Tip of the Month

Here’s a strategy for NG tube placement

Try these tips for passing and proper placement of nasogastric (NG) tubes, recommends Ellie Encapera, RN, CEN, staff nurse at Hoag Memorial Hospital Presbyterian in Newport Beach, CA. "To stiffen the tube, place the tube in an emesis basin of ice water," she says. "Cooling the lubrication, if possible, also helps with patient discomfort. Cool your tubes or packets in the med refrigerator."

Don’t use a too-large tube

First, look into each side of the nose with a flashlight and decide which side has the larger passageway, says Encapera. "Septal defects can be a problem, and forcing a tube too large for the passage causes pain, trauma, and bleeding," she warns. After measuring nose tip to jaw tip for first stage placement in the posterior pharynx, lubricate the tube well, says Encapera. "Use Xylocaine if the patient denies allergies," she suggests.

With the patient’s head erect or slightly extended, lift the tip of the tip of the nose and pass the tube through the largest of the two passages until you reach your first-stage measurement, Encapera says. Next, with the patient sitting upright, ask him or her to flex his or her neck forward and place his or her chin on their chest. "Then offer ice water with a straw. Instruct the patient to sip and swallow,’ and pass the tube with each swallow," Encapera says. "Keep encouraging the patient not to stop."

Encapera uses three methods of placement verification: placing the tip in a ¼ cup of water without bubbling from the tip with patient’s expiration, aspiration of gastric contents, and auscultation of epigastric air instillation with a syringe.

[Editor’s note: For more information, contact Ellie Encapera, RN, CEN, Hoag Memorial Hospital Presbyterian, One Hoag Drive, Box 6100, Newport Beach, CA 92658-6100. Telephone: (949) 760-5890. E-mail: miselliern@socal.rr.com.]