Feeding Tubes: Small-Bore Feeding Tube

   1. Perform hand hygiene.
   2. Don nonsterile gloves.
   3. Sit patient upright and tip patient's head forward.
   4. Estimate depth of tube insertion by measuring tube from tip of nose to ear, then inferior to stomach.
   5. Lubricate tip of tube with water.
   6. Insert tip of tube into either naris; advance to posterior pharynx until resistance is met.
   7. At this point, ask patient to swallow. If the patient is able to cooperate, give sips of water to trigger swallow reflex and ease tube passage.
   8. As patient swallows, advance tube to desired marking. Remove guide wire with one hand, while holding the tube securely at the naris. The initial swallow gets the tube into the esophagus, and the nurse can advance it to desired position without repeated swallowing.
   9. Apply skin preparation to nose and securing surface of face and allow to dry.
  10. Tape tube securely to nose, using one half of a 3-cm strip. The lower portion of the tape is then split up to the tip of the nose and wrapped around the tube.
  11. Remove gloves, and perform hand hygiene.
  12. Obtain chest x-ray (lower chest view) to verify placement.
  13. If postpyloric placement is desired, tape additional length with coil in stomach.
  14. Position patient on right side. This assists with peristalsis. If tube is in stomach, peristalsis should move it beyond the sphincter.
  15. Obtain abdominal x-ray.
  16. If tube has not migrated postpylorically, continue to position patient on right side and recheck x-ray.
  17. If tube remains in stomach, consult with physician or advanced practice nurse to administer metoclopramide IV and repeat x-ray.
  18. Document in patient record.