Caring For Patients With Nasogastric Tubes

  • Nasogastric tubes are commonly used medical devices to deliver medication, nutrition, or remove stomach contents. 
  • Nurses must follow specific guidelines for inserting, caring for, and removing nasogastric tubes to ensure patient safety and comfort. 
  • Nurses must also monitor patients for potential complications and take appropriate measures to address them, such as nausea, vomiting, or aspiration. 

Mariya Rizwan

Pharm. D.

March 14, 2023
Simmons University

A nasogastric tube is a medical device that is commonly used to deliver medication, nutrition, or remove stomach contents. It is essential for nurses to understand the appropriate nursing interventions and care that are necessary to ensure the safety and comfort of patients with nasogastric tubes.  

In this post, we will discuss the nursing considerations, nursing diagnoses, and nursing interventions that are crucial for providing the best care to these patients. 


Nasogastric Tube complications

Nasogastric Tube Insertion

To insert the nasogastric tube, follow these guidelines: 

  • Explain the procedure to the patient and ask for their reassurance. 
  • if you are inserting the nasogastric tube for the administration of feedings or medication, auscultate the patient’s abdomen for positive bowel sounds. 
  • Sit the patient upright in a high Fowler position. Ask them to keep the chin-to-chest posture during the tube insertion. This helps prevent the accidental insertion of the nasogastric tube into the trachea. 
  • Measure the tube from the tip of the nose to the earlobe, then down to the xiphoid. On it, mark this point with tape. 
  • Use a water solvent lubricant to lubricate the tube that ensures smooth insertion. Never use petroleum jelly as a lubricant because it degrades PVC tubing. 
  • Insert the tube through the nostril until you reach the previously marked point on the tube. 
  • Ask the patient to take small sips of water during the tube insertion, which makes it easy to pass it. 
  • Secure the tube to the patient’s nose using tape. Be careful not to block the nostril because it can affect breathing. 
  • Tape the tube 12–18 inches below the insertion line and then pin tape to the patient’s gown. Allow slack for movement. 
  • Keep in mind to keep the air vent unclamped and above the stomach level. 
  • To minimize the risk of aspiration, keep the head of the bed at 30 to 45 degrees. 
  • Finally, assemble the equipment, such as wall suction or feeding pump. 
  • Document the following points:
    • The type of nasogastric tube you have inserted.
    • In which nostril you have inserted the tube.
    • How patient tolerated the tube insertion.
    • How the tube placement was confirmed
    • Whether tubing was left clamped or attached to the feeding pump or suction.

    Patient Care With A Nasogastric Tube

    As a nurse, you must take care of the patient with a nasogastric tube.  

    Here are some common examples: 

    • Before administering bolus feedings, fluids, or medicines, reassess the tube placement at every shift and for continuous feedings. 
    • After each feeding session and medication administration, flush the tube with 30 ml of water to prevent occlusion. 
    • Assess the patient’s nose for skin irritation or breakdown. Re-tape daily and at alternate sites to avoid constant pressure on one area of the nose. Gently wash around the patient’s nose with soap and water. Provide nasal hygiene daily and as per need. 
    • Provide adequate oral hygiene for the patient every 2 hours and as needed. 
    • Make a routine of mouthwash, water, and toothpaste to clean the tongue, inside of the cheeks, gums, and mucous membranes of the patient. However, if the patient performs oral hygiene by themself, remind them not to swallow any water.


    Nasogastric Tube complications

    Nasogastric Tube Removal

    For the removal of the nasogastric tube, follow these steps: 

    • Explain the procedure of the nasogastric tube removal to the patient. 
    • Remove the tape from the nose of the patient. 
    • Clamp or plug the tube to prevents aspiration. 
    • Ask the patient to hold their breath and remove the tube in a single take swiftly. 
    • Assess the patient for signs of aspiration. 

    Common Complications, Causes, and Interventions of a Nasogastric Tube

    The common complications that occur with the nasogastric tube are:

    Complications Causes & Interventions
    Nausea, vomiting, or bloating 
    • Large residuals- Withhold or decrease feeding 
    • Medications- Review medications and consult with a physician 
    • Rapid infusion rate- Decrease the infusion rate 
    • Too rapid administration- Reduce administration rate 
    • Refrigerated tube feeding- Administer feed at room temperature 
    • Tube migration into the duodenum– Retract the tube to reposition in the stomach and reconfirm placement. 
    • Decreased fluid intake- Provide the patient with adequate 
    • hydration. 
    • Decreased dietary fiber- Use formula with fiber 
    Aspiration and gastric reflux 
    • Improper tube placement- Recheck the tube placement. 
    • Delayed gastric emptying- Check residuals 
    • Positioning- Keep the head of the bed elevated at 30°–45° 
    Occluded tube 
    • Inadequate flushing- Flush the tube more often. 
    • Use of crushed meds- Instead of using crushed medications switch to liquid formulations. 
    Displaced tube 
    • Improperly secured tube- Re-tape the tube 


    The Bottom Line

    In conclusion, caring for patients with nasogastric tubes requires careful attention and knowledge of the proper nursing interventions and care needed to ensure patient safety and comfort. As a nurse, it’s crucial to understand the guidelines for inserting, caring for, and removing the nasogastric tube.  

    Additionally, nurses must monitor patients for any potential complications, such as nausea, vomiting, or aspiration, and take appropriate measures to address them. By following the guidelines and nursing interventions outlined in this post, nurses can ensure the best possible care for their patients with nasogastric tubes. Remember to always prioritize patient safety and comfort, and document all procedures and care provided. 

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