Respiratory distress, coughing, choking, or inability to speak during insertion signals tracheal placement; withdraw immediately.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client returns from surgery with a nasogastric tube set to low intermittent suction. Which finding indicates the tube is functioning effectively?
Answer: A. An NG tube to suction decompresses the stomach; effective function is shown by a soft, nondistended abdomen with active drainage of gastric contents. Increasing distention, vomiting around the tube, or absent drainage with nausea suggest the tube is blocked or not working.
Question 2 of 3
A nurse is reviewing the results of a Mantoux tuberculin skin test (TST) on an HIV-positive client. The site shows 6 mm of induration. How should the nurse interpret this result?
Answer: B. For clients who are HIV-positive or otherwise severely immunocompromised, an induration of 5 mm or greater is considered a positive TST result. Therefore 6 mm of induration is positive for this client and requires follow-up. The general healthy-population cutoff of 15 mm does not apply to immunosuppressed clients, and redness without induration is not measured.
Question 3 of 3
A client with a nasogastric tube to continuous suction for three days is at risk for which acid-base imbalance?
Answer: B. Prolonged nasogastric suction removes hydrochloric acid and gastric contents, causing loss of hydrogen ions and resulting in metabolic alkalosis. Associated electrolyte losses include hypokalemia and hypochloremia, which help maintain the alkalosis.
Keep the streak going with more questions like these, each with a full rationale.
What is nasogastric tube insertion and care?
Correct placement must be confirmed before any use because a misplaced tube in the lung can be fatal. The single most reliable bedside confirmation is X-ray; pH testing of aspirate supports it.
Key points to remember
- Measure tube length from tip of nose to earlobe to xiphoid process (NEX) before insertion.
- Have the client sit high-Fowler's with head tilted forward and swallow/sip water as the tube advances past the throat.
- Gastric aspirate pH is typically 1 to 5 (acidic); respiratory/intestinal aspirate is more alkaline (pH 6 or higher).
- X-ray is the gold standard to verify placement before the first feeding or medication.
- Auscultation of an air bolus (whoosh) is no longer considered reliable for confirming placement.
- For decompression, low intermittent suction is used with a Salem sump (double-lumen) tube; keep the blue air vent (pigtail) above stomach level and never clamp it.
Nursing priorities
- Verify placement by X-ray initially, then check pH and external tube length/markings before each use.
- Keep head of bed elevated 30 to 45 degrees during and after feeding to prevent aspiration.
- Flush the tube with 30 mL water before and after feedings and medications to maintain patency.
- Provide nostril and oral care; reposition/retape to prevent skin and mucosal breakdown.
- If the client coughs, gags, or shows respiratory distress during insertion, withdraw the tube and stop.
Labs & values
Patient teaching
- Sit upright for at least 30 to 60 minutes after each feeding.
- Report nausea, vomiting, cramping, or feeling of fullness during feeding.
- Do not pull on or reposition the tube yourself.
Red flags: report now
- Respiratory distress, coughing, choking, or inability to speak during insertion signals tracheal placement; withdraw immediately.
- Never instill feeding or medication until placement is confirmed.
- Aspirate that is not acidic, or a change in external tube length, means STOP and re-verify by X-ray before use.
References
Clinical references for this topic
