Removing a Nasogastric Tube

Skill 13-10

Removing a Nasogastric Tube

When the nasogastric (NG) tube is no longer necessary for treatment, removal of the tube will be prescribed. The NG tube is removed as carefully as it was inserted, to provide as much comfort as possible for the patient and to prevent complications. When the tube is removed, the patient should hold their breath to prevent aspiration of any secretions or fluid left in the tube as it is removed.

Delegation Considerations

The removal of an NG tube is not delegated to assistive personnel (AP). Depending on the state's nurse practice act and the organization's policies and procedures, removal of an NG tube may be delegated to licensed practical/vocational nurses (LPN/LVNs). The decision to delegate must be based on careful analysis of the patient's needs and circumstances as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A.

Equipment

Tissues
50-mL syringe
Nonsterile gloves
Additional PPE, as indicated
Stethoscope
Disposable plastic bag
Bath towel or disposable pad
Normal saline solution for irrigation (optional)
Emesis basin

Assessment

Perform an abdominal assessment by inspecting for presence of distention, auscultating for bowel sounds, and palpating the abdomen for firmness or tenderness. If the abdomen is distended, consider measuring the abdominal girth at the umbilicus. If the patient reports any tenderness or nausea, exhibits any rigidity or firmness with distention, and if bowel sounds are absent, confer with the health care team before discontinuing the NG tube. Assess any output from the NG tube, noting amount, color, and consistency.

Actual or Potential Health Problems and Needs

Many actual or potential health problems or issues may require the use of this skill as part of related interventions. An appropriate health problem or issue may include:

Knowledge deficiency
Aspiration risk
Risk for impaired gastrointestinal system function

Outcome Identification and Planning

The expected outcomes to achieve when removing an NG tube is that the tube is removed with minimal discomfort to the patient, and the patient does not aspirate.

Implementation

Action	Rationale
1. Check the health record for the prescribed intervention for removal of the NG tube. Gather equipment.	This ensures the patient receives the correct treatment. Gathering equipment provides for an organized approach to the task.
2. Perform hand hygiene and put on PPE, if indicated.	Hand hygiene and PPE prevent the spread of microorganisms. PPE is required based on transmission precautions.
3. Identify the patient.	Identifying the patient ensures the right patient receives the intervention and helps prevent errors.
4. Explain the procedure to the patient and why this intervention is warranted. Describe that it will entail a few moments of discomfort. Perform key abdominal assessments as described above.	Patient engagement is facilitated when explanations are provided. Due to potential changes in a patient's condition, assessment is vital before initiating intervention.
5. Pull the patient's bedside curtain. Raise the bed to a comfortable working position (VHACEOSH, 2016). Assist the patient to a 30- to 45-degree position. Place a towel or disposable pad across the patient's chest (Figure 1). Give tissues and an emesis basin to the patient.	This provides for privacy. An appropriate working height facilitates comfort and proper body mechanics for the nurse. A towel or pad protects the patient from contact with gastric secretions. An emesis basin is helpful if the patient vomits or gags. Tissues are necessary if the patient wants to blow their nose when the tube is removed.
6. Put on gloves. Discontinue suction and separate the tube from suction. Detach the tube from any securement to patient's gown and/or face and carefully remove the securement device or adhesive tape from the patient's nose.	Gloves prevent contact with blood and body fluids. Disconnecting the tube from suction and the patient allows for its unrestricted removal.
7. Check placement (refer to Skill 11-2 in Chapter 11) and flush the tube with 10 mL of water or normal saline solution (optional) or clear with 30 to 50 mL of air (Figure 2) (refer to Skill 13-9).	Air or saline solution clears the tube of secretions or debris.
8. Clamp the tube with your fingers by doubling the tube on itself (Figure 3). Instruct the patient to take a deep breath and hold it. Quickly and carefully remove the tube while the patient holds their breath. Coil the tube in the disposable pad as you remove it from the patient.	Clamping prevents drainage of gastric contents into the pharynx and esophagus. The patient holds their breath to prevent accidental aspiration of gastric secretions in the tube. Careful removal minimizes trauma and discomfort for the patient. Containing the tube in a towel while removing it prevents leakage onto the patient.
9. Dispose of the tube per facility policy. Remove gloves. Perform hand hygiene.	This prevents contamination with microorganisms.
10. Offer mouth care to the patient and facial tissue to blow their nose. Assist the patient to a position of comfort, as needed.	These interventions promote patient comfort.
11. Remove equipment, raise the side rail, and lower the bed.	Positioning promotes patient comfort and safety.
12. Put on gloves and measure the amount of NG drainage in the collection device. Record the measurement on the output flow record, subtracting irrigant fluids if necessary (Figure 4). Add solidifying agent to the NG drainage and dispose of the drainage according to facility policy.	Irrigation fluids are considered intake. To obtain the true NG drainage, irrigant fluid amounts are subtracted from the total NG drainage. NG drainage is recorded as part of the output of fluids from the patient. Solidifying agents added to liquid NG drainage facilitate safe biohazard disposal.
13. Remove gloves and additional PPE, if used. Perform hand hygiene.	Proper removal of PPE reduces the risk for infection transmission and contamination of other items. Hand hygiene prevents transmission of microorganisms.

Evaluation

The expected outcomes have been met when the tube has been removed with minimal discomfort to the patient, and the patient has not aspirated.

Documentation

Guidelines

Document assessment of the abdomen. If an abdominal girth reading was obtained, record this measurement. Document the removal of the NG tube from the naris where it had been placed. Note if there is any irritation to the skin of the naris. Record the amount of NG drainage in the suction container on the patient's intake-and-output record as well as the color of the drainage. Record any pertinent teaching, such as instructions to the patient to notify the nurse if they experience any nausea, abdominal pain, or bloating.

Sample Documentation

Developing Clinical Reasoning and Clinical Judgment

Unexpected Situations and Associated Interventions

Within 2 hours after NG tube removal, the patient's abdomen is showing signs of distention: Notify the health care team. Anticipate an order to reinsert the NG tube.
Epistaxis occurs with removal of the NG tube: Occlude both nares until bleeding has subsided. Ensure that patient is in upright position. Document the epistaxis in the patient's health record.

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Skill 13-10