1. Objective

To safely and effectively insert a nasogastric (NG) or feeding tube for nutrition, medication administration, or gastric decompression, while minimizing patient discomfort and preventing complications.

2. Scope

This SOP applies to all licensed healthcare professionals providing NG tube insertion under Upashay’s doctor services. This SOP is for planned NG tube insertions and is not intended for emergency scenarios.

3. Required Personnel

  • Licensed doctor or registered nurse trained in NG tube insertion

4. Required Equipment and Supplies

  • Sterile gloves
  • Personal protective equipment (PPE): mask, face shield, gown
  • Naso Gastric (NG) / feeding tube (appropriate size and type)
  • Water-soluble lubricant
  • 60 mL syringe (for air bolus or irrigation)
  • pH indicator strips (to confirm placement)
  • Adhesive tape (for securing the tube)
  • Glass of water with a straw (for patients who can safely swallow)
  • Stethoscope
  • Emesis basin (in case of vomiting)
  • Waste disposal bag (for biohazard materials)

5. Pre-Procedure Preparation

  1. Patient Assessment
    • Review the patient’s medical history and indications for NG tube insertion, including any previous difficulties with NG tube placement.
    • Explain the procedure to the patient, including the steps involved, expected sensations, and any potential discomfort.
    • Obtain informed consent and assess the patient’s ability to cooperate during the procedure.
  2. Environment Preparation
    • Ensure a clean, well-lit area with all required equipment within easy reach.
    • Position the patient in a high Fowler’s position (sitting upright) to reduce the risk of aspiration and make the procedure easier.
  3. Hand Hygiene and PPE
    • Perform thorough hand hygiene and wear sterile gloves.
    • Don PPE, including a mask and face shield, to ensure safety and minimize infection risk.

6. Procedure Steps

  1. Prepare the Tube
    • Inspect the NG tube to ensure it is intact, and measure the insertion length. To measure, hold the tube against the patient, measuring from the tip of the nose to the earlobe and down to the xiphoid process (lower sternum).
    • Mark the measured length with a piece of tape or note where it aligns on the tube.
  2. Lubricate the Tube
    • Apply a water-soluble lubricant to the first few inches of the tube to ease insertion and reduce patient discomfort.
  3. Begin Insertion
    • Instruct the patient to tilt their head slightly forward, which will help close the airway and guide the tube toward the esophagus.
    • Gently insert the tube into one nostril, advancing it slowly along the floor of the nasal passage and down the back of the throat.
  4. Patient Assistance with Swallowing
    • Encourage the patient to sip water through a straw (if safe to do so) and swallow as you advance the tube. Swallowing helps direct the tube into the esophagus instead of the trachea.
    • Continue advancing the tube to the pre-marked length, stopping if the patient experiences significant discomfort, coughing, or resistance.
  5. Confirm Tube Placement
    • Auscultation Method: Attach a 60 mL syringe to the tube, push 10-20 mL of air into the tube, and listen for a “whoosh” sound over the stomach using a stethoscope.
    • pH Test: Aspirate a small amount of stomach content and test with pH indicator strips. A pH of 1-5 indicates proper placement in the stomach.
    • Observation: Observe the patient for signs of respiratory distress, which would indicate improper placement in the airway.
  6. Secure the Tube
    • Once confirmed in the stomach, secure the tube with adhesive tape, placing it on the patient’s cheek or nose to prevent movement.
    • Ensure the tube is properly anchored without causing discomfort or skin irritation.

7. Post-Procedure Care

  1. Documentation
    • Document the procedure, including the tube type, size, insertion length, confirmation method, and patient’s response.
    • Record any complications or adjustments and note specific instructions provided to the patient or caregivers for tube care.
  2. Patient Education
    • Educate the patient (and caregivers, if applicable) on tube maintenance, including keeping the insertion site clean, preventing kinks, and monitoring for signs of dislodgement or infection.
    • Instruct the patient to report any discomfort, difficulty breathing, or changes in the appearance of aspirated content.

8. Emergency Protocols

  • If the patient exhibits severe discomfort, coughing, or difficulty breathing during insertion, stop the procedure immediately and remove the tube.
  • If placement cannot be confirmed, or if complications arise, seek immediate medical consultation.

9. Quality Assurance and Safety Compliance

  • Ensure adherence to infection control standards, including proper PPE use and sterilization.
  • Conduct regular reviews of the procedure and address any safety or quality concerns to improve patient care standards.