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100
What position should the patient be in for NG tube insertion (General, comatose, unable to sit)?
Position the patient in a sitting or high Fowler's position.
If comatose-semi fowlers.
If the patient is unable to sit upright, lie on one side.
Support the patient's head with pillows.
100
Before inserting the NG tube, which action is essential for communication?
Arrange a signal with the patient to stop the procedure
100
What are the monitoring parameters for patients on NGT? List at least 4.
Body weight
Fluid Balance
Stool frequency, volume and consistency
Clinical status
Hydration Status
Nutrition related lab values
Energy and protein requirement
100
How often should the sterile water bottle used for flushing be replaced?
Every 24 hours
100
You are initiating bolus feeding. What is the recommended rate?
Begin with 60mL-120mL, then increase volume by 60-120 mL every 4-8 hours until goal rate is achieved.
Maximum volume of feed should not exceed 400mL.
Reducing frequency of feeds (eg. Every 3-4 hours) once higher volumes of fluids are tolerated.
200
How do you assess the patency of the nares before NGT insertion?
Check that the nostrils are patent by asking the patient to sniff with one nostril closed.
Repeat with the other side.
Check the patient's nostrils for a deviated septum or nasal polyps, can use a torch (if available)
Clean mucus and secretions from nares with moist gauze
200
What would you do if the patient starts coughing or gagging during insertion?
Pause and wait until it stops
200
When administering any of the following medications (Phenytoin, Levodopa/L-dopa, Warfarin, Mono-amine oxidase inhibitors / MAOI), how many hours before should you stop the feeding?
Stop for 1 to 2 hours before and after administration
200
What volume (mL) of sterile water is used to flush the NG tube for feeding or administering medications?
At least 15mL before and after administering medication
200
You are initiating continuous feeding. What is the increment used to advance the tube feeding rate?
Nasogastric and gastrectomy initial feeding rate 10-40ml/hr with advance feeding of 10-20ml/hr every 4-8 hours.
Nasoduodenal and nasojejunal always continues feed over (16-24) hrs start at lower rate of 20ml/hr with increments of 20ml/hr every (4-8) hours.
300
List at least 10 items needed for NGT insertion.
NGT (desired size, 14 Fr. or 16 Fr.)
Tongue depressor
PH test strips
Non-allergic adhesive tape
Nasofix adhesive tape (Tegaderm/Duoderm)
Glass of water (if not contraindicated)
Non-sterile gloves (use sterile gloves for immunocompromised patients)
Water soluble lubricant
50ml Catheter tip syringe
Emesis basin (kidney dish)
Gauze swabs
Clamp/spigot
Torch
Drainage bag (if required)
300
What is the First-line method to confirm tube placement? And what are other recommended methods?
pH paper test
X-ray confirmation (the best)
Note the location of the external site marking on the tube.
300
What must be documented after successful NG tube insertion?
type and size of the tube
name of the person who inserted the tube
the measurement on the tube at the exit point from the nostril
the pH value of gastric aspirate
ease of insertion
the health care professional reading the chest X-ray records the result in the patient's notes
300
How often must the NGT position be checked?
Once every 6 hours, or before commencing a new feed or before administering medicines.
300
A nurse is administering three oral medications through a patient's NGT/PEG tube. Which technique demonstrates correct nursing practice?
Crush each medication separately, dissolve each in water, and flush the tube with 15 mL of water before, between, and after each drug.
400
How should you measure the NGT?
From the bridge of the nose to the earlobe, plus the distance from the earlobe to the bottom of the xiphisternum.
Mark the location of the sternal notch along the tubing with a small strip of tape.
400
What pH range suggests the tube is correctly placed in the stomach?
pH level between 1 and 5.5
400
For a patient whom you have just administered medication through NGT, when is the best time to check the pH?
After waiting an hour from the last feed or medication
400
A nurse is preparing to feed the patient via NGT. What should a nurse do if a pH of 6.0 or above is obtained, or there is doubt over the result in the pH range?
Should not commence feeding until a second competent person checks the reading or retests.
400
500
When must NGT insertion be done by ONLY a physician? (List at least 3)
Head Injury, basal skull fracture.
Maxillofacial/Facial fractures, disorders, surgery, or trauma
Esophageal varices, tumors, fistulas, or recent surgery
Laryngectomy
Any head and neck surgery
Patients with a tracheostomy tube
Coagulopathy
500
How often should the assigned nurse refill/replace feeds for open and closed systems?
Open system feeds: every 4 hours
Closed system feeds: limit hang time to 24 hours.
500
What is the correct angle for the patient’s head during continuous feeding?
30–45 degrees
To maintain gravitational drainage of feed and prevent gastric pooling.
500
How often is it recommended to routinely aspirate gastric contents from patients on NGT feeding to assess tolerance?
Not recommended. Only when Required by Protocol.
Recommendation: focused nursing assessment for signs and symptoms of enteral feeding intolerance, such as vomiting, abdominal distention, and abdominal pain.
500
How high should the syringe be elevated above the patient's abdomen during PEG tube feeding?
30-45 cm