Inform the patient about the procedure and its potential discomfort.
Position the patient with pillows behind the shoulders.
Lubricate the tube with a water-soluble lubricant.
- Measure the length of the tube to be passed:
- a. Measure from the bridge of the nose to the earlobe to the xiphoid process.
- b. Indicate this length with a piece of tape on the tube.
Determine which nostril is more patent.
Encourage the patient to swallow or drink water if the level ofconsciousness and treatment plan permit.
- Insert the tube:
- a. Pass the tube gently into the nasopharynx. Ask the patient to swallow repeatedly while the tube is advanced.
- b. If resistance is met, rotate the tube slowly, aiming downwardand toward the closer ear.
- c. In the intubated or semiconscious patient, flex the headtoward the chest while passing the tube.
Withdraw the tube immediately if any change is noted in respiratory status.
- Test for tube placement by using these techniques:
- a. Obtain a sample of the gastric contents by aspirating with a 50-mL catheter-tipped syringe.
- b. Test the pH of the gastric contents (should be between 1 and3.5).
- c. Obtain a request for an x-ray study to confirm placement.
- Connect the tube to suction at low pressure:
- a. The Levin tube is connected to intermittent low suction.
- b. The Salem sump or Anderson tube (has pigtail vent) is connected to continuous low suction.
- Secure the tube to the patient's nose and to his or her gown:
- a. Tie a slipknot around the tube with a rubber band.
- b. Pin the rubber band to the gown.
Check intake and output every 4 hr or more often, as indicated.
Observe the patient for nausea, vomiting, abdominal fullness, ordistention.
If irrigation is indicated, use only a normal saline solution.
Observe the patient for alterations in fluid and electrolyte balance.
If indicated, instruct the patient about movement that will not dislodge the tube and cause nasal irritation.
Remove the tape securing the tube to the nose daily and PRN to clean skin; reapply tape.