NASOGASTRI

C TUBE
INSERTION
 • Feeding purposes
-Neurological conditions causing dysphagia/unsafe swallow such as
stroke.

• Medication delivery
-NG tubes can also be used to deliver certain medications directly
Indications into the stomach of patients with the same stipulations as feeding.

for NG • Removal of gastric contents

tube: -Initial and continued gastric decompression in the endotracheal

intubated patients

• Diagnostic uses

-Assessment of the presence or volume of upper gastrointestinal

bleeding
-Administration of radiographic contrast
Equipment needed
for placement of
NG tubes:

•NASOGASTRIC TUBE
•KY JELLY
•STERILE GLOVES
•ASEPTO SYRINGE
•LEUKOPLAST
 1. The doctor explains to the patient and watcher the need for the

PROCESS
procedure.
2. The doctor transcribes the order in the patient's chart.

FLOW
3. Verifies the written order of the attending physician.

4. Secure written consent from the patient. If the patient is unable to give consent, a relative
may do so on his/her behalf (must be of legal age).

5. Prepare the needed materials (nasogastric tube, KY jelly, sterile gloves, asepto syringe,
micropore/plaster, and 10 cc syringe.

6. Coordinate with the resident/trained nurse on duty regarding the procedure.

7. The nurse and resident on duty perform hand washing before the procedure.

8. Greet and introduce self to patient and relative.

9. Ask the patient to state his/her name and birthdate. Check ID band if the patient is unable
to speak, the relative should state the patient's name and birthdate.
10. The resident/trained nurse on duty explains the procedure and expectations to the patient and
relatives.
11. Assist the patient in a fowlers or moderate to a high backrest position for optimal neck, stomach
alignment. The patient may lay flat with pillows supporting the head if unable to sit (depending on
patient’s case)
12. The resident/trained nurse don sterile gloves and the nurse dons clean/sterile glove depending on
whose available to do the insertion.
13. The resident /trained nurse on duty gets the nasogastric tube from the package and uses it to measure
the length to be inserted. Measure the tube from the tip of the patient's nose as a point of reference to
the patient's ear and down to the epigastric area.
14. The nurse applies an amount of lubricating jelly on his hand/the resident's hand just enough to
lubricate the tube for easier insertion.
16. The resident/trained nurse on duty inserts the nasogastric tube through the selected nostril.
17. The nurse and resident on duty check for the patency. The nurse connects the tube to an asepto
syringe and instills air through the tube. The nurse uses a stethoscope and places it over the epigastric
area to listen for any gurgling sound. If no sound is heard over the stomach, this may indicate improper
placement of the tube. The resident/trained nurse may need to re-adjust the tube.

18. The nurse will secure it with adhesive tape to protect the nasogastric tubing from accidental pulling.

19. The nurse/resident on duty will remove their gloves and perform hand washing.
20. The nurse will dispose of all used materials in their designated receptacles.
21. The nurse will reassess the patient for any discomfort.
22. The resident/Attending physician may require a chest x-ray to confirm the validity of insertion
depending on hospital protocol.
23. The nurse documents the action is taken, observations, the outcome of the procedure, time, and name
of the person who executed the procedure in the nurse's notes. Kardex to be updated regarding time and
date of insertion, size of the NGT.
 FOLEY
CATHETER
INSERTION
EQUIPMENTS
NEEDED FOR
FOLEY CATH
INSERTION
•FOLEY CATHETER
•URINE BAG
•KY JELLY
•10CC WITH STERILE WATER
•COTTON BALLS WITH POVIDONE-
IODINE
•STERILE GLOVES
 [Link] doctors order
2. Carry out doctor’s order after proper validation of order.
3. Explain the procedure to the patient and secure written consent.
4. Gather all the needed materials.

PROCESS 5. Perform handwashing.

