1. Positioning: Upright in high-Fowler’s—maintain a chin-to-chest posture during insertion (reduces chance of intubating trachea).
2. Measure tube from tip of nose to earlobe, then down to xiphoid. Mark point on tube with tape.
3. Lubricate tube with water-soluble lubricant (petroleum-based jelly degrades PVC tubing).
4. Insert tube through nostril until you reach previously marked point on tube. Instruct Pt to take small sips of water during insertion to help pass tube.
5. Secure tube to Pt’s nose with tape, being careful not to block nostril. Tape tube 12–18 in. below insertion line and then pin tape to Pt’s gown. Allow slack for movement.
   Double lumen (Salem sump): Secure (unclamped) above level of stomach.
6. Position HOB at 30°–45° to minimize risk of aspiration.
7. Document type and size of NG tube, which nostril, how Pt tolerated procedure, how tube placement was confirmed, and whether tubing was left clamped or attached to feeding pump or suction.

Withdraw tube immediately if Pt becomes cyanotic or develops dyspnea. An inability to speak suggests intubation of trachea.