Hi Everyone,
Nasogastric Tube Insertion for Nasogastric Feedings:
- Nasogastric Tubes (NG tubes) are used to transport liquid nutrients from the nasal passage to the stomach. NG tubes allow gastric substances to be drained, decompression of the stomach and allows for samples of gastric substances to be taken. This helps to treat individuals with gastric immobility, bowel obstruction, drainage/lavage for possible drug overdoses/poisons, helps to prevent aspiration and vomiting, Gastrointestinal (GI) bleeding, and enteral feeding.
The NG tube is a small tube inserted through the nose to carry liquid nutrients to the stomach. It can be used for individuals of all ages and for numerous health reasons. Some students are able to eat in addition to having the tube for extra calories and some students may need to solely rely on a NG for their nutrients. A doctor and dietitian will determine how the feeding is done for the student. Several things that need to be addressed are the type of tube, how often it’s changed, amount of liquid/nutrients, and duration of feeding time. A checklist should be used during every feeding to ensure each step in the feeding process is done accurately. (https://www.childrensmn.org/educationmaterials/childrensmn/article/15553/nasogastric-tube-feeding/ (Links to an external site.)). In addition, the “General Environmental Suggestions and Guidelines” and “Feeding Guidelines: Do’s and Don’ts” by French, Gonzalez, & Tronson-Simpson can be used for feeding after the NG tube is accurately inserted.
Steps for Pre-Insertion of the Nasogastric Feeding Tube:
- Wash hands.
- Wear gloves when handling the feeding tube (Make sure the student does not have any allergies).
- Have items ready- gloves, feeding tube, measuring tape, permanent marker, journal to keep student’s measurements, and a writing utensil (Make sure all items have been disinfected prior to use, as you will be handling the feeding tube).
- “With your fingers, find the student’s sternum (breastbone). Gently feel the bone in the center of the chest, and then find its bottom edge. It will be below nipple level, and you will feel the bottom of the rib cage curving away to each side.” (https://www.childrensmn.org/educationmaterials/childrensmn/article/15553/nasogastric-tube-feeding/ (Links to an external site.))
- Visualize the spot on the student’s stomach that is halfway between the belly button and the bottom edge of the breastbone. Remember the spot or use a washable marker safe for the skin to mark the spot. (Make sure the student has no allergies.)
- Using a tape measure, measure from the tip of the student’s nose to the bottom of the earlobe, then down to that spot midway between the belly button and breastbone edge. Write the number down in the student’s journal.
- Take tube measurements if unknown, then subtract the measurement from the total tube length.
- Measure the distance starting from the tip of the tube and mark it using a permanent marker (waterproof).
- You are ready to insert the feeding tube.
Steps for Insertion of the Nasogastric Tube:
- Wash hands.
- Wear gloves. (allergies should have already been established)
- Have equipment ready- feeding tube, liquid meal, water/vaseline for lubrication, syringe (correct size), pH testing strips, tape (correct tape/allergies should have already been established), purified water for rinsing if needed, and sterile gauze if needed.
- Make sure the student’s position is comfortable and he/she is relaxed. (This may require more than one adult.) The student will need to be in a position where he/she can be turned quickly in case vomiting occurs.
- The tube may require lubrication (allergies should have already been established) or water may be applied to the end of the tube.
- Insert the tube through the nasal passage by gently pushing the tube until the mark (you measured and marked from step 7 in the pre-insertion steps) has reached the tip of his/her nose. Drinking or swallowing if able may help with the insertion. Coughing and/or sneezing is normal for the student to experience during the NG insertion.
- Remove the NG tube promptly if the student experiences, excessive coughing, gagging, excessive sneezing, vomiting, wheezing, cannot breathe, change in respiratory rate, oxygen levels change, decrease in pulse oximeter reading, change in color, new discomfort (irritability/restlessness (if it was not present prior to NG insertion), abdominal pain/pain, change speech or pain expression, the tube comes out, and any circumstance that may appear to be harming the student after insertion. The above steps may be repeated once the student is ready to try again.
- Secure the tube in place with tape (should have already checked for tape allergies in the pre-insertion steps).
- Check the NG tube placement for accurate placement.
There are quite a few steps to check for accurate placement of the NG tube prior to starting the student’s feeding. This is very important, as it could cause aspiration.
Steps for Nasogastric Tube Removal:
- Wash hands.
- Wear gloves.
- Gently remove the tape.
- Pinch the tube while pulling the tube out in one quick motion.
- Make sure the student is comfortable and the entire procedure is as stress-free as possible. Have the student do something that they enjoy after the NG tube insertion, feeding, and removal. This will help with the student’s cooperation and level of enjoyment.
- According to Nevada’s Nurse Practice Act, the school nurse is the only person allowed to administer the Nasogastric feedings and Nasogastric tube insertion unless it has been delegated by the nurse to a “qualified” person, and if the procedure has been Board approved. This means that a person who is certified or licensed by the State with the ability to provide nursing care has authorization. In addition, the school nurse must find the person to have the knowledge and skill to perform the task safely and effectively. The only person or people who are exempt are a family member/friend who is/are identified by the student’s legal guardian(s) to perform the task(s)/procedure(s).
- Yes, this procedure warrants an individualized health care plan. “The school nurse is responsible for developing, implementing, evaluating, and revising the individualized health care plan for each student with special health care needs under his/her supervision.” (Nevada State Board of Nursing, School Nurse Regulation and Advisory Opinion).
- Information that should be included in the student’s individualized health care plan is written policies and procedures that address any possible medical emergencies that can happen while the student is attending school or any school-related activities. The Nevada State Board of Nursing lists 6 policies and procedures that should be included:
- Medical emergency defined
- Emergency contacts
- The person listed who will take action on the student’s behalf
- Action(s) to be taken during the emergency(ies)
- Who will transport the student (internal/external) and where
- How will the actions for medical emergencies be documented and formatted
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