4.

1a STANDARD OPERATING PROCEDURE – Insertion of a naso-gastric feeding tube

Policy: Policy Reference: Originator:

Food, Fluid & Nutritional Care 4.1 (a) Julie Fyall
Operation The insertion of a naso-gastric feeding tube.
Part number/name The insertion of a naso-gastric feeding tube for enteral nutritional
support for all adults identified as at risk of malnutrition.
Safety Tools/ Universal precautions e.g. wash hands before administration.
Clothing Disposable apron
Tools/Equipment Fine bore naso-gastric (FG 8/10) radio-opaque throughout their
length and have externally visible length markings.
60ml purple enteral syringe
Bowl
Non-sterile gloves
PH paper
Naso-gastric tube insertion checklist
Incapacity form if patient unable to provide verbal consent

No Main Operating Steps Rationale Evidence/support

1 Select appropriate FG Corflo To provide patient with tube NMC Code of
tube to suit clinical need of which meets their clinical Professional
patient. need. Conduct (2005)
2 Staff preparing the patient Patient safety and good NMC Code of
must introduce themselves to practice. Professional Conduct
the patient by name and title. (2005)
3 Staff must ensure that it is the Patient safety. NHS Tayside
correct patient - check name, Safe and Secure
date of birth, CHI (in-patients) Handling of
or address (primary care). Medicines Guidance
(2008) NMC Code of
Professional
Conduct (2005)
4 Staff must explain the Patient safety and good NHS Tayside
procedure to the patient and practice. Informed Consent
gain verbal consent if able and Policy (2011)
if not then signed consent NMC Code of
using incapacity form. Professional
Conduct (2005)
5 Assist patient to sit in semi- To ensure patient is in NMC Code of
upright position with their head correct position for inserting Professional
in a neutral position (if naso-gastric feeding tube. Conduct (2005)
possible).
6 Decontaminate hands and put Patient safety. NMC Code of
on gloves. Professional
Conduct (2005)
NHS Tayside
Infection and Control
Policy (2011)
7 Measure the distance from the To identify length of tube to NMC Code of
patient’s ear lobe to bridge of be inserted into correct Professional
the nose to the bottom of the insertion site. Conduct (2005)
xiphisternum with the tube.
8 Select and note appropriate To note length of tube to be Manufacturer
marker on the tube from the inserted in stomach. instructions
patient’s measurements.
9 Place the end of the tube in a To lubricate tube before Manufacturer
bowl of water and flush tube insertion. instructions
with water.
10 Advise patient that procedure Good practice. NMC Code of
is about to occur and relax. Professional
Conduct (2005)
11 Insert the tube into the clearer To place tube correctly and Manufacturer
nostril in a backwards and does not go into or trachea. instructions
inwards direction along the
floor of the nasal cavity.
12 As the tube passes the To place tube correctly and Manufacturer
nasopharynx encourage the to prevent going into instructions
patient to swallow. Give the trachea.
patient water to sip if
permitted.
13 Advance the tube through the To place tube correctly and Manufacturer
pharynx until the prevent it going into trachea. instructions
predetermined mark has been
reached.
14 Check tube position by To check tube placement, National Patient
aspirating stomach contents patient safety. Safety Alert
with a 60ml syringe and check /2011/PSA 002:
with the pH paper that the reducing the harm
aspirate is below pH 5.5. caused any
If aspirate can NOT be misplaced tubes in
obtained then as second line adults, children and
test please refer patient for X- infants March 2011
ray to establish position of
naso-gastric tube.
15 Remove the guide-wire, mark To secure tube and mark the Manufacturer
the tube at the nostril with an correct tube position. instructions
indelible pen and secure the
tube to the patient’s nostril with
tape.
16 Ensure the patient is left Patient safety. NMC Code of
comfortable and document Professional
procedure in the patients Conduct (2005)
nursing notes.
17 Complete naso-gastric Patient safety. NMC Code of
insertion checklist and file in Professional
nursing notes. Conduct (2005)
 APPENDIX 1: Competencies for Insertion and Care of Naso-Gastric (NG)Tube

Name of Practitioner …………………………………………………... Date ………..…………………..

