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8.6 Nasogastric Tubes and Therapeutic Procedures

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NCLEX-RN Registered Nurse

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1 Introduction

About the NCLEX-RN Exam Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM) How to Use This Course

2 Chapter 2: Management of Care

2.1 Legal Rights and Responsibilities 2.2 Advance Directives and Self-Determination 2.3 Informed Consent Protocols 2.4 Client Advocacy and Rights (HIPAA) 2.5 Assignment, Delegation, and Supervision 2.6 Five Rights of Delegation 2.7 Scope of Practice (RN vs LPN vs UAP) 2.8 Ethical Practice Principles

3 Chapter 3: Safety and Infection Prevention and Control

3.1 Standard Precautions and Hand Hygiene 3.2 Transmission-Based Precautions (Contact, Droplet, Airborne) 3.3 PPE Donning and Doffing Sequences 3.4 Fall Prevention and Restraints 3.5 Fire Safety (RACE/PASS) 3.6 Disaster Triage and Emergency Response

4 Chapter 4: Health Promotion and Maintenance

4.1 Growth and Development (Erikson/Piaget) 4.2 Developmental Stages: Infancy through Older Adult 4.3 Maternal and Newborn Care (Antepartum) 4.4 Intrapartum Care and Fetal Monitoring 4.5 Postpartum Care (BUBBLE-HE) 4.6 Health Screening Guidelines 4.7 Immunization Schedules

5 Chapter 5: Psychosocial Integrity

5.1 Therapeutic Communication Techniques 5.2 Non-Therapeutic Communication (What to Avoid) 5.3 Anxiety Disorders and Mental Health Concepts 5.4 Schizophrenia: Hallucinations and Delusions 5.5 Depression and Suicide Assessment 5.6 Substance Misuse and Withdrawal 5.7 Grief and End-of-Life Care

6 Chapter 6: Basic Care and Comfort

6.1 Mobility and Hazards of Immobility 6.2 Assistive Devices (Crutches, Canes, Walkers) 6.3 Nutrition and Diet Therapy 6.4 Enteral Nutrition (Tube Feeding) 6.5 Bowel Elimination and Ostomy Care 6.6 Urinary Elimination and Catheter Care

7 Chapter 7: Pharmacological and Parenteral Therapies

7.1 Medication Administration Rights 7.2 Medication Calculations 7.3 High-Alert Medications: Insulins 7.4 High-Alert Medications: Anticoagulants 7.5 High-Alert Medications: Opioids 7.6 High-Alert Medications: Digoxin and Electrolytes 7.7 IV Therapy and Complications 7.8 Blood Product Administration 7.9 Total Parenteral Nutrition (TPN)

8 Chapter 8: Reduction of Risk Potential

8.1 Laboratory Values: Hematology (CBC) 8.2 Laboratory Values: Metabolic Panel (BMP) 8.3 Laboratory Values: Coagulation Studies 8.4 Vital Signs and Trend Recognition 8.5 Perioperative Care (Pre-Op and Post-Op) 8.6 Nasogastric Tubes and Therapeutic Procedures

9 Chapter 9: Physiological Adaptation

9.1 Fluid Imbalances (Hypovolemia and Hypervolemia) 9.2 Arterial Blood Gases (ABGs) and Acid-Base Balance 9.3 Medical Emergencies: Stroke (CVA) 9.4 Medical Emergencies: Myocardial Infarction (MONA) 9.5 Diabetic Emergencies (Hypoglycemia and DKA) 9.6 Respiratory Conditions (COPD, Pneumonia) 9.7 Cardiac Conditions (Heart Failure) 9.8 Neurological Conditions (Seizures)

8.6 Nasogastric Tubes and Therapeutic Procedures

Key Takeaways Explain This Topic AI

NG tube placement is verified by X-ray (gold standard) for initial placement; bedside pH testing (pH < 5 indicates gastric placement) is used for ongoing verification

Elevate head of bed 30-45 degrees during NG tube feeding and for 30-60 minutes after to prevent aspiration

Check gastric residual volume before bolus feedings; hold feeding and notify provider if residual exceeds threshold (typically 250-500 mL per facility policy)

NG tubes for decompression are connected to low intermittent suction; irrigation is done with normal saline to maintain patency

Chest tube drainage systems must remain below the level of the chest; never clamp a chest tube without an order; assess for tidaling and air leak

Last updated: January 2026

Nurses manage various therapeutic devices and procedures that carry significant risks if not properly maintained. This section covers nasogastric tubes, chest tubes, and other common therapeutic procedures essential for NCLEX success.

  • Nasogastric (NG) Tubes
  • Purposes of NG Tubes
  • Purpose Description Suction Setting
  • Decompression Remove gas and fluids from stomach Low intermittent suction
  • Lavage Wash out stomach contents (overdose, bleeding) Not connected to suction
  • Feeding Provide enteral nutrition Not connected to suction
  • Medication administration Deliver crushed medications Not connected to suction
  • Tube Types
  • Type Use Lumen
  • Salem Sump Decompression Double lumen (blue pigtail is air vent)
  • Levin Feeding, medication Single lumen
  • Dobhoff Feeding (small bore) Single lumen, weighted tip
  • NG Tube Placement Verification
  • Initial Placement: X-ray is the Gold Standard

X-ray confirmation is required before using a newly placed NG tube for feeding or medication administration.

Ongoing Verification Methods:

  • Method Expected Finding Notes
  • pH testing pH < 5 (gastric) Most reliable bedside method
  • Aspirate appearance Green, tan, or clear Intestinal is usually yellow/bile-colored
  • Auscultation Air whoosh over stomach No longer considered reliable alone

pH Interpretation:

  • pH < 5 = Gastric placement (stomach acid)
  • pH 6-7 = Possible intestinal or respiratory placement
  • pH > 7 = May indicate respiratory placement (DANGER)

Important: NEVER use auscultation alone to verify placement. Air can be heard over the stomach even with respiratory placement.

