" colspan=\"2\">1. Verify healthcare provider's orders to remove NG tube.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 19px\" colspan=\"2\">An order is required to remove an NG tube.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 57px\" colspan=\"2\">2. Collect supplies.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 57px\" colspan=\"2\">Supplies include waterproof pads, 20 ml catheter tip syringe, tissues, non-sterile gloves, and plastic garbage bag.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 38px\" colspan=\"2\">3. Verify patient using two identifiers. Explain procedure to patient and place patient in high Fowler's position.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 38px\" colspan=\"2\">Follow agency policy for proper patient identification.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 215px\" colspan=\"2\">4. Perform hand hygiene. Place waterproof pad on patient's chest.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 215px\" colspan=\"2\">This reduces the transmission of microorganisms.\r\n\r\n[caption id=\"attachment_5083\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/08\/DSC_1100.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1100-150x150.jpg\" alt=\"Perform hand hygiene\" class=\"wp-image-5083 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Perform hand hygiene[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 260px\" colspan=\"2\">5. Depending on the purpose of the tube either:\r\n<ul>\r\n \t<li>stop the tube feed and disconnect from feeding tube tubing; or<\/li>\r\n \t<li><span style=\"text-indent: 1em;font-family: inherit;font-size: inherit\">disconnect from suction tubing.<\/span><\/li>\r\n<\/ul>\r\n&nbsp;<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 260px\" colspan=\"2\">This reduces risk of aspiration of tube feed and makes disposal of equipment easier.\r\n\r\n[caption id=\"attachment_5615\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1664.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1664-150x150.jpg\" alt=\"Disconnect tube from feed or suction\" class=\"wp-image-5615 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Disconnect tube from feed or suction[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 306px\" colspan=\"2\">6.Flush tube with air and then kink tube<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 306px\" colspan=\"2\">\r\n\r\n[caption id=\"attachment_5616\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1667.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1667-150x150.jpg\" alt=\"Insert 10-20 mL of air into NG tube\" class=\"wp-image-5616 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Flush tube with air to clear tube feed \/ secretions[\/caption]\r\n\r\nFlushing the tube with air and kinking prevents leakage of fluid from the tube and prevents aspiration of tube feed or residual gastric secretions.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 260px\" colspan=\"2\">7. Unclip NG tube from patient's gown.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 260px\" colspan=\"2\">This allows for tube to be easily removed and disposed of immediately.\r\n\r\n[caption id=\"attachment_5614\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1663.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1663-150x150.jpg\" alt=\"Unclip NG tube from patient's gown\" class=\"wp-image-5614 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Unclip NG tube from patient's gown[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 150px\" colspan=\"2\"><span style=\"font-family: inherit;font-size: inherit\">8.\u00a0Remove securement device from nose (this is the last step prior to removing the tube thus preventing accidental tube removal before either the nurse or client are ready)<\/span><\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 150px\" colspan=\"2\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1669.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1669-150x150.jpg\" alt=\"Remove tape or securement device from nose\" class=\"wp-image-5618 size-thumbnail aligncenter\" width=\"150\" height=\"150\" \/><\/a><\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 38px\" colspan=\"2\">9.Instruct patient to take a deep breath and hold it.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 38px\" colspan=\"2\">Holding the breath closes the glottis, decreases risk of\u00a0aspiration, and distracts the patient.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 443px\" colspan=\"2\">10. Hold the NG tube near the naris and gently pull out tube in a swift, steady motion. Dispose of tube in garbage bag.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 443px\" colspan=\"2\">&nbsp;\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1672.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1672-150x150.jpg\" alt=\"Pull out tube in a swift, steady motion\" class=\"wp-image-5619 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Pull out tube in a swift, steady motion[\/caption]\r\n\r\n[caption id=\"attachment_5626\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1684.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1684-150x150.jpg\" alt=\"Wrap tube in glove and dispose as per agency policy\" class=\"wp-image-5626 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Wrap tube in glove and dispose as per agency policy[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 279px\" colspan=\"2\">11. Offer tissue or clean the nares for the patient, and offer mouth care as required.