 What comes in nursing school explained in this video on how to insert a nasogastric tube into a patient. After checking the orders and making sure that we confirm everything that we need in order to make sure that the procedure can be performed safely, we need to also make sure that we educate and inform our patient about the procedures and the details. Now this is an uncomfortable procedure and sometimes patients they vomit during the procedure so the better you prepare a patient for all the eventualities and what to expect the better and the smoother the insertion will go. I'll tell you that as a new nurse I had a lot of trouble inserting nasogastric tubes into patients when I worked in the emergency department but a senior experienced nurse told me that the key to this is to have the patient put their chin to their chest once the tube is in the posterior fairings because then you close off the epiglottis and then the tube just slides down when you have them swallow the water. But first things first, so first of all we need to make sure that we have all the equipment that we need to do this. So first of all we need our nasogastric tube. We also will need a stethoscope to confirm placement after it's been inserted. We need a cup of water with a straw that's very important the straw because the patient won't be able to tilt the head back to drink water in an attempt to swallow the tube and then a piece of tape as well as a piston or catheter tip syringe, an MSS basin and an extra towel just in case the patient throws up so that we are prepared for all the eventualities. And the way that I usually explain the procedure to the patient is this is then can be an uncomfortable procedure but the most important part is that you don't swap my hand away because that's a reaction that some patients will have and they will attempt to to move your hand away when it becomes uncomfortable when you when the tube hits the back of their throat. So I'll just tell them right away in case it becomes too uncomfortable or unbearable or you need a moment to breathe just raise your hand and I'll stop right there but I'm not going to let the go of the tube because I don't want to jeopardize any progress that I've made with the tube because if the patient coughs or starts to vomit or gags they can push that tube right out and any progress that we've made will be not happening anymore. So once I've told the patient about this then I get my equipment then we can start the procedure and then depending for the reason of the reason for the anti-tube insertion if this is for example for a bowel obstruction and the patient will need suctioning then we certainly need to also make sure that we have the wall suction set up at the correct setting and have that tubing ready to go so that we can hook it up once the ng-tube is inserted. Okay so this is a clean procedure not a sterile procedure so I'm going to wash my hands and don my gloves and in this case I've already explained the procedure to my patient so after I don my gloves I will assess their nears first because it is important to know the anatomy and if there are any abnormalities that I could expect so questions to ask would be have you ever had a nasal fracture or a deviated septum or any kind of nasal surgery and if they say yes then you have to be extra careful and notified of physician and then maybe they want to have an ENT or somebody else insert the ng-tube for safety reasons but if that is not the case then we want to make sure we have a patent there one of them might be more patent than the other the simplest way to do this is to include one of the patient's nostrils and ask them to exhale and then you can see or you can actually hear if there's a patency and airflow and then we do the same thing on the other side exhale okay and then we can know that the other thing you could do is use a sterile q-tip and then sort it gently into the patient's nostril kind of like you would do when you correct a nasopharyngeal swab for for a respiratory secretion panel or swab for any kind of testing and to see how patent the nostril is once you've determined the patency of the nostril we can go ahead and start with the procedure so I always place a towel right here on the patient's chest you want to make sure that you sit them up as much as possible but depending on why they need it and what's going on with their abdomen they might only be able to tolerate a certain degree of elevation of the head of the bed but the minimum you should aim for would be 45 degrees otherwise it's going to be more difficult to insert this ng-tube the other thing that I need to do once I have inserted the ng-tube I'm going to have to secure it and some facilities use some newer devices that that have like a little plastic clip that can go around the tube and the sticker that goes to the patient's nose but the good old-fashioned way is to just use some tape and in this case you would use transport tape and you would get about I guess this is about four inches or so strip and then you want to tear the strip for a small portion and eventually the strip that's still intact that's not torn will go on the patient's nose and then these two ends will twirl around the tube to keep it in place so I'll just make sure that I have this strip of paper ready to go here and then I will explain the procedure and I will say once you're going to fill the tube in the back of your throat then I'm going to ask you to put your chin to your chest and at the same time drink the water with the straw of course one more thing that's important to check is the patient able to swallow and is that okay or are they completely in PO but for the most part once we get the tube down there any water that the patient has swallowed we can suction that back out if that is the purpose of the tube so so we'll instruct the patient chin to the chest and at the same time drink the water and then as the patient is drinking the water the epiglottis will open and then we can we can pass the tube as the patient swallows so with every swallow we'll be able to pass the tube okay I'll be ready here with my stethoscope around my neck I have my emesis space in here that I'll tell the patient to hold with their left hand preferably that's also the hand that I'll instruct them to hold up in case they need me to stop for whatever reason if they need to catch their breath and then I will open up to many times many times you can just use the wrapper the inside wrapper as the source for your lubrication so you can just I'm just going to squirt my lubricating jelly on here and actually before they come to come in different sizes also this particular one is a protein fridge sealant some to depending on why the patient needs it is it for suctioning is it for feeding how long is the tube expected to stay in will depend on the size of to that you that you select and then the tube has these centimeter markings on here which will allow us to know the depth of the tube once it is in there but of course first we'll