Before embarking on this procedure, be sure to set up your tray with the necessary equipment and/or medication.

Attach a disposable bag to the tray for depositing your used non-sharp materials.

Agree on a signal to alert you to pause if the patient is uncomfortable or having respiratory difficulty.

Check for a history of previous nasal surgery, trauma, or if there are any problems breathing through any particular nostril.

Ask the patient to blow their nose prior to inserting the NGT.

Drape a linen protector over the front of the patient to protect their clothing.

Position the patient in the high Fowler's position or in the left lateral position if the patient is unconscious or semi-conscious. Ensure that there are no contra-indications to these positions (eg, spinal trauma).

Take universal precautions.

Using the flashlight/torch, inspect the patient's nasal passages.

Check for septal deviation and other abnormalities.

If any abnormalities are present, use the opposite nostril. If there are abnormalities on both sides, try each side in turn, inserting the tube gently.

Lateral nasal wall
anatomy

Use the tube as a measuring device.

Starting at the tip, measure from the nose to the ear lobe and then down to the xiphoid process.

Note the length from the markings on the tube or mark this with a small piece of tape or steristrip.

Lubricate the insertion end of the tube generously with lubrication jelly.

With the tube pointing downwards and towards the opposite ear (not upwards), insert the tube gently into the chosen nasal passage until you reach the nasopharynx. You will feel a slight resistance at this point. Do this gently to avoid trauma to the turbinates and subsequent epistaxis.

If not contraindicated, ask the patient to sip some water and to swallow slowly.

Twist the tube 180 degrees and continue to insert it until the predetermined marker is reached.

Aspirate on the tube using the catheter tip syringe and check to see if the contents are acidic using the pH indicator strips (see reference). The blue litmus pH indicator strip should turn red. If the litmus paper does not turn red, use a flashlight to check if the tube has curled up at the back of the mouth. If it has, remove it and start again.

It may be necessary to confirm the position with a chest radiograph if there are any doubts.

Apply the skin preparation or Friar's Balsam to the bridge of the nose. Wrap the steristrip around the tube and then stick it onto the bridge of the nose. Use 2 steristrips for this.

Alternatively, a pre-packaged NGT anchor can be used.

Postprocedure considerations