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 279px\" colspan=\"2\">This clears the nares\/nasal passages of any remaining secretions.\r\n\r\n[caption id=\"attachment_5627\" align=\"aligncenter\" width=\"150\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1687.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1687-150x150.jpg\" alt=\"Offer tissue or clean the nares for the patient \" class=\"wp-image-5627 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a> Offer tissue or clean the nares for the patient[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 131px\" colspan=\"2\">12. Remove gloves and place patient in a comfortable position. Assess patient's level of comfort. Perform hand hygiene.<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 131px\" colspan=\"2\">This promotes patient comfort and reduces the transmission of microorganisms.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 38px\" colspan=\"2\">13. Document procedure according to\u00a0agency policy<\/td>\r\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 38px\" colspan=\"2\">Document removal of NG tube and patient response to the removal.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;width: 977.4px;height: 19px\" colspan=\"4\">Data source:\u00a0 BCIT, 2015b; Perry et al., 2018<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"bcc-box bcc-info\">\r\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\r\n<ol>\r\n \t<li>You are inserting a nasogastric tube and the patient begins to cough and turn red in the face. Explain your next steps.<\/li>\r\n \t<li>Your patient has a nasogastric tube and is requesting water because her throat feels dry. Describe your next actions.<\/li>\r\n \t<li>Your patient calls you to say they've accidentally pulled out the NG. Explain your next steps.<\/li>\r\n<\/ol>\r\n<\/div>","rendered":"<h2>Using a Nasogastric Tube<\/h2>\n<p>A nasogastric (NG) tube is a hollow flexible plastic or silicone tube inserted through a nare, past the nasopharynx, oropharynx and into the stomach or the upper portion of the small intestine (the later referred to as naso-jejunum). NG tubes are used for feeding, gastric decompression, or gastric lavage.<\/p>\n<p><strong>An NG tube used for feeding<\/strong> is usually softer and has a smaller lumen than tubes used for gastric suctioning \/ decompression. NG feeding tubes are used for patients who may have swallowing difficulties or require additional nutritional supplements. Placement of blindly inserted enteral tubes must be verified by x-ray before initial use for feedings or medication administration (Bourgault et al., 2014).\u00a0Blindly inserted means there has not been direct visualization that the tube in the correct position.<\/p>\n<p>Sometimes normal peristalsis is interrupted (i.e., post op, in association with certain conditions). In these situations a <strong>naso gastric tube is used for gastric decompression<\/strong>. Removal of gastric contents can be done either by gravity or by being connected to a suction pump. In these situations, the NG tube is used to relieve gastric distention and in doing so prevent nausea and vomiting. In the event a patient swallows toxic substances, a nasogastric tube can be inserted and used to lavage or wash the stomach of\u00a0its contents. NG tubes for these purposes generally have a larger lumen than tubes used for feeding purposes (Perry et al., 2018). Sometimes referred to as a Salem Sump or Levin, these tubes are double lumen. The main lumen is attached to suction, the second lumen acts as an air vent which prevents suctioning of gastric mucosa when the stomach is empty.<\/p>\n<p>When working with people who have nasogastric tubes, remember the following care measures:<\/p>\n<ul>\n<li>There is potential for pressure injury at the nares and in the mucosa. The tube constantly irritates the nasal mucosa. Ensure that the tube is securely\u00a0anchored to the patient&#8217;s\u00a0nose to prevent excess tube movement, and is secured to the gown to avoid excessive pulling or dragging.<\/li>\n<li>There is potential for nasal and mouth dryness and discomfort. Because one nostril is blocked, patients tend to mouth breathe. This can cause drying of the nasal and oral mucosa, and patients will complain of thirst, but they are usually NPO (<em>nil per os<\/em>, or nothing by mouth). Provide mouth care frequently. This can include rinsing the mouth with cold water or mouthwash as long as the patient does\u00a0not swallow. Silicone based mouth care products are helpful for some. Some patients\u00a0may be allowed to suck on ice chips.<\/li>\n<li>Potential for tube obstruction resulting in abdominal pain, discomfort, nausea, or vomiting. In such cases the nurse must investigate complaints of these things immediately, ensuring the drainage flow is not obstructed and to determine if the tube needs to be irrigated.<\/li>\n<li>Risk of aspiration. Persons with these tubes should <em>never <\/em>be allowed to lie completely flat. Lying flat increases the patient&#8217;s risk of aspirating stomach contents. The head of bed should always be raised 30 degrees or higher (consult agency policy).<\/li>\n<li>Potential for tube migration. Ensure tape is secure on the tube and nose or face. Measure and record the external length and compare to previous measurements.<\/li>\n<li>If used for decompression, assess GI function including secretion volume, character, and pH (Perry et al., 2018).