6. Proceed to the patient's room.
FLOW 7. Ask the patient to state his/her name and birthdate. Check ID band if the
patient is unable to speak, the relative should state the patient's name and
birthdate

8. Provide privacy by closing the curtain or door. Minimize the people in the
room by asking some relatives to leave the room temporarily.
9. Position the patient properly, including the height of the bed and side rails.
10. For the male patient: the patient will be asked to lie in a supine position with legs slightly
spread and spread.
11. For the female patient: the patient will be asked to lie in a supine position with legs
slightly spread and bend.
12. Drape the patient's abdomen and thigh.
13. Ensure adequate lighting to the perineal area.
14. Perform hand hygiene.
15. Open and apply sterile gloves maintaining sterile technique.
16. Attach the catheter to the urine drainage bag.
17. Clean the perineal area using povidone-iodine swabsticks from the inner to the outer
part.
18. For males: with one hand, gently grasp the penis and retract the foreskin (if present). On
the other hand, cleanse the glans penis.
19. For females: gently spread the labia minora with your fingers and visualize the urinary
meatus. Holding the labia part, cleanse the periurethral mucosa using one downward stroke
and dispose of it.
20. Coat the distal portion of the catheter with water-soluble, sterile lubricant.
21. For males: Hold the penis perpendicular to the body and gently pull up. Continue
inserting until the hub of the catheter is inserted.
22. For females: Steadily insert the catheter into the meatus until urine is noted. Continue
inserting 1 to 3 inches if there is a negative passage of the urine.
23. Attach the water-filled syringe to the inflation port.
24. Inflate the retention balloon .If the client experience pain during the balloon inflation.
Deflate the balloon and insert the catheter farther into the bladder. If the pain continues
with balloon inflation, remove the catheter and notify the client attending physician.

25. Once the balloon has inflated, gently pull the catheter until the retention balloon is
resting against the bladder. Neck.
26. Tape the catheter to the thigh to maintain proper placement.
27. Place the drainage bag on the lower part of the bed.
[Link] gloves
[Link] all use materials in their respective receptacle
30. Perform handwashing.
[Link] the client back to a more comfortable position
and assesses the patient's condition
32. Document the procedure is done and the patient's
response. The nurse must also monitor the quantity of
urine voided.
 [Link] and verify doctors order
2. Prepare the needed materials.

3. Perform hand washing.

4. Proceed to the patient room.

5. Ask the patient to state his/her name and birthdate. Check wrist tag if the patient is unable to
speak, the relative should state the patient's name and birthdate.

6. Greet the patient and introduce yourself to the patient.

7. The nurse will explain the procedure to the patient.

8. Provide privacy to the patient by closing the doors and curtains. May ask relatives to leave the
room temporarily to minimize the crowd.

9. Place the patient in a supine position.

REMOVAL 10. If male: Instruct the patient to slightly spread legs.

11. If female: Instruct to slightly spread and bend legs.

12. Perform hand hygiene and wear gloves.

13. Gently remove all plasters used to secure the foley catheter.

14. Using a 10cc syringe aspirate the distilled water to deflate the Foley catheter balloon.

15. Instruct the patient to take a deep breath while gently pulling the foley catheter.

16. Remove the gloves.

17. Assist the patient in a comfortable position.

18. Dispose of all the materials used.

19. Perform hand washing.

20. Document the procedure is done and note if the patient can void freely within an hour after
removal of the catheter.
DONNING OF PPE
 1. Health Care Worker (HCW) has completed the following:
 Hair tied or pulled back if needed
 Remove jewelry, lanyards etc.
 Staff are clean shaven if wearing N95 respirator

2. Put on shoe covers

3. Put on hair net
4. Perform hand hygiene
5. Put on gown, gown should fully cover torso from neck to knees, arms to wrist and wrap around back.
6. Put on N95 mask.
7. Hold mask with outside touching palm of hands with nose piece towards fingertips and head strap hanging freely below hand.

PROCESS
8. Position the mask below chin with nose piece up.
9. While holding mask in place pull top strap overhead and place high on back of head. Secure.
10. Pull bottom strap over your head and rest below ears, and at the back of your neck. Straps should be beneath your hair.

FLOW 11. Untwist straps and position so mask low on nose. Using both your hands (index and middle finger)mold the mask to your nose by
pushing down and outward over the nosepiece and moving your fingertips down along the outside of both sides of the nosepiece.

