Cornwall Community Nasogastric Tube Insertion & Management ...

Peninsula Community Health
Cornwall Community Nasogastric Tube Insertion,
Management Policy & Procedure
Title: Cornwall Community Nasogastric Tube
Insertion & Management Policy &
Procedure
Procedural Document Type: Guidelines
Reference: OP-CN-G01
CQC Outcome: Outcome 4
Version: VERSION 2
Approved by: Professional Practice Forum
Ratified by: Clinical Quality and Safety Committee
Date ratified: 7th August 2012
Freedom of Information: This document can be released
Name of originator/author: Andy Shaw
Name of responsible team: Clinical Management
Review Frequency: 3 yearly
Review Date: 7th August 2015
Target Audience:
Executive Signature (Hard Copy Only):
PCH Clinical Staff
Registered in England and Wales No: 7564579
Registered office: Peninsula Community Health CIC,
Sedgemoor Centre, Priory Road, St Austell PL25 5AS
www.peninsulacommunityhealth.co.uk
Quality care, closer to you
Peninsula Community Health is a not for profit
Community Interest Company responsible for
providing NHS adult community health
services
in Cornwall and the Isles of Scilly

Contents
1 Introduction ..........................................................................................................2
2 Definitions ............................................................................................................2
3 Duties...................................................................................................................2
4 Policy Statement..................................................................................................2
5 Purpose ...............................................................................................................2
6 Right decision & Risk Assessment ......................................................................3
7 Nasogastric Tube insertion ..................................................................................3
7.1 Equipment ....................................................................................................3
7.2 Tube measurement ......................................................................................3
7.3 Tube insertion Action & Rationale ................................................................4
7.4 Fine bore feeding tubes................................................................................5
7.5 Securing the tube .........................................................................................6
8 Ongoing Care and Management of Tube once confirmed in Situ ........................6
9 Managing tube in patients home..........................................................................7
10.1 Family involvement .....................................................................................7
10.2 District Nurse Management ........................................................................7
10 Trouble shooting ..................................................................................................7
11 Risk Management Strategy Implementation ........................................................8
11.1 Implementation & Dissemination ...........................................................8
11.2 Training and Support.............................................................................8
11.3 Document Control & Archiving Arrangements .......................................8
11.4 Equality Impact Assessment .................................................................8
12 Process for Monitoring Effective Implementation.................................................9
13 References ..........................................................................................................9
Please Note the Intention of this Document
The procedures described below are intended to support staff in complying with the stated
Peninsula Community Health policy and to ensure the care is safe and effective.
Review and Amendment Log
Version No Type of Change Date Description of change
Registered in England and Wales No: 7564579
Registered office: Peninsula Community Health CIC,
Sedgemoor Centre, Priory Road, St Austell PL25 5AS
www.peninsulacommunityhealth.co.uk
Quality care, closer to you
Peninsula Community Health is a not for profit
Community Interest Company responsible for
providing NHS adult community health
services
in Cornwall and the Isles of Scilly

1 Introduction
This policy and procedure gives information and instruction regarding safe and effective
placement and position checking of the tube thus reducing risk.
The document has been developed to support community staff in Cornwall in the ongoing
management of nasogastric tubes once a tube has been inserted.
Risks associated with the insertion of NG tubes includes being misplaced into the lungs
during insertion or move out of the stomach at a later stage, undiagnosed this may lead to
severe harm or death if nutritional products or medications are administered into the lungs.
The National Patient Safety Alert in February 2005 (NPSA SPA 05) and March 2011 (NPSA
PSA002) “Reducing the harm caused by misplaced nasogastric feeding tubes”… and this
policy is written to comply with that guidance.
2 Definitions
The insertion of a nasogastric (NG) tube, including fine bore feeding tubes, is defined as the
passage of a tube, appropriate for its intended purpose, via the nostril into the stomach.
3 Duties
This section includes an overview of individual roles, departmental and committee duties
including levels of responsibility:
All Staff - Staff engaged in the process of inserting, checking and managing the use of NG
tubes is expected to be competent to do so and have the evidence logged in their personal
file. All staff are expected to comply with this policy.
4 Policy Statement
PCH Service aims to deliver safe and effective care to all its patients.
The insertion, tube positioning and subsequent management of NG tubes will be safe,
effective and comfortable for the patient.
5 Purpose
The purpose of a nasogastric tube is to:
a) Allow drainage of the contents of the stomach when indicated
b) Allow removal of air from the stomach when indicated
c) Provide a safe access route to the gastrointestinal tract for the administration of fluids,
medicines or nutrients. For medicines see (see BAPEN Guidance at
www.bapen.org.uk/res drugs.html)
2