<\/li>\n<li>NG tubes used for decompression: Set suction as ordered or low if not specifically ordered<\/li>\n<li>Tubes that appear plugged from medications or tube feed may require declogging (consult agency guidelines).<\/li>\n<\/ul>\n<ul>\n<li>Check agency policy for checking tube placement, which may include:<\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>X-ray. This is the gold standard for NG tube verification (Stewart, 2014).<\/li>\n<li>Gentle aspiration with a syringe to observe gastric contents for amount, colour, and quality. Gastric contents can be green, off white, tan, bloody, brown, or yellow.<\/li>\n<li>Use pH paper to measure pH of aspirate. Keep in mind that certain medications can alter gastric pH making this part of the assessment unreliable\u00a0 for some patients (Lilley et al., 2016). pH alone cannot accurately distinguish between gastric and respiratory placement. Radiographic confirmation may still be necessary (Perry et al., 2018).<\/li>\n<li>External length when recorded, assessed frequently and compared with current readings helps to establish tube migration.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Know the patient\u2019s history: Persons with recent gastric surgery cannot have NG tubes inserted or reinserted blindly.<\/li>\n<\/ul>\n<p>Checklist 80 outlines the steps for inserting a nasogastric tube.<\/p>\n<table style=\"border-color: #000000\">\n<tbody>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"4\">\n<h3 style=\"text-align: center\"><a id=\"checklist80\"><\/a>Checklist 80: Inserting a Nasogastric Tube\u2014Adult<\/h3>\n<h5 style=\"text-align: center\"><em><span style=\"color: #000000\">Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 837.906px\" colspan=\"4\">\n<h5><span style=\"color: #333333\">Safety considerations:\u00a0<\/span><\/h5>\n<ul>\n<li>Perform\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-3-hand-hygiene-and-non-sterile-gloves\/\">hand hygiene<\/a>.<\/li>\n<li><span style=\"color: #333333\">Check room for <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-4-additional-precautions-and-personal-protective-equipment-ppe\/\">additional precautions.<\/a><\/span><\/li>\n<li><span style=\"color: #333333\">Introduce yourself to patient.<\/span><\/li>\n<li><span style=\"color: #333333\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\n<li>Know the patient history for nasal problems, facial trauma, anticoagulant therapy, basilar skull fracture, conditions involving the esophagus (varices, strictures, surgery).<\/li>\n<li>Know the rationale for the NG.<\/li>\n<li><span style=\"color: #333333\">Explain process to patient;\u00a0offer analgesia, bathroom, etc.<\/span><\/li>\n<li><span style=\"color: #333333\">Listen and attend to patient cues.<\/span><\/li>\n<li><span style=\"color: #333333\">Ensure patient&#8217;s privacy and dignity.<\/span><\/li>\n<li><span style=\"color: #333333\">Complete <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-13-quick-priority-assessment-qpa\/\">QPA<\/a> including safety<\/span><\/li>\n<li><span style=\"color: #333333\">Apply <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-5-principles-of-surgical-asepsis\/\">principles of\u00a0asepsis<\/a>\u00a0<\/span><\/li>\n<li><span style=\"color: #333333\">Check\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-4-vital-signs\/\">vital signs.<\/a><\/span><\/li>\n<li><span style=\"color: #333333\">Complete\u00a0necessary\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-5-head-to-toe-systems-approach-to-assessment\/\">focused assessments<\/a>.<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 50%;text-align: center\" colspan=\"2\">\n<h4 style=\"text-align: center\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000;width: 50%;text-align: center\" colspan=\"2\">\n<h4 style=\"text-align: center\">\u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">1. Perform <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-3-hand-hygiene-and-non-sterile-gloves\/\">hand hygiene<\/a>. Check prescriber&#8217;s orders for type of NG tube to be placed and reason for placement. Gather supplies.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This\u00a0prevents the transmission of microorganisms. Check\u00a0appropriate orders relevant to patient safety.<\/p>\n<p>Supplies include NG tube, lubricant, towel, tape securement device, catheter tip syringe, cup of water with straw.<\/p>\n<p>If no specific order for NG tube size, use your nursing judgment: large lumens\u2192decompression; small lumens\u2192feeding.<\/p>\n<figure id=\"attachment_5642\" aria-describedby=\"caption-attachment-5642\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1715.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1715-150x150.jpg\" alt=\"Gather supplies\" class=\"wp-image-5642 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5642\" class=\"wp-caption-text\">Gather supplies<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">2. Assess patient&#8217;s level of consciousness and understanding of procedure.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">Patient must be able to follow instructions related to NG\u00a0insertion to allow for passage of tube through nasal and gastrointestinal tracts.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">3.\u00a0Visually inspect condition of patient&#8217;s nasal and oral cavities.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">Check for\u00a0signs of infection or skin breakdown. If the patient is at risk for intracranial passage of the tube (i.e., basilar skull fracture) avoid the nasal route. Consult prescriber for alternate route.