Feeding Through NG/Enteral Tubes

Preparation:

  • Verify placement (pH or X-ray)
  • Assess gastric residual volume
  • Check tube patency
  • Verify correct formula and rate

Preventing Aspiration:

  • Intervention Rationale
  • Elevate HOB 30-45° Uses gravity to keep formula in stomach
  • Maintain elevation during and 30-60 min after feeding Prevents reflux
  • Check residual before bolus feeding Identifies delayed gastric emptying
  • Avoid rapid bolus administration Reduces distention and reflux risk

Gastric Residual Volume (GRV):

  • Check before each bolus feeding or every 4-6 hours for continuous feeding
  • Return aspirate to stomach (contains electrolytes)
  • Hold feeding if GRV exceeds threshold (usually 250-500 mL per facility policy)
  • Notify provider for persistently high residuals

Tube Patency:

  • Flush with 30 mL water before and after feedings
  • Flush before and after medication administration
  • For continuous feeding: flush every 4 hours
  • Use warm water if clogged (avoid cranberry juice - no evidence it works)
  • NG Tube for Decompression
  • Purpose: Remove gastric contents to relieve distention, prevent aspiration, or rest the bowel

Suction Settings:

  • Low intermittent suction for Salem Sump (to protect gastric mucosa)
  • Blue pigtail (air vent) should remain OPEN and above stomach level

Nursing Care:

  • Assess for placement before suctioning
  • Monitor color and amount of drainage
  • Document output as gastric drainage
  • Assess for electrolyte imbalances (loss of Na, K, Cl, H+)
  • Provide mouth care (patient is NPO)

Common Complications:

  • Complication Signs Intervention
  • Tube migration Increased drainage, coughing Verify placement
  • Clogging No drainage, resistance to irrigation Irrigate with NS
  • Mucosal erosion Blood in drainage, nasal irritation Tape securely, reposition
  • Electrolyte imbalance Muscle weakness, dysrhythmias Monitor labs, replace
  • Chest Tubes
  • Indications
  • Indication Purpose
  • Pneumothorax Remove air from pleural space
  • Hemothorax Remove blood from pleural space
  • Pleural effusion Remove fluid from pleural space
  • Post-thoracic surgery Drain fluid and air, re-expand lung
  • Chest Drainage System Components
  • Chamber Function
  • Collection chamber Collects drainage (measure output)
  • Water seal chamber Prevents air from re-entering pleural space
  • Suction control chamber Regulates amount of suction
  • Assessment

Tidaling:

  • Normal fluctuation of water level with respiration
  • Rises with inspiration, falls with expiration (spontaneous breathing)
  • Opposite pattern if on mechanical ventilation
  • Absence of tidaling may indicate lung re-expansion OR tube obstruction

Air Leak:

  • Continuous bubbling in water seal chamber indicates air leak
  • Can be from patient (expected with pneumothorax initially)
  • Can be from system (loose connections - check all sites)
  • Intermittent bubbling with coughing is normal
  • Nursing Care
  • Do Do NOT
  • Keep system below chest level Clamp the tube (unless ordered or emergency)
  • Maintain airtight dressings Elevate system above patient
  • Monitor drainage amount/color hourly Allow dependent loops in tubing
  • Assess for subcutaneous emphysema Disconnect without protecting the tube end
  • Keep petroleum gauze at bedside Strip/milk tubing routinely

Emergency Situations:

  • Situation Action
  • Tube pulled out Cover site with petroleum gauze + dry sterile dressing, tape on 3 sides
  • Tube disconnected Place tube end in sterile water or saline
  • System cracked/broken Clamp tube BRIEFLY, replace system immediately
  • Documentation
  • Color, consistency, and amount of drainage
  • Presence of tidaling
  • Presence of air leak
  • Patient's respiratory status
  • Dressing condition
  • Patient position and comfort
  • Other Therapeutic Procedures
  • Paracentesis
  • Purpose: Remove fluid from peritoneal cavity (ascites)

Nursing Care:

  • Have patient void before procedure (prevents bladder perforation)
  • Position patient upright or on side
  • Monitor vital signs (hypotension from fluid shift)
  • Measure abdominal girth before and after
  • Monitor for hypovolemia post-procedure
  • Thoracentesis
  • Purpose: Remove fluid or air from pleural space

Nursing Care:

  • Position patient sitting up, leaning forward over bedside table
  • Monitor for pneumothorax after procedure
  • Assess breath sounds before and after
  • Monitor for respiratory distress
  • Lumbar Puncture
  • Purpose: Obtain CSF sample, measure pressure, administer medication

Nursing Care:

  • Position in fetal position (knees to chest) or sitting leaning forward
  • Post-procedure: Keep patient flat for 1-4 hours (prevents headache)
  • Encourage fluids post-procedure
  • Monitor for headache, assess neurological status
  • On the Exam

The NCLEX frequently tests:

  • NG tube placement verification (pH < 5, X-ray gold standard)
  • Aspiration prevention (HOB elevation, residual checks)
  • Chest tube management (keep below chest, never clamp without order)
  • Emergency situations (tube displacement, system problems)
  • Patient positioning for procedures

Priority Tip: For NG tubes, always verify placement before administering anything. For chest tubes, if you see continuous bubbling in the water seal chamber, check all connections for air leaks. If the tube comes out, cover with petroleum gauze taped on three sides.