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Checklist - Removing A Nasogastric Tube

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GORDON COLLEGE

College of Allied Health Studies


B AC H E LO R OF S CI EN C E I N NU RS IN G

Name: ________________________________________ Section/Group: ___________________ Date:_______________

REMOVING A NASOGASTRIC TUBE

Equipment:
 Disposable pad or towel
 Tissues
 Clean gloves
 50-mL syringe (optional)
 Moisture-proof trash bag

Rating Criteria
5 Correctly and independently perform the procedure and states rationale.
4 Performs procedure and states rationale with minimal guidance.
3 Satisfactorily performs the procedure with moderate guidance
2 Procedure incorrectly done without rationale.
1 Not performed.

PROCEDURE 5 4 3 2 1
1. Prior to performing the removal, introduce self and verify the client’s identity using agency protocol.
Explain to the client what you are going to do, why it is necessary, and how he or she can participate.
Discuss how the results will be used in planning further care or treatments.
2. Perform hand hygiene and observe other appropriate infection prevention procedures.
3. Provide for client privacy.
4. Detach the tube.
 Apply clean gloves.
 Disconnect the nasogastric tube from the suction apparatus, if present.
 Unpin the tube from the client’s gown.
 Remove the adhesive tape securing the tube to the nose.
5. Remove the nasogastric tube.
 Optional: Instill 50 mL of air into the tube.
 Ask the client to take a deep breath and to hold it.
 Pinch the tube with the gloved hand.
 Smoothly, withdraw the tube.
 Place the tube in the trash bag.
 Observe the intactness of the tube.
6. Ensure client comfort.
 Provide mouth care if desired.
 Assist the client as required to blow the nose.
7. Dispose of the equipment appropriately.
 Place the pad, bag with tube, and gloves in the receptacle designated by the agency.
 Remove and discard gloves.
 Perform hand hygiene.
8. Document all relevant information.
 Record the removal of the tube, the amount and appearance of any drainage if connected to
suction, and any relevant assessments of the client
TOTAL
𝐴𝑐𝑡𝑢𝑎𝑙 𝑆𝑐𝑜𝑟𝑒
Computation: × 60 + 40
𝑇𝑜𝑡𝑎𝑙 𝑆𝑐𝑜𝑟𝑒

Grade: _______________

Remarks: ________________________________________________________________________________________________

________________________________________________________________________________________________________

Evaluated by:

__________________________________
Clinical Instructor

Conforme:

__________________________________
Signature of Student

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