have to measure it another thing that I always like to go over are these two parts so we have this blue part and then we have this other part at the end of the tube here with this adapter and so many times what this adapter is needed for if you would hope this up to suction the suction tubing connects right here so this is basically an adapter otherwise the suction tubing won't fit on this end of the tube another thing here blue just think blue equals air and that is the airport or the air vent of the ng-tube and the purpose of it is once the tube is in the patient stomach and we put it to suction it's going to move and so it will it there's a possibility that the tube might suction itself against the wall of the stomach but because we have the air vent there is not really a vacuum in the stomach otherwise there would be but because we have that vacuum there it allows the air to get in there not a vacuum to occur and so if we had if even if we had a continuous or intermittent suction even if the tube suction itself against the wall of the stomach we would it would still eventually become free again because of the air vent and the concern here is that if the tube suction itself against the wall of the stomach and it does that for a prolonged period of time it could create an ulcer a pressure ulcer in this case a more of a suction ulcer and it could cause a GI bleed so we want to be extra careful with that and so now that I have got the tube ready I have a lubricating jelly here I will put the cup in my patient's left hand and one more thing I am right-handed so I'm going to be standing on the patient's right side because I'm going to use my right hand for the insertion of the tube so next I need to make sure that I know the how much length of the tube I need and so I'm going to measure from the patient's the tip of the nose through the earlobe and then down to the xiphoid process and remember the xiphoid process is the last piece of a bono cartilage in your chest so in this case in my case this comes out to be 48 centimeters you can either mark it with a sharpie which is what I prefer or you can put a piece of tape there the reason I don't like the piece of tape is because sometimes it's hard to take it off after the fact and I like to use a different sharpie a different color because it's easier to see on the black markings so now we are ready to go so now that I know the length of my tube I'm going to lubricate it and I want to make sure I lubricate at least the first 10 centimeters or so of the tube to make this easier for the patient okay sir I'm going to start the insertion of your tube now once I hit the back of the throat we're going to take a quick break and then once you feel the tube in the back of the throat and I instruct you to do so please drink the water and put your chin all the way to the chest so here we go so I'm going to start inserting the tube by aiming more back rather than up some people think you go up but it really the the nasal bearings opens up more to worse like a straight line rather than out so now I'm hitting resistance okay sir now I'm hitting resistance what I need you to do now please pick up the cup of the straw and put your chin all the way to the chest so I'm going to have him do that and then while he drinks the water I'm going to continue inserting that tube and he might call for gag and if he raises his hand I'll just stop right here but I will keep my hand on the tube because I let go if I let go it might slide back out so I'm going to the patient is coughing I'm going to give him a some time to breathe and then once he's okay again now that I'm past the epic goddess I can actually have him bring the chin back up and I just continue inserting the tube until I get to my blue marker right there at the tip of the nose which is where I started where I marked it now that that's been done I'm going to take the tape that I will be going to use for securement and the bigger part of the tape that's still together I'm going to take on his nose and then I'm going to use the two ends that I have here to twirl around the tube to secure it make sure that the marking that I have the depth of the tube is still where it needs to go now that I've secured that up definitely make sure my patient is okay and then depending on the order I'm either going to hook the end up to suctioning the other thing that I can do is I can hook up my catheter tip syringe to the end of the tube but I have to take this adapter out and then aspirate the fluid and this is one of the verification methods that could be used to measure to see if we're in the right spot and then the fluid that I have aspirated goes on a pH card where it reads the stomach acid and I know then I'm in the right spot by the pH of the stomach the other two verification methods are either an air bolus which is where I fill my syringe with air and typically about 30 mls are okay I put the end of the syringe on the tube and then I take my catheter scope and I listen right over the patient's stomach and as I am inserting the air bolus so pushing that air in I'm going to hear that gurgling in the patient's stomach if the tube were in the lungs or had gone through down to the trachea then I wouldn't hear the gurgling because the lungs are supposed to have air and it's just gonna sound like a deeper breath but in this case the gurgling is very very distinct and once you've heard it you will know that that's what it is the third verification method is a chest x-ray which is the most reliable method but also make sure that you know at your facility what are the method well what is the policy to do a verification of the NG2 placement after the insertion so if this NG2 was just let's say for feeding then I would put the cap on here and then hook it or use a safety pin to secure it to the patient's gown but this can be a little bit iffy because you know the patient might pull on it or somebody might change the gown what I like to do is take a washcloth that's different from this towel or a small towel and just kind of wrap it up because sometimes gastric juices come up as the patient coughs or sneezes and that way the end is contained and we won't have a big mess with stomach contents and that will take care of the NG2 insertion of course will take care of our patient and document all the findings that we had particularly how deep or how far the tube went in the length of it how the patient tolerated the procedure as always and then any kind of verification method that we use such as the gastric acid aspiration or a chest x-ray and then we can just refer to the chest x-ray or the air bolus depending on actually again the facility that you're working at so thank you for watching this video on nursing school explain on the insertion of a nasogastric tube please also watch my other videos in the skills playlist that go over other important basic nursing skills give me a thumbs up if you've enjoyed the video subscribe to my channel see you soon right here on nursing school explained