Fig 1. Examples of indications for use of NG tube
Indication Action Rationale
Paralytic Ileus
Leave tube on free drainage To allow drainage of
accumulated gastric contents
and facilitate gastric motility
Gastro intestinal disease
Aspirate as indicated or
requested
Gut surgery
Check tube position
To provide nutrition for patient Check tube position before
any introduction of any
To hydrate patient
substance into the tube
To administer medication
To avoid aspiration of gastric
contents
To confirm correct placement
of the tube in order to avoid
aspiration of gastric contents
and subsequent complications
6 Right decision & Risk Assessment
Before a decision is made to insert an NG tube, an assessment is undertaken to identify if
nasogastric feeding is appropriate for the patient and the rationale is recorded in the patient
notes.
In areas where nursing care is not 24hr i.e. at home, a full risk assessment is to be conducted
and the decision passed through the Clinical Governance channels.
NG tube insertion can be dangerous as well as difficult in patient with altered anatomy, for
example oesophageal fistula or pharyngeal pouch or in certain clinical conditions, such as a
basal skull fracture. In these situations, or if suspected senior clinical help should be sought
and any attempt to insert should be done in an acute setting.
7 Nasogastric Tube insertion
7.1 Equipment
a) Clinically clean tray
b) Full Length radio opaque NG tube (NPSA 2011) Can be stored in fridge to aid
insertion
c) Sterile water for Lubrication (Aquagel may change pH)
d) 50ml Oral catheter tipped syringe
e) Elastoplast to secure/or an appropriate alternative if allergic
f) Spigot/Drainage bag Non sterile gloves and apron
g) Approved pH Indicator strips
h) Drink of cool water for patient to aid swallowing
7.2 Tube measurement
Decision to use short term tube or long term tube will be a clinical decision. The initial
process is the same and the additional requirements for long term feeding tubes are listed
below.
Nasogastric tubes used for the purpose of feeding must be radio-opaque throughout their
length and have externally visible length markings. (NPSA 2011/PSA002)
CORNWALL COMMUNITY NASOGASTRIC POLICY VERSION 1 3

The tube length should be estimated before insertion using the NEX measurement (place exit
port of tube at tip of nose. Extend tube to earlobe, and then to xiphisternum - this is known as
the NEX measurement). Once inserted, the external tube length should be recorded and
confirmed before each feed.
Fig 2 Tube Measurement
7.3 Tube insertion Action & Rationale
Any member of staff who introduces a nasogastric tube into a patient must be competent and
have the evidence logged in their personal file. Insertion should follow baseline observations
and a review of the patient’s medical history noting any previous contraindication.
Action Rationale
1. Identify patient and gain informed consent.
Discuss any previous history that will change any
actions for the procedure i.e. Injury to nasal
airway. Arrange a signal to stop.
2. Wash hands and put on gloves. Prepare
equipment and sit patient in the upright position
using pillows to support back and shoulders
3. If a patient is unconscious/semi unconscious
lay them down on right hand side
4. Mark the NEX measurement distal on the tube.
Dip the proximal end in clean water/lubricant and
get the patient to sniff to clear nostril
Aids in intubation and gives patient understanding of
procedure. Identifies which nostril to use. Allows patient
some control over procedure
Reduce cross contamination. Patient comfort.
Aids insertion
Allows guide to insertion, lubricates tube and clears
airway
4