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">4.\u00a0Palpate patient&#8217;s abdomen for distension, pain, and\/or rigidity. Auscultate for bowel sounds.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">Document assessment findings and determine appropriateness of NG tube insertion related to reason for insertion and patient&#8217;s physical assessment.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">5. Apply clean gloves. Assess for the best nostril before you begin. Do this by occluding one side and asking the patient to sniff.\u00a0Ask the patient about previous injuries or history of a deviated septum.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">If either nostril is equally suitable, select the nostril closest to the suction.<\/p>\n<figure id=\"attachment_5627\" aria-describedby=\"caption-attachment-5627\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1687.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1687-150x150.jpg\" alt=\"Assess for most patent nostril\" class=\"wp-image-5627 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5627\" class=\"wp-caption-text\">Assess for most patent nostril<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">6. Position patient sitting up at 45 to 90 degrees (unless contraindicated by the patient&#8217;s condition), with a pillow under the head and shoulders.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This position allows the NG tube to pass more easily through the nasopharynx and into the stomach.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">7. Raise bed to a comfortable working height.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This helps prevent biomechanical injury to the healthcare provider.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">8. Explain the procedure to the patient. Agree on a signal the patient can use if they wish you to pause during the procedure.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This procedure can be anxiety-provoking and uncomfortable for many patients. Providing a means for the patient to communicate discomfort and a desire to pause during the procedure helps alleviate anxiety.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">9. Place a towel on\u00a0the patient&#8217;s chest and provide facial tissues and an emesis basin.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">Nasal and oral secretions may be evident during the procedure.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">10. Provide patient with drinking water and a straw if the patient is not fluid restricted and can hold the cup.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">Sipping water through a straw helps to\u00a0initiate the swallowing reflex and facilitate passing of NG tube.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">11. Stand on patient&#8217;s right side if you are right-handed and the left side if you are left-handed.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">You will use your dominant hand to insert the tube.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">12. Measure distance of the tube from:<\/p>\n<ul>\n<li>The tip of the nose, to&#8230;<\/li>\n<li>The earlobe, to&#8230;<\/li>\n<li>The xiphoid process,<\/li>\n<\/ul>\n<p style=\"padding-left: 30px\">and then mark the tube at this point.<\/p>\n<p><strong>Note:<\/strong> Add 20 to 30 cm for an NJ tube.<\/p>\n<p>&nbsp;<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This determines the appropriate length of NG tube to be inserted.<\/p>\n<figure id=\"attachment_6404\" aria-describedby=\"caption-attachment-6404\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2210.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_2210-150x150.jpg\" alt=\"Measure from tip of nose to earlobe\" class=\"wp-image-6404 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-6404\" class=\"wp-caption-text\">Measure from tip of nose to earlobe<\/figcaption><\/figure>\n<figure id=\"attachment_6405\" aria-describedby=\"caption-attachment-6405\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2211.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_2211-150x150.jpg\" alt=\"Measure from earlobe to xiphoid process\" class=\"wp-image-6405 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-6405\" class=\"wp-caption-text\">Measure from earlobe to xiphoid process<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">13. Curve 10 to 15 cm of the end of the NG tube around your gloved finger, and then release it.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">Curling the NG tube around your finger helps it conform to the normal curve\u00a0of the nasopharynx.<\/p>\n<p><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_2123.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_2123-150x150.jpg\" alt=\"Curl the NG tube around your finger to help it conform to the normal curve of the nasopharynx\" class=\"aligncenter wp-image-6387 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">14. Lubricate NG tube tip according to your agency policy (often approx 10 cm).<\/p>\n<p>If inserting a weighted feeding tube with a stylet or guidewire, follow manufacturer&#8217;s instructions for lubrication (often involves injecting water into in)<\/p>\n<p>Prepare securement device.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">\n<figure id=\"attachment_5633\" aria-describedby=\"caption-attachment-5633\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1697.