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04.02 NG (Nasogastric)Tube Management

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Overview

  1. Purpose
    1. Management of an NG tube requires  the following:
      1. Verifying placement before use
      2. Oral and Nasal care
      3. Flushing before and after use
      4. Checking gastric residuals

Nursing Points

General

  1. Supplies needed
    1. Tape measurer
    2. 60 mL catheter tip syringe
    3. Graduated canister
    4. Oral care supplies
    5. Washcloth with warm water
    6. Lubricant jelly
      1. *NOTE – water based lubricants only if patient is on oxygen

Nursing Concepts

  1. Steps and Nursing Considerations
    1. Once your patient has had their NG tube confirmed with abdominal x-ray – use a tape measurer to measure the length from the nose to the hub of the NG tube.
      1. Document in cm
      2. Communicate across shifts
    2. This measurement should be checked every shift or more often to make sure the NG tube hasn’t moved
    3. NG Tubes should be flushed with 30-60 mL of tap water before and after use, and at least every 4 hours to maintain patency (count as intake)
      1. Fill catheter tip syringe with tap water
      2. Insert into the end of the NG tube
      3. Flush gently
      4. Room temperature water is preferred
        1. Cold water can cause spasms
      5. Should not meet any resistance
      6. If NG tube being used for gastric decompression – immediately reconnect to suction
        1. Still counts as Intake!
    4. Gastric residual volumes (GRV)
      1. EBP shows that routine checking of GRV is no longer recommended.
      2. When it should be checked:
        1. Signs of reflux
        2. Signs of fullness or distention
      3. Attach 60 mL syringe and aspirate stomach contents
        1. Use a graduate container to measure.
        2. Pull until you get a suction feeling
        3. If you are still getting air bubbles, keep pulling
      4. Only concerned if > 400 mL
        1. Notify provider
        2. Refeed up to 400 mL
      5. Facility policy may vary – be sure to follow it
    5. At least once a shift – Oral and Nasal care
      1. Allow patient to swish/swallow or swish/spit with mouthwash
      2. Allow patient to brush teeth
      3. Wash around NG tube in nose with warm washcloth
      4. Use lubricant jelly around insertion site to prevent friction
      5. Inspect for signs of pressure breakdown

Patient Education

  1. Purpose for NG tube
  2. Signs of reflux or fullness to report to nurse

Reference Links

Study Tools

Video Transcript

In this video, we’re going to look at a couple of the things you need to do when managing a patient who has an NG tube.

So, let’s say we just placed this NG tube and it has been confirmed by abdominal X-ray. The first thing We need to do is measure the length of the tube from the nose to the tip of the NG Tube. Most NG tube packages come with this tape measurer. You’ll want to record it in centimeters and make sure that length gets communicated.
What that does is allow us to know if the NG tube has moved from its original position. So we want to check that at least once a shift or anytime we’re concerned about placement.

The other thing we want to do for these NG tubes is flush them with 30 to 60 mL of water every 4 to 8 hours, or before and after we use it for something. So you will get your 60 mL syringe and fill it with tap water. Remember that the gut is not sterile so tap water is sufficient.

Then you will attach the syringe to the NG tube and flush. It should flush easily without resistance. You also want to avoid cold water because it can cause stomach cramping.

Make sure that you count this flush in your intake measurements. If the patient has the NG tube for gastric decompression, go ahead and reattached to suction right away. What you suck out will all be counted in output.

Another thing we may do for a patient with an NG tube is to measure gastric residual volumes. You’ll use your 60 mL syringe to aspirate stomach contents into a graduated cylinder. You’ll do that one syringe at a time until the stomach is empty.

This is something that we used to do routinely every 4 hours, but evidence based practice now shows that that is not recommended. Instead, we check Gastric residual volumes anytime we suspect a problem like signs of reflux or abdominal distention.

If you’re getting air bubbles, keep pulling until you can’t pull anymore, then measure the total volume. We don’t really get concerned unless it’s over about 400 mL.

Then you’ll just return the stomach contents to the patient and flush with 30-60 mL of water afterwards. Your facility policy may vary on this, so make sure you’re familiar with it.

Finally, every shift we want to do oral and nasal care. That includes allowing the patient to brush their teeth or use mouthwash.

It also means checking around the tube for any signs of pressure breakdown.
Then we’ll wash around the tube with a warm cloth and apply a lubricant jelly. This keeps the tube from putting too much pressure on the skin around the nose and causing breakdown

So those are the major highlights when caring for a patient with an NG tube. Make sure, of course, that you’re managing their tube according to your orders and your facility policy.

We have another lesson on giving meds through an NG tube, so make sure you check that out as well. Now, go out and be your best selves today. And, as always, happy nursing!

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