Action Rationale
5. Insert proximal end into nostril keeping it
straight and to the back of the cavity. If resistance
is felt pull back and choose different angle
6. As the tube passes the nasopharynx get the
patient to drink and swallow. If the patient
becomes distressed coughs or appears cyanosed
withdraw tube until patient recovers.
7. Advance the tube until it reaches the distal
marker and secure the tube using the method
described in 8.5
8. Using the 50ml syringe on the distal end
aspirate 2-5mls and test using approved human
pH strips (see decision tree NPSA appendix 1)
9. If required get a chest x-ray and a doctor to
confirm position
The whoosh test is not a method of confirming
tube placement
10. Annotate on form at Appendix 2 and in patient
notes
11.Attach spigot/drainage bag until use is
required
12. Attach a marker/flag to area where the tube
exits the nostril and log distance in notes and
care plan.
Back of cavity helps guide tube into position
The patient swallow will help the epiglottis close the
trachea opening allowing the tube to pass into the
oesophagus
To ensure the tube is in far enough and secured firmly
to eliminate it becoming displaced
To ensure correct placement. pH must be 5.5.
Consider medication such as Omeprazole (Decreases
acid in stomach changing pH) (see NPSA decision tree
attached to this document)
Maintain contemporaneous documentation
Stops leakage
Guide to every time tube is accessed to see if tube
has been displaced
At No time is fluid to be flushed down tube until correct placement is confirmed NPSA
2012/RRR001
7.4 Fine bore feeding tubes
Fine bore feeding tubes are the tube of choice when feeding patients. They have a longer life
span time which is dependent on the make. Insertion is the same for the short term tube with
the exception of the guide-wire.
Action Rationale
1. Once inserted and secured leave the guide-wire
in place until the tube has been confirmed by
either aspirate or chest x-ray
2. Once confirmed by either aspirate pH or chest
X-ray use side arm access port and flush with
10mls of water
Once removed the guide-wire can not and should not
be re-inserted whilst tube is in patient
Activates lubricant inside tube before removal of guidewire
(stylet)
3. Annotate in notes and insertion form Maintains contemporaneous documentation
At No time is fluid to be flushed down tube until correct placement is confirmed NPSA
2012/RRR001
CORNWALL COMMUNITY NASOGASTRIC POLICY VERSION 1 5

7.5 Securing the tube
In areas where tubes are used frequently the choice of securing tape is Elastoplast. Some
areas use a special device or in patients who are at high risk of removing tubes sutures are
used attaching it to septum. Elastoplast is excellent for securing tubes but some patients with
allergies to this will require hypoallergenic tape. As the tube will hang loose after being
secured it can also be taped to the side of the face removing it from the patients view.
a) Cut tape to approximately 8 cm
b) Cut one end of the tape 4cm up the middle at one end making a pair of ‘trousers’
c) Stick the uncut end part to the bridge of the nose and wrap the two legs in opposite
directions around the tube
d) Attach white marker flag where the tube enters the nose. This is crucial to identifying
tube displacement
Fig 3. Securing the tube
8 Ongoing Care and Management of Tube once confirmed
in Situ
Prior to use of a nasogastric tube the practitioner must assess the risk before continuing.
Repeat checks after the initial placement has been confirmed. Only a pH between 1 and 5.5
or X-ray confirmation is an acceptable checking method.
Confirmation of position of the NG tube must be assessed:
Following initial insertion
Before each feed or administration of medicines (see BAPEN Guidance at
www.bapen.org.uk/res drugs.html) for medicines management in NG tubes
Before tube flushing for patency
Following violent coughing or vomiting
If the tube fails to drain or appears blocked
After nasopharyngeal suction
If the tube has become dislodged
6

If the patient is complaining of discomfort
If the patient becomes breathless or develops difficulty in breathing during
administration or if the patient has a persistant irritated cough
If it is suspected the tube has moved
If there is any doubt that the tube is not in the stomach
At least once each day
When feed has already passed through the tube, a minimum of an hour delay, without further
feeding, should be instigated prior to obtaining gastric aspirate.
9 Managing tube in patients home
Where the risk has been assessed and passed through Clinical Governance and an NG tube
is to be managed by the family/ carers/ District nurse, the pH must be checked at every visit
and prior to any new flush or feed commencement.
9.1 Family involvement
Where possible family involvement is crucial in the feeding regime and management of
nasogastric tubes. Where there is adequate participation training can be given providing that
Clinical Governance has been met and advice sought with the risk assessments and a level
of responsibilty assumed by the carer/relative. Different situations will require different level of
risk assessment and assumed responsibility. It is imperative that in such circumstances
Clinical Governance is involved.
9.2 District Nurse Management
The nurse can not be made responsible once they have left the patients home. Once the
nurse has gone through the routine for positioning checks and documented the correct
positioning of the tube there must be a comprehensive risk assessment/care plan and
information contained within the property to alert the carer to any issues and it must be clear
who assumes responsibility for the tube in the nurse absence.
10 Trouble shooting
Problem Reason Action
Persistent coughing on
insertion
Tube in trachea Remove tube and start again
No aspirate on insertion Tube sitting too high in Advance tube until aspirate
Oesophagus
gained
Tube blocked whilst feeding Medication clogged tube/old
feed in tube
Cannot gain aspirate on
checking before feed
Consider chest X-ray
Flush with 50mls warm water
creating turbulence by
pumping oral syringe
If persists flush with soda
water/fizzy plain water (NOT
LEMONADE or COLA) and
leave for 30 minutes before
re attempting flush (Royal
Marsden 2011)
Massage the tube between
fingers
Tube against stomach wall Use a oral syringe to blow
10-15mls of air into tube and
re-attempt
CORNWALL COMMUNITY NASOGASTRIC POLICY VERSION 1 7