Knowledge All criteria must be met Met Not
met
Knows what information the patient needs before NG tube is passed.
Demonstrated knowledge of complications associated with insertion and use of NG
tube.
Demonstrated knowledge of NHS Tayside’s NG insertion policy.
Lists all the equipment needed for insertion of NG tube insertion and explains why
each piece of equipment is used.
Can describe how the correct position of the NG tube is confirmed and explain
action to be taken if NG tube is suspected not to be in stomach.
Can discuss infection control principles in relation to NG insertion and subsequent
care of tube.
Can describe the appropriate documentation needed and why the tube should be
marked with an indelible pen after insertion.
Can describe when the position of NG tube should be rechecked.
Skills
Effectively discusses procedure with patient and obtains oral consent when
appropriate.
Chooses appropriate equipment and prepares the environment.
Demonstrated appropriate infection control practices.
Demonstrates appropriate skills in assessing the correct position of the NG tube.
Follows hospital policy for insertion and care of NG tube.
Secures the tube and marks the tube with an indelible pen at the nostril.
Awareness/Attitude
Recognises own competency level and can explain implications of accountability
when undertaking this practice.
Recognises the individual needs of the patient/client and deals with them
sensitively.
Supervised practice of NG Date Comments
insertion
1
2
Formal assessment

I feel I have received sufficient theoretical knowledge and supervised practice to undertake the
practice of insertion and care of naso-gastric tube.

Signature of Practitioner: ……………………………………………. Date: ………………….……

This practitioner has successfully met all the criteria for assessment.

Name of assessor: ……………………………………………………………………………..……..

Signature of Assessor: ………………………………………………. Date: ………………………

 APPENDIX 2: Naso-Gastric (NG) Tube Insertion Checklist

Equipment List
- Fine bore naso-gastric tube which is radio-opaque throughout their length and
have externally visible length markings.
- 60ml syringe, bowl, non sterile gloves, pH paper and tape

Initials
Introduce self to patient by name and title.
Ensure you have the correct patient, check name, DOB, CHI (in-patients) or
address (primary care).
Explain procedure to patient.
Gain verbal consent.
Assist patient to sit in semi-upright position with their head in a neutral position (if
possible).
Decontaminate Hands.
Put on gloves.
Measure the distance from the patient’s ear lobe to bridge of the nose to the bottom
of the xiphisternum with the tube.
Select appropriate marker on the tube from the patient’s measurements.
Place the end of the tube into a bowl of water and flush the tube with water.
Insert the tube into the clearer nostril in a backwards and inwards direction along
the floor of the nasal cavity.
As the tube passes the nasopharynx encourage the patient to swallow. Give the
patient water to sip if permitted.
Advance the tube through the pharynx until the predetermined mark has been
reached.
Check tube position by aspirating stomach contents with a 50ml syringe.
Test with pH paper and confirm pH below 5.5.*
Secure tube to the nostril with tape.
Remove and retain the guide wire.
Ensure the patient is left comfortable.
Document procedure in the patient’s notes.

*A pH of 5.5 or less is a reliable indicator of gastric placement.

Medications particularly H2 receptor antagonists (Ranitidine) or proton pump

inhibitors (Omeprazole, Lansoprazole), reduce or inhibit gastric acid. This can
elevate the pH of gastric aspirate. Elevated gastric pH can also occur in the
presence of refluxing duodenal and pancreatic fluid which may occur after gastric
surgery.

Normal bronchial fluid is 7.6, however it has been reported as low as 5.5, although it
is usually greater than 6.

When pH readings are inconclusive, or if aspirate is unable to be obtained, the tube

will require removing and reinserting, or the use of radiology to confirm tube position
may be required.