12. Do a fit check by placing both hands over the mask and exhaling sharp. If air leaks repeat adjusting the nosepiece to fit as instructed
in previous step and adjust head straps. Repeat fit check. If air leak still present, you can NOT enter room. Air leak must be done with
EACH donning of mask.

13. Perform hand hygiene.

14. Don goggles and face shield. Adjust to fit so not loose.
15. Don gloves- select correct size and extend them to cover wrist of gown.
16. Make sure PPE fits comfortably so you won’t be needing to adjust when in room with patient.
17. Keep hands away from face. Limit surface touching.
18. Change gloves immediately if see gloves are torn or heavily soiled. Perform hand hygiene after doffing, or before donning a clean
pair.
DOFFING OF PPE
 1. Remove shoe cover.
2. Remove gown and gloves.
3. Grasp the gown in the front and pull away from your body, fold or rolling the gown inside-
out into a bundle.
4. As you remove the gown, peel off the gloves as well, only touching the inside of the gown
and gloves with your bare hands.
5. Place gown and gloves into a waste receptacle.

PROCESS 6. Remove goggles/face shield without touching the fronts. Remember the outside is
contaminated so if hands get contaminated, immediately perform hand hygiene.

FLOW
7. Remove face protection from the back by lifting band and holding out by strap or grabbing
sides and pulling forward away from face.
8. Drop in receptacle or if reusable, in designated receptacle for reprocessing.
9. Remove N95, do not touch the front of mask.
10. Pull bottom strap overhead, continuing to hold strap and the using other hand to remove
top strap overhead, continuing to hold strap. If your hands get contaminated, stop and
perform hand hygiene.

11. Remove hair cover.

12. Perform hand hygiene.
 ASSISTING IN
ENDOTRACHEAL
INTUBATION
 [Link] the doctor’s order for the procedure
2. Inform patient and relative for the procedure, discuss with them the risk and benefits.
3. Secure consent.
4. Prepare the patient, check for the reliable IV access, assess the airway of the patient
5. Prepare the equipment:
Correct ET tube size
Laryngoscope
Ambubag
Cardiac monitor
Induction agents and muscle relaxants
Emergency cart with drugs and IV fluids.

PROCESS 6. Prepare the team and assign roles:

Team leader: AP/ Resident Doctor
Airway: Respiratory Therapist

FLOW Compressor: Nurse 1/NOD of the patient

Drug Administration: Nurse 2
Recorder: Head Nurse/Nurse Supervisor

7. Wash hands and don personal protective equipment.

[Link] with 100% O2 using ambubag
9. The Attending Physician/Resident Doctor is now ready to intubate the patient. Grasp the laryngoscope in the left
hand (non-dominant hand).
10. Open the mouth and inspect (tilt head into 'sniffing position'); remove any dentures/debris, suction any secretions
11. Slowly insert the blade into the right side of the patient’s mouth using it to push the tongue to the left. Advance
the blade inward and midline toward the base of the tongue.
12. The tip of the curved blade should be placed in front of the epiglottis in the valecula. The tip of the straight blade
should be placed under the epiglottis. Apply pressure caudally and upward with the handle at a 45 degree angle the
bed.
13. Lift the handle until the vocal cords are visualized ensuring that the blade or
handle is not levered against the incisors.
14. Grasp the ETT tube with the right (dominant) hand.
15. Gently insert the ETT along the right side of the mouth under direct visualization
of the vocal cords until the cuff is no longer visible.
16. Firmly hold the ETT in place, withdraw the blade and inflate the ETT cuff with 5-
10ml of air.
17. Assess for proper placement of ETT by end tidal CO2 waveform, fogging in ETT,
bilateral breath sounds, symmetric chest movement, and absence of breath sounds
over the epigastrum, as well as return to baseline vital signs.
18. If assessment indicates that the ETT is not placed in the trachea, deflate the cuff
and remove the ETT. Resume mask ventilation with 100% O2. Consult with staff on
strategy to reattempt intubation
19. f breath sounds are absent on the left, deflate the cuff and withdraw the ETT 1-
2cm and evaluate for correct placement. Attach the secure the ETT with tape.
20. Attach the ETT to the mechanical ventilator. Ask the AP for the parameters.
21. Document the procedure. Assess for patient’s response.