If unsuccessful tilt patient on
side left or right and try again
with air until successful
Patient has feed in mouth Possible Tube displacement Stop feed. Listen to chest.
Remove tube IF suspect
aspiration consult medic
Patient has persistent cough
during feed
Marker at nose has moved
during feed or patient has
attempted to remove tube
pH is > 5.5 no apparent
movement
If no aspiration is suspected
wait 1 hour and try aspirate
for pH. Get medical advice if
unsure or chest X- ray
Possible Tube displacement Stop Feed. Assess as above.
Remove tube if suspect
aspiration inform medical
Possible Tube displacement
or tube causing anxiety
Tube in lungs/PPI medication
causing false reading
staff.
Review need. Stop feed.
Check position by Ph
Stop feed and flush tube.
Review medication. Wait 1
hour without medication and
retest pH.
NB. A radiographer assumes responsibility for visibility of tube on X-ray (NPSA/2011/PSA002)
11 Risk Management Strategy Implementation
11.1 Implementation & Dissemination
Once ratified this document will be loaded onto the documents library (read only)
and replace any existing policies for nasogastric insertion and management in
Peninsula Community Health.
Staff will be made aware of its implementation via their service leads after
discussion at the PCH professional practice forum.
11.2 Training and Support
Nurses, Health Care Assistants and students (under supervision) can insert a NG
tube, provided they have had training and fulfilled the competencies laid out in this
document. Please see appendix 3 for further details.
11.3 Document Control & Archiving Arrangements
Once ratified, this policy will be loaded to the documents library. Any previous
versions will be electronically archived by the Policy Administrator in the electronic
Policy Drive Archive Folder.
A signed hard copy of the policy will be forwarded to the Policy Administrator and
an electronic copy will be saved by the Policy Administrator in the electronic Policy
Drive. Further copies of current and archived policies can be obtained from the
Policy Administrator including versions in large print, Braille and other languages.
11.4 Equality Impact Assessment
Peninsula Community Health aims to design and implement services, policies and
measures that meet the diverse needs of our service, population and workforce,
ensuring that none are placed at a disadvantage over others.
8

As part of its development, this strategy and its impact on equality have been
assessed. The assessment is to minimise and if possible remove any
disproportionate impact on employees on the grounds of race sex, disability, age,
sexual orientation or religious belief. No detriment was identified.
12 Process for Monitoring Effective Implementation
The effective implementation of this policy will be monitored by the Clinical Facilitators,
hospital matrons, and ward sisters and if applicable district nurse leads. This will be
discussed at the Professional Practice Forum and changes made through the Clinical
Facilitators. An annual audit of training, recording forms (Appendix 2) and clinical need will be
conducted by the Clinical Facilitators for the locality via the PCH matrons. These audit tools
will be the key performance indicators used to dictate the success of this policy and be
reported to the Clinical Governance Lead for PCH.
13 References
NPSA Patient Safety Alert NPSA/2011/PSA002
Dougherty, L & Lister, S (Eds) (2011) Chapter 8, Nutritional Support, Royal Marsden Hospital
Manual of Clinical Nursing Procedure (8thEdn). Oxford. Wiley Blackwell.
www.bapen.org.uk/res
CORNWALL COMMUNITY NASOGASTRIC POLICY VERSION 1 9

Appendix 1
10

Appendix 2
Nasogastric Tube
Recording Form
Type of Tube & Size
Placed
Date/Time
Tube Inserted
Tube
Inserted by &
Designation
Level
Tube
Passed to
(cm)
Patient Name………………………………..
Ward/Community Team……………………
Hospital No………………………………….
NHS No……………………………………...
D.O.B…………………………………………
Aspirate
pH
reading
X-ray
RQD
Aspirate
volume and colour
When unable to obtain an aspirate a request may be made to obtain a chest X-ray for correct placement
confirmation. In these cases signed confirmation of correct placement must be by a RADIOGRAPHER or suitably
qualified medic prior to administering feed or medication.
Please sign below.
Date Name (Printed) Signature Designation
Nasogastric Tube Position Record
Date/time pH before flush,
meds & feed
Position in cm/
graduation No @ Flag
Date Tube
Removed
Signature Printed Remarks (i.e. secured with )
CORNWALL COMMUNITY NASOGASTRIC POLICY VERSION 1 11

Appendix 3
Insertion and Care of Nasogastric Tubes
Name
Designation
Base
Date
Commenced
Date
Completed
Skills Training Package
For
Registered Healthcare Professionals
12

