Position the patient in bed with the head of the bed elevated 45-90 degrees and place a towel across the chest up to the patient's neck. Explain the nasal intubation procedure to the patient. Let them know that by holding their breath as the tube is passed through the pharynx, they will close off the airway and that if they swallow when instructed, it will help move the tubing down the esophagus into the stomach. Have the patient blow their nose to clear out the nasal passages and remove dentures if they have them. Question the patient about whether they have had sinus problems, nasal problems such as nosebleeds or nasal surgery in the past. Consult with the physician if the patient has a history of nasal problems. Select a nostril to use for intubation. Assemble the equipment needed, including a nasogastric tube, flash light, emesis basin, tissues, 30cc-60cc catheter tip syringe and irrigation set, a glass of water, water-soluble lubricant, clear plastic tape, a transparent dressing, stethoscope and gloves. Obtain a suction apparatus and connection tubing if the NG tube is to be used for suctioning the stomach. Prepare a piece of 1-inch tape that is cut horizontally half way through the piece of tape to make two tails. The uncut end will be placed along the patient's nose and the tails wrapped around the tube in opposite directions to secure the tube to the nose after insertion. Develop a hand signal with the patient so that they can ask to stop the procedure to let them rest if they are in distress during the procedure.
NG tubes are available in a variety of types, lengths and sizes. Large-bore tubes (some with a second lumen) are used for suctioning stomach contents. Small-bore tubing is used for feedings. Select the tube appropriate to the patient's size and the purpose for which the tube is being inserted. Wash the hands and put on gloves. Remove the tube from the packaging and uncoil it. Examine the tubing for flaws. Run some water through the tubing to check for leaks. To find the distance to the patient's stomach, use the tube to measure from the tip of the patient's nose back to the ear and then down to the tip of the sternum. Mark this place on the tube using a small piece of tape. Moisten the tip and first few inches of the tubing with water-soluble lubricant and lay it back into the packaging.
Mary Elizabeth Martelli R.N., B.S., The Gale Group Inc., Gale, Detroit,