Nasogastric Tube Insertion (OSCE)

Introduction

Greet the patient and introduce yourself

Briefly explain the procedure in a patient friendly manner 

Get patient consent ✍

Check for allergies 

Check the patient is not in any pain 

Wash hands ✋

❌ Avoid nasogastric tube insertion if there is any chance the patient has a base of skull fracture!  ❌

Equipment

Disposable gloves ✋

Disposable bowl

Paper towels

Dressing 

Water for patient

Nasogastric tube (fine bore)

Large syringe 

Local anaesthetic spray

Lubricant

Gauze

pH testing strips

Measure insertion length

1. Put disposable gloves ✋ on
2. Measure 📏 the distance between the bridge of nose to the ear lobe, then measure downwards to 5cm 📏 below the xiphisternum

Insertion of nasogastric tube

1. Apply lubricant to the tip of the nasogastric tube
2. Spray local anaesthetic to the back of throat
3. Inform the patient you are ready to insert the tube
4. Insert the tube, entering through on of the nostrils 👃
5. Move the tube through the nasopharynx 
6. Continue insertion down the oesophagus
7. Ask the patient to drink a few sips of water to make insertion easier
8. When the insertion length 📏 is met, tape the tube to the nose

Aspiration

1. Aspirate gastric contents:
   1. Successful ✅ aspiration: pH <4 indicates the tube is in the correct position
   2. Unsuccessful ❌ aspiration/pH >4: chest x-ray needed
2. Remove guide-wire once aspirated and safe to use to nasogastric tube
3. Dispose of waste appropriately
4. Wash hands ✋

Completion

Tell the patient the procedure is complete ✅

Thank patient 

Offer paper towels so the patient can clean their face

Tell nurses it is safe to use the nasopharyngeal tube 

Document ALL of the data ✍

Summary:

1. Greet the patient and briefly explain the procedure
2. Measure the insertion length
3. Apply lubricant and anaesthetic then insert the nasogastric tube
4. Aspirate gastric contents
5. Complete the procedure by thanking the patient