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1697-150x150.jpg\" alt=\"Lubricate tip of tube as per agency policy\" class=\"wp-image-5633 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5633\" class=\"wp-caption-text\">Lubricate tip of tube as per agency policy<\/figcaption><\/figure>\n<p>Never use non-water-soluble lubricant (e.g., Vaseline), as it will not dissolve and may cause respiratory complications if it enters the lungs.<\/p>\n<p>Agency policy might restrict who can insert a weighted feeding tube.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">15. Have patient drop head forward\u00a0and breathe through the mouth.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">Dropping the head forward closes the trachea and opens the esophagus, which\u00a0allows the NG tube to pass more easily through the nasopharynx and into the stomach.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">16. Insert NG tube tip slowly into\u00a0the patient&#8217;s nostril and advance it steadily, in a downward direction, along the bottom of the nasal passage, with the curved end pointing downward\u00a0in the direction of the ear on the same side as the nostril.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This follows the natural anatomical alignment of the nasopharynx.<\/p>\n<figure id=\"attachment_5634\" aria-describedby=\"caption-attachment-5634\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1700.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1700-150x150.jpg\" alt=\"Insert nasogastric tube slowly into patient's nostril\" class=\"wp-image-5634 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5634\" class=\"wp-caption-text\">Insert nasogastric tube slowly into patient&#8217;s nostril<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">17. You may feel slight resistance as you advance along the nasal passage. Twist the tube slightly, apply downward pressure, and continue trying to advance the tube. If significant resistance is felt, remove the tube and allow the patient to rest before trying again in the other nostril.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">It is common for the patient to feel discomfort, and this may be expressed with light coughing and gagging. More aggressive coughing and gagging may indicate that the tube has entered the airways, in which case\u00a0you should STOP and wait for the coughing to stop. If it doesn&#8217;t stop, withdraw the NG tube.<\/p>\n<figure id=\"attachment_5635\" aria-describedby=\"caption-attachment-5635\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1702.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1702-150x150.jpg\" alt=\"Advance the tube gently\" class=\"wp-image-5635 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5635\" class=\"wp-caption-text\">Advance the tube gently<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">18. If the patient has difficulty in passing the NG tube, you may ask the patient to sip water slowly through a straw unless oral\u00a0fluids are contraindicated. If oral fluids are not allowed, ask the patient to try dry swallowing while you advance the tube.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">If patient continues to gag or cough, check that the tube is not coiled\u00a0in the back of the mouth, using a tongue blade and a flashlight to check the back of the mouth. If tube is coiled, withdraw the tube until only the tip of the tube is seen in the back of the mouth. Then try advancing the tube again while the\u00a0 patient tries to swallow.<\/p>\n<figure id=\"attachment_5636\" aria-describedby=\"caption-attachment-5636\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1704.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1704-150x150.jpg\" alt=\"Patient may sip water slowly through a straw\" class=\"wp-image-5636 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5636\" class=\"wp-caption-text\">Patient may sip water slowly through a straw<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">19. Continue to advance NG tube until you reach the mark\/tape you had placed for measurement.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This ensures accurate placement.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">20. Temporarily anchor the tube to patient&#8217;s cheek with a piece of tape until you can check for correct placement.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This prevents displacement of the NG tube while checking placement.<\/p>\n<figure id=\"attachment_5617\" aria-describedby=\"caption-attachment-5617\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1668.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1668-150x150.jpg\" alt=\"Anchor tube\" class=\"wp-image-5617 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5617\" class=\"wp-caption-text\">Anchor tube<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">21. Verify tube placement according to agency policy. This may include<\/p>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>X-ray (gold standard)<\/li>\n<li>Gentle aspiration with a syringe to observe gastric contents for amount, color, and quality. Gastric contents can be green, off white, tan, bloody, brown, or yellow.<\/li>\n<li>Use pH paper to measure pH of aspirate.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Color-coded pH paper is usually used,\u00a0as an initial and interim check, to confirm that acidic contents are present. Then an X-ray is taken to confirm placement prior to using NG tube for feeding.