INTRODUCTION
Scene Safety and Privacy:
Assess for scene safety.
Provide privacy for the patient.
Hand Hygiene:
Perform hand hygiene using the 7 steps technique.
Patient Interaction:
Greet the patient to create rapport.
Introduce yourself and explain the purpose of the visit.
Gaining Consent and Positioning:
Obtain patient consent.
Position the patient in a semi-upright position.
Preparation:
Ensure a working suction machine and oxygen are near the patient (verbalize this).
Ensure the patient is comfortable, has no concerns, and the call bell is within reach.
Inform the patient you will be back with the necessary items.
Perform hand hygiene again.
GATHER ARTICLES
- Clean tray.
- Hypoallergenic tape.
- Enteral pH strip (check that the pack is dry, intact, and within the expiry date).
- Kidney dish (clean and dry).
- Enteral syringe (check that the pack is dry, intact, and within the expiry date).
- Fine bore nasogastric tube.
- Scissors.
- Drape.
- Glass with warm water (to be used as a lubricant).
PROCEDURE
Hand Hygiene and Personal Protection:
Perform hand hygiene.
Wear apron and gloves.
Patient Comfort and Communication:
Ask the patient if they are comfortable.
Inform the patient to use a hand signal if they need to stop the procedure.
Positioning:
Ask the patient to maintain a semi-upright position in the chair/bed, supporting their head with pillows to ensure no head tilt forward or backward.
Check Nostrils:
Check the patency of the nostrils by asking the patient to sniff with one nostril closed, then repeat with the other nostril.
Measurement:
Perform a NEX (Nose-Ear-Xiphisternum) measurement:
Measure the distance from the patient’s nose to their earlobe.
Add the distance from the earlobe to the bottom of the xiphisternum.
Add 5-10 cm to this measurement.
Note the measurement marks on the tube.
Lubrication:
Lubricate approximately 15-20 cm of the tube with warm water.
Inserting the Tube:
Ensure the kidney tray is ready.
Insert the proximal end of the tube into the nostril, sliding it backwards and inwards along the floor of the nose to the nasopharynx.
If any obstruction occurs, stop and try again in a slightly different direction or use the other nostril.
Ask the patient to start swallowing as the tube passes down the nasopharynx into the esophagus.
Advance the tube through the pharynx as the patient swallows until the measured indicator on the tube reaches the entrance of the nostril.
Monitoring:
Recognize any signs of distress such as coughing or breathlessness. If these occur, remove the tube immediately.
Securing the Tube:
Secure the tube with adherent dressing tape to the nostril and cheek.
Confirmation of Tube Position:
Aspirate a small amount of stomach contents using a 50ml or 60ml syringe.
Confirm the position of the tube by checking the pH of the gastric content using a pH strip. The pH should be equal to or less than 5.5.
Use the integral cap to cap the tube.
Post-Procedure:
Discard waste materials.
Ensure the patient is comfortable, has no concerns, and the call bell is within reach.
Perform hand hygiene.
Document the procedure.
Provide health education (e.g., instruct the patient not to pull out the tube, do regular mouth care, etc.).
Perform hand hygiene again.
Conclude by informing the assessor that you have finished the procedure, discarded used items according to hospital policy, documented as per NMC guidelines, cleaned the tray for next use, and ensured the patient is comfortable.
