Insertion of Nasogastric Tube

Competent

Not Competent

1. Wash hands

2. Identify patient (name and DOB) and explain procedure to patient

3. Gather/check equipment:
    (gloves, mask, tube, lubricant, tape, syringe, water, emesis basin,
    suction, stethoscope)

4. Put on protective gloves

5. Estimate distance of  tube insertion (use black lines as
    guide)

6. Inspect nose and identify optimal nostril for NG tube insertion

7. Position patient sitting, with head in "sniffing position".

8.. Lubricate tip of tube

9. Insert tube parallel to the floor of the nasal canal

10. Insert to level of oropharynx  (patient may gag at this point)

11. When gagging ceases (may need to pull tube back slightly), instruct
      the patient to drink sips of water

12. Insert tube remainder of distance into stomach while patient 
      swallows water

13. Check for designated black mark to determine proper distance of
      insertion

14. Check to make sure patient can talk, and not coughing or breathless

15. Attach piston syringe to end of tube, draw back to aspirate stomach
      contents.

16. If no return, insufflate 30 cc of air, while auscultating for "bubble
      sound" in epigastrium

17. When properly in place, secure tube with tape to the nasal bridge

18. Attach the end of the tube to proper suction

19. Obtain CXR for proper positioning if anything is to be administered
      into the tube.

20. Wash hands before leaving the room

                                                                                                         Pass

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                                                                               Remediation Required

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Student Name (please print) __________________________________

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Student Signature__________________________________________________

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Evaluator Signature________________________________________________

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