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">The contents aspirated from the tube should be acidic with a pH &lt; 5. If the pH is more than 6, it\u00a0may indicate the presence of respiratory fluids or small bowel content, and the tube should be removed. Note: some medications alter gastric pH thus making this method of assessing placement NOT 100% reliable.<\/p>\n<figure id=\"attachment_5640\" aria-describedby=\"caption-attachment-5640\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1711.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1711-150x150.jpg\" alt=\"Verify tube placement using pH paper\" class=\"wp-image-5640 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5640\" class=\"wp-caption-text\">Verify tube placement using pH paper<\/figcaption><\/figure>\n<p>Auscultation of air being injected into the stomach is not a reliable means to determine position of a feeding tube . It cannot distinguish between gastric and small bowel placement nor if the tube tip is in the esophagus.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">22. Once the tube placement has been confirmed, secure the tube to the patient&#8217;s nose with tape or a securement device.<\/p>\n<p>Determine <strong>external length<\/strong> (the length of tubing extending from the nose to the outer end of the tube).<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This aids in timely recognition and identification of tube displacement or migration.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">23. Secure the tube to the patient&#8217;s gown with a safety pin, allowing enough tube length for comfortable head movement.<\/p>\n<p>&nbsp;<\/p>\n<p>Help the patient to a comfortable position.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">This keeps the NG tube in place.<\/p>\n<figure id=\"attachment_5639\" aria-describedby=\"caption-attachment-5639\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1708.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1708-150x150.jpg\" alt=\"Secure the tube to the patient's gown with a safety pin\" class=\"wp-image-5639 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5639\" class=\"wp-caption-text\">Secure the tube to the patient&#8217;s gown to avoid tugging and pulling<\/figcaption><\/figure>\n<p>Persons with tube feeds require the head of bed elevated at 30 degrees (or as per agency policy) unless contraindicated to\u00a0\u2193 risk of aspiration.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 405.906px\" colspan=\"2\">24. Document the procedure according to\u00a0agency policy, and report any unexpected findings to the appropriate healthcare provider.<\/td>\n<td style=\"border: 1px solid #000000;width: 415.906px\" colspan=\"2\">Timely and accurate documentation promotes patient safety.<\/p>\n<p>Sample documentation: <em>date \/ time: Abdomen distended, firm. Reports ++ nausea. Frequent vomiting throughout morning. No bowel sounds. Reported to Dr GI. Orders received. #16 levine inserted right nare for 800 ml dark green returns. Attached to low suction. Tolerated well with reports of less nausea following.&#8212;&#8212;RLeaf\u00a0 \u00a0RN<\/em><\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 837.906px\" colspan=\"4\">Data sources: BCIT, 2015c; Berman &amp; Snyder, 2016;\u00a0Bourgault et al., 2014; Potter et al., 2018; Simons &amp; Abdallah, 2012.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h5>Special Considerations with NG Tubes:<\/h5>\n<ul>\n<li>Always assess correct placement of the NG tube prior to infusing any fluids or tube feeds as per agency policy. Check external length, color and pH of the fluid aspirated from the tube. Routine evaluation of tube placement will promote patient safety by reducing risk of aspiration. Do not instill air to test location of tube.<\/li>\n<li>Do not give the patient anything to eat or drink without knowing that the patient has passed a swallowing assessment.<\/li>\n<li>If changing the gown or re-positioning the patient, take care not to pull on the NG tube. Remember to unfasten the tube from the gown and refasten the tube afterward.<\/li>\n<li>If the NG tube falls out of the patient, it\u00a0is not an emergency. <em>But<\/em> be sure to\u00a0assess your patient.<\/li>\n<li>A patient who appears to be in respiratory distress\u00a0should be considered an emergency, and emergency procedures should be followed. Respiratory distress may present as\u00a0coughing, choking, or reduced oxygen saturation.<\/li>\n<\/ul>\n<div class=\"textbox shaded\" style=\"text-align: center\">Watch the video<span>\u00a0<a href=\"https:\/\/barabus.tru.ca\/nursing\/nasogastric_tube_insertion.html\"><em>Insertion of a NG Tube<\/em><\/a> developed by Ren\u00e9e Anderson and Wendy McKenzie (2018) of Thompon Rivers University School of Nursing.\u00a0\u00a0<\/span><\/div>\n<h2>Removing a NG Tube<\/h2>\n<p>A NG tube should be removed if it is no longer required. The process of removal is usually very quick. Prior to removing the NG tube, verify physician orders. If the NG tube is ordered to remove gastric contents, the physician&#8217;s order may state to &#8220;trial&#8221; clamping the tube for a number of hours to see if the patient tolerates oral intake or their own accumulation of gastric secretions prior to the tube removal. During the trial, the patient should not experience any nausea, vomiting, or abdominal distension. If they do experience these things, simply reattach the NG to suction.\u00a0To review how to remove a NG tube, refer to\u00a0Checklist 81.