Coughing, choking, inability to speak, or respiratory distress during insertion — the tube may be in the airway: withdraw it 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?
It is used to decompress the stomach in bowel obstruction or ileus, to give feedings or medications to a client who cannot swallow, or to remove an ingested poison. A tube can enter the airway without causing any coughing, so placement must be confirmed by X-ray before first use and rechecked before every use. Nursing care focuses on preventing aspiration, keeping the tube patent, and protecting the nose from pressure injury.
Key points to remember
- Measure nose → earlobe → xiphoid (NEX) and mark the tube. In adults the stomach is about 55 cm from the nostril, but every estimate has error, so measuring never replaces confirmation.
- Insert with the client in high Fowler's, chin flexed toward the chest, sipping water to swallow the tube down. Use a water-based lubricant and the more open nostril.
- X-ray is the gold standard before the first feeding or medication. Before each later use, check aspirate pH (gastric 1–5) and the external length mark.
- The air-bolus 'whoosh' test is unreliable and should not be used to confirm placement.
- A tube can enter the airway with no cough or distress, so a quiet insertion does not prove gastric placement.
- For decompression, a double-lumen Salem sump runs on low intermittent suction. Its blue air vent keeps the stomach lining from being sucked into the tube, so keep the vent above stomach level and never clamp it.
- Avoid blind insertion with suspected basilar skull fracture or severe facial trauma, because the tube can enter the skull. Use caution with esophageal varices, strictures, caustic ingestion, or bleeding disorders.
Nursing priorities
- Confirm placement by X-ray before first use, then check pH and the external mark before every feeding or medication, because feeding through a tube in the lung goes straight into the airway.
- Keep the head of the bed at 30–45 degrees during and after feedings, because elevation lowers aspiration risk.
- Flush with 30 mL of water before and after each feeding and medication, because flushing keeps the tube patent.
- For decompression, confirm suction is working and record the amount and color of drainage, because output and patency show whether the stomach is being emptied.
- Give nose and mouth care and retape the tube regularly, because constant pressure on the nostril causes pressure ulcers and necrosis.
Labs & values
Worked example
- Cue: After a feeding tube is placed, the client is calm with no cough, but the aspirate pH is 6.
- Meaning: A quiet insertion does not prove placement, and pH 6 suggests airway or intestine.
- Action: Hold the feeding, keep the head of the bed up, and obtain X-ray confirmation.
- Evaluation: Feeding starts only after X-ray confirms gastric placement; the external mark is documented for later checks.
Patient teaching
- Sit upright for at least 30 to 60 minutes after each feeding.
- Tell the nurse if you feel nausea, cramping, or fullness, or if you start coughing or have trouble breathing during a feeding.
- Do not pull on or move the tube yourself. Tell us if the tape loosens or your nose gets sore.
Common mistakes
- Choosing the air-bolus 'whoosh' test to confirm placement. X-ray confirms; pH and the length mark recheck.
- Assuming no coughing means the tube is in the stomach.
- Clamping the Salem sump's blue vent or letting it drop below stomach level.
- Inserting a nasal tube after head trauma with a possible basilar skull fracture.
Red flags: report now
- Coughing, choking, inability to speak, or respiratory distress during insertion — the tube may be in the airway: withdraw it immediately.
- Aspirate pH 6 or higher, a changed external length, or no aspirate — stop, do not feed, and re-verify by X-ray.
- New cough, fever, or trouble breathing in a tube-fed client — stop the feeding and notify the provider; aspiration pneumonia is a known complication.
- An order for a nasal tube in a client with suspected basilar skull fracture or severe facial trauma — do not insert; clarify with the provider.
References
Clinical references for this topic
