d. Look inside the patient's mouth with a flashlight to see if the tube is coiled in
the throat. If it is, withdraw the tube until it is straight. Reassure the patient and allow
him to rest a few moments before you continue.
e. Discontinue the procedure completely and refer the case to the doctor if the
patient chokes, coughs a second time, or gags excessively.
f. Insert the tube to the tape mark. About 20 to 30 inches of the tube will be in
5-15. CHECK TUBE PLACEMENT
It is important to be sure that the nasogastric tube is in the correct place--the
patient's stomach. There are three methods by which you can verify that the tube has
actually reached the patient's stomach: check by aspiration; check by the patient's
vocal response; and check by auscultation.
a. Check by Aspiration. Squeeze the bulb of a large syringe to get rid of all the
air in the syringe, then fit the syringe into the near end of the nasogastric tube.
Squeeze the bulb, release the bulb, and check the barrel of the syringe for gastric
content. If the gastric contents are found in the barrel of the syringe, it indicates that the
nasogastric tube is properly inserted and is in the patient's stomach.
b. Check by Patient's Vocal Response. Ask the patient to talk or hum. If he is
unable to do so, remove the tube and try again. The tube is probably between the vocal
cords and the trachea. If the patient can talk or hum, you know that the nasogastric
tube is not in the larynx.
c. Check by Auscultation. Auscultation is the act of listening for sounds within
the body with the use of a stethoscope. For this check, squeeze the bulb to void air
from the syringe and prevent air from being injected into the stomach. Fit the syringe
into the near end of the nasogastric tube. Place the diaphragm end of the stethoscope
to the patient's stomach about two inches below the sternum. Squeeze the bulb of the
syringe to inject air into the nasogastric tube. Listen for gurgling sounds; these sounds
indicate that the nasogastric tube is properly placed. Move the diaphragm of the
stethoscope to the front part of the lung area. Squeeze the syringe bulb again and
listen for gurgling sounds. If you hear gurgling sounds in the lung area, withdraw the
nasogastric tube immediately. Sounds in that area indicate that the tube is not in the
correct position. Begin again to place the nasogastric tube properly.
If the patient becomes cyanotic or has difficulty breathing, REMOVE
THE TUBE IMMEDIATELY. The tube is probably in the trachea.