<\/p>\n<table style=\"border-color: #000000;height: 3050px\">\n<tbody>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;text-align: center;height: 204px;width: 977.4px\" colspan=\"4\">\n<h3 style=\"text-align: center\"><a id=\"checklist81\"><\/a>Checklist 81: Removal of a NG Tube<\/h3>\n<h5 style=\"text-align: center\"><em><span style=\"color: #000000\">Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;height: 472px;width: 977.4px\" colspan=\"4\">\n<h5><span style=\"color: #333333\">Safety considerations:\u00a0<\/span><\/h5>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>Perform\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-3-hand-hygiene-and-non-sterile-gloves\/\">hand hygiene<\/a>.<\/li>\n<li><span style=\"color: #333333\">Check room for <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-4-additional-precautions-and-personal-protective-equipment-ppe\/\">additional precautions.<\/a><\/span><\/li>\n<li><span style=\"color: #333333\">Introduce yourself to patient.<\/span><\/li>\n<li><span style=\"color: #333333\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\n<li>Know the rationale for the NG.<\/li>\n<li><span style=\"color: #333333\">Explain process to patient;\u00a0offer comfort measures ie. bathroom, etc.<\/span><\/li>\n<li><span style=\"color: #333333\">Listen and attend to patient cues.<\/span><\/li>\n<li><span style=\"color: #333333\">Ensure patient&#8217;s privacy and dignity.<\/span><\/li>\n<li>Complete <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-13-quick-priority-assessment-qpa\/\">QPA<\/a> including safety.<\/li>\n<li><span style=\"color: #333333\">Apply <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/1-5-principles-of-surgical-asepsis\/\">principles of\u00a0asepsis<\/a> and safety.<\/span><\/li>\n<li><span style=\"color: #333333\">Complete\u00a0necessary\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-5-head-to-toe-systems-approach-to-assessment\/\">focused assessments<\/a>.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;text-align: center;height: 121px\" colspan=\"2\">\n<h4 style=\"text-align: center\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;text-align: center;height: 121px\" colspan=\"2\">\n<h4 style=\"text-align: center\">\u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 19px\" colspan=\"2\">1. Verify healthcare provider&#8217;s orders to remove NG tube.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 19px\" colspan=\"2\">An order is required to remove an NG tube.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 57px\" colspan=\"2\">2. Collect supplies.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 57px\" colspan=\"2\">Supplies include waterproof pads, 20 ml catheter tip syringe, tissues, non-sterile gloves, and plastic garbage bag.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 38px\" colspan=\"2\">3. Verify patient using two identifiers. Explain procedure to patient and place patient in high Fowler&#8217;s position.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 38px\" colspan=\"2\">Follow agency policy for proper patient identification.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 215px\" colspan=\"2\">4. Perform hand hygiene. Place waterproof pad on patient&#8217;s chest.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 215px\" colspan=\"2\">This reduces the transmission of microorganisms.<\/p>\n<figure id=\"attachment_5083\" aria-describedby=\"caption-attachment-5083\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/08\/DSC_1100.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_1100-150x150.jpg\" alt=\"Perform hand hygiene\" class=\"wp-image-5083 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5083\" class=\"wp-caption-text\">Perform hand hygiene<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 260px\" colspan=\"2\">5. Depending on the purpose of the tube either:<\/p>\n<ul>\n<li>stop the tube feed and disconnect from feeding tube tubing; or<\/li>\n<li><span style=\"text-indent: 1em;font-family: inherit;font-size: inherit\">disconnect from suction tubing.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 260px\" colspan=\"2\">This reduces risk of aspiration of tube feed and makes disposal of equipment easier.<\/p>\n<figure id=\"attachment_5615\" aria-describedby=\"caption-attachment-5615\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1664.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1664-150x150.jpg\" alt=\"Disconnect tube from feed or suction\" class=\"wp-image-5615 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5615\" class=\"wp-caption-text\">Disconnect tube from feed or suction<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 306px\" colspan=\"2\">6.Flush tube with air and then kink tube<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 306px\" colspan=\"2\">\n<figure id=\"attachment_5616\" aria-describedby=\"caption-attachment-5616\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1667.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1667-150x150.jpg\" alt=\"Insert 10-20 mL of air into NG tube\" class=\"wp-image-5616 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5616\" class=\"wp-caption-text\">Flush tube with air to clear tube feed \/ secretions<\/figcaption><\/figure>\n<p>Flushing the tube with air and kinking prevents leakage of fluid from the tube and prevents aspiration of tube feed or residual gastric secretions.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 260px\" colspan=\"2\">7. Unclip NG tube from patient&#8217;s gown.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 260px\" colspan=\"2\">This allows for tube to be easily removed and disposed of immediately.