Preparation
What position should the patient be in for NG tube insertion?
Position the patient in a sitting or high fowlers position.
If comatose-semi fowlers.
If patient unable to sit upright lie on one side.
Support the patient's head with pillows.
Before inserting the NG tube, which action is essential for communication?
Arrange a signal with the patient to stop the procedure
As per the policy, if tube is accidentally removed and is still required, when should it be reinserted?
Within 6 hours
How often should the sterile water bottle used for flushing be changed?
Every 24 hours
What is the initial infusion rate for continuous PEG tube feeding?
50 ml/hr
How do you need to assess the patency of nares prior 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 patients' nostrils for deviated septum or nasal polyps, can use torch (if available)
Clean mucus and secretions from nares with moist gauze
What would you do if the patient starts coughing or gagging during insertion?
Pause and wait until it stops
What volume of sterile water is used to flush between medications?
10 ml.
medications must never be mixed
What volume of sterile water is used to flush the NG tube for feeding?
The NGT should be flushed with 30-50 ml of sterile water before starting a feed/medication and when the feed/medication is stopped.
What is the increment used to advance the tube feeding rate after assessing tolerance?
25 ml/hr daily until the necessary volume is reached or an infusion rate of 150 ml/hr, unless clinically indicated?
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)
Ice chips or glass of water (if not contraindicated)
Non sterile gloves (use sterile gloves for immunocompromised)
Water soluble lubricant
50ml Catheter tip syringe
Emesis basin (kidney dish)
Gauze swabs
Clamp/spigot
Torch
Drainage bag (if required)
What is the First-line method to confirm tube placement?
pH paper test
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 record the result in patient notes
How often the NGT position must be checked?
Once every 6 hours, or before commencing new feed and before administering medicines
How often should residuals be checked for patients on continuous PEG tube drip feeding?
Every 4 hours
How should you measure the NGT?
From bridge of the nose to the earlobe, plus the distance from the earlobe to the bottom of the xiphisternum.
Mark location of sternal notch along the tubing with small strip of tape.
What pH range suggests the tube is correctly placed in the stomach?
pH level of between 1 and 5.5
For a patient on continuous NGT feeding, what is the best time to check the pH?
After waiting an hour from the last feed or medication
Bonus!
Bonus!
How high should the syringe be elevated above the patient's abdomen during PEG tube feeding?
45 cm
As per hospital policy, when NGT insertion must be done by a physician?
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 Tracheostomy tube
Coagulopathy
What are the recommended methods to confirm tube placement?
X-ray confirmation
Testing pH of aspirate
Note location of external site marking on the tube.
What is the correct angle for the patient’s head during overnight feeding?
30–45 degrees
If the patient is bed-bound or on overnight feeding, the head and shoulders should be elevated 30-45 degrees during feeding and for at least one hour afterward to maintain gravitational drainage of feed and prevent gastric pooling.
How to Handle a Blocked Feeding Tube?
Ensure the clamp on the giving set is open.
Use a 60 ml purple female luer or 50 ml catheter-tip syringe to gently pull back and attempt to unblock.
Gently massage the tube, starting from the far end toward the abdomen.
Try flushing with 30 ml of warm water. If unsuccessful, wait 30 minutes and try again with carbonated soda water.
Avoid using excessive force, sharp objects, or reinserting the guide wire.
If still blocked, remove and replace the nasogastric tube (NGT).
Explain PEG tube bolus feeding procedure?
Fill the syringe with 150 ml of formula and allow it to flow by gravity.
Withhold feeding temporarily.
After 2 hours, check the residual volume:
If ≥150 ml, notify the physician.
If <150 ml, proceed with tube feeding as ordered.
Once feeding is complete, flush the tube with 10–30 ml of clear water and recap it.
Ask the client to stay in a sitting or slightly elevated right lateral position for at least 30 minutes post-feeding.