<\/p>\n<figure id=\"attachment_5614\" aria-describedby=\"caption-attachment-5614\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1663.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1663-150x150.jpg\" alt=\"Unclip NG tube from patient's gown\" class=\"wp-image-5614 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5614\" class=\"wp-caption-text\">Unclip NG tube from patient&#8217;s gown<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 150px\" colspan=\"2\"><span style=\"font-family: inherit;font-size: inherit\">8.\u00a0Remove securement device from nose (this is the last step prior to removing the tube thus preventing accidental tube removal before either the nurse or client are ready)<\/span><\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 150px\" colspan=\"2\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1669.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1669-150x150.jpg\" alt=\"Remove tape or securement device from nose\" class=\"wp-image-5618 size-thumbnail aligncenter\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 38px\" colspan=\"2\">9.Instruct patient to take a deep breath and hold it.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 38px\" colspan=\"2\">Holding the breath closes the glottis, decreases risk of\u00a0aspiration, and distracts the patient.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 443px\" colspan=\"2\">10. Hold the NG tube near the naris and gently pull out tube in a swift, steady motion. Dispose of tube in garbage bag.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 443px\" colspan=\"2\">&nbsp;<\/p>\n<figure style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1672.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1672-150x150.jpg\" alt=\"Pull out tube in a swift, steady motion\" class=\"wp-image-5619 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption class=\"wp-caption-text\">Pull out tube in a swift, steady motion<\/figcaption><\/figure>\n<figure id=\"attachment_5626\" aria-describedby=\"caption-attachment-5626\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1684.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1684-150x150.jpg\" alt=\"Wrap tube in glove and dispose as per agency policy\" class=\"wp-image-5626 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5626\" class=\"wp-caption-text\">Wrap tube in glove and dispose as per agency policy<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 279px\" colspan=\"2\">11. Offer tissue or clean the nares for the patient, and offer mouth care as required.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 279px\" colspan=\"2\">This clears the nares\/nasal passages of any remaining secretions.<\/p>\n<figure id=\"attachment_5627\" aria-describedby=\"caption-attachment-5627\" style=\"width: 150px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_1687.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/08\/DSC_1687-150x150.jpg\" alt=\"Offer tissue or clean the nares for the patient\" class=\"wp-image-5627 size-thumbnail\" width=\"150\" height=\"150\" \/><\/a><figcaption id=\"caption-attachment-5627\" class=\"wp-caption-text\">Offer tissue or clean the nares for the patient<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 131px\" colspan=\"2\">12. Remove gloves and place patient in a comfortable position. Assess patient&#8217;s level of comfort. Perform hand hygiene.<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 131px\" colspan=\"2\">This promotes patient comfort and reduces the transmission of microorganisms.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 480.6px;height: 38px\" colspan=\"2\">13. Document procedure according to\u00a0agency policy<\/td>\n<td style=\"border: 1px solid #000000;width: 479.8px;height: 38px\" colspan=\"2\">Document removal of NG tube and patient response to the removal.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;width: 977.4px;height: 19px\" colspan=\"4\">Data source:\u00a0 BCIT, 2015b; Perry et al., 2018<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"bcc-box bcc-info\">\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\n<ol>\n<li>You are inserting a nasogastric tube and the patient begins to cough and turn red in the face. Explain your next steps.<\/li>\n<li>Your patient has a nasogastric tube and is requesting water because her throat feels dry. Describe your next actions.<\/li>\n<li>Your patient calls you to say they&#8217;ve accidentally pulled out the NG. Explain your next steps.<\/li>\n<\/ol>\n<\/div>\n","protected":false},"author":397,"menu_order":3,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by"},"chapter-type":[],"contributor":[],"license":[50],"class_list":["post-1043","chapter","type-chapter","status-publish","hentry","license-cc-by"],"part":1017,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/1043","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/users\/397"}],"version-history":[{"count":25,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/1043\/revisions"}],"predecessor-version":[{"id":5161,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/1043\/revisions\/5161"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/parts\/1017"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/1043\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/media?parent=1043"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapter-type?post=1043"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/contributor?post=1043"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/license?post=1043"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}