Contents
Aims of the competency framework for the insertion and management of
nasogastric tubes
14
Assessment process 14/15
Core knowledge and understanding performance criteria 16
Feedback sheet for knowledge and understanding core performance criteria 17
Part 1- the insertion and confirming position of fine bore and wide bore
nasogastric tubes
18
Feedback sheet for part 1 19
Part 2- Assessment sheet for the management of fine bore and wide bore
nasogastric tubes
20
Feedback sheet for part 2 21
Certificate of Achievement Part 1 22
Certificate of Achievement Part 2 23
CORNWALL COMMUNITY NASOGASTRIC POLICY VERSION 1 13

Competency Framework for the Insertion and Care of Nasogastric Tubes
This pack is applicable for registered nurses and healthcare professionals in the Cornwall Community
as appropriate.
Student nurses should always carry out the procedure under supervision and therefore should see the
skills package as a training aid but should not complete it.
Part 1 of this pack is for the assessment of competency for Registered Healthcare Professionals who
intend to insert and confirm position of both fine bore and wide bore nasogastric tubes.
Part 2 of this pack is for Registered Healthcare Professionals who will manage and check position of
nasogastric tubes.
Aim of assessment process:-
Assessors:
To ensure understanding of the rationale for the use of nasogastric (NG) tubes
To demonstrate understanding of the potential risks and contraindications associated
with the use of NG tubes and how to minimise/respond to these.
To demonstrate competency in the insertion and subsequent care of NG tubes
To promote best practice throughout the healthcare environment in the use and care of
NG tubes
It is recommended that fine bore tubes be used for enteral feeding whenever possible,
as they are less likely to cause complications such as, oesophageal ulcers, gastritis.
Fine bore tubes are more comfortable for the patient (Royal Marsden 2008).
Assessors must be registered healthcare professional who are familiar with, and who
regularly carry out insertion and care of fine bore NG tubes.
They must be familiar with and preferably have completed this package or have
experience gained from an acute area.
The most important aspect of the assessment is that the patient’s safety is maintained
at all times.
When undertaking instruction and assessment and before signing the certificate of competence,
assessors should use the enclosed assessment form to satisfy themselves that the healthcare worker:
1. Demonstrates the knowledge of local protocols, standards and guidelines in relation to
this skill.
2. Demonstrates the ability to carry out the procedure competently.
3. Identifies problems and deals with them appropriately.
4. Demonstrates correct documentation of the procedure.
14

Trainees:
Staff who undertake the procedure to insert tubes must:
Process
Complete the requirements of the nasogastric tube skills package.
Familiarize themselves with the community protocol for insertion of NG tubes
Undertake supervised practice with a competent practitioner who is skilled in the
procedure and who is familiar with/has undertaken the skills package.
Take responsibility thereafter for maintaining competence in the skill and seek
supervision from a competent practitioner if for reason of sickness or absence they
have not carried out the procedure in the previous 12 months.
The core performance criteria must be assessed and successfully completed prior to the
assessment by clinical observation of part 1 and part 2 of this skill.
Directly Observed Procedural Skills Assessment process
The trainee must undertake at least three witnessed procedures.
To be passed as competent to carry out the procedure for which the trainee is being
assessed the numbered skills all have to be scored as ‘yes’.
If any section is scored as ‘no’ but has understandable reasons i.e. procedure could
not be accomplished because patient unable to tolerate, then assessor can choose not
to class that procedure as one of the trainee’s three attempts.
The outcomes must be documented within the feedback sheets.
CORNWALL COMMUNITY NASOGASTRIC POLICY VERSION 1 15

Core knowledge and Understanding Performance Criteria
Prior to clinical assessment, the trainee must demonstrate knowledge and understanding of
the following in relation to the insertion, checking position and management of all types of
nasogastric tubes.
Describes the indication for the
insertion of a fine bore or wide bore NG
tube
Describes the basic anatomy of the
upper GI tract and the NGT route
Demonstrates understanding of
nutritional screening and the patients
nutritional risk score (MUST)
Describes actions to be taken to avoid
cross contamination and infection
Demonstrates awareness of the
contraindications for NG tubes
Accurately describes the indication
when a chest X-ray is necessary to
confirm tube position
Accurately describes the indications
when checking position with aspirate is
appropriate
Describes actions when aspirate is not
obtained
Describes reasons why pH is above
5.5
Demonstrates awareness of potential
complication and appropriate remedial
action
Utilises all appropriate documentation
which includes NG tube recording form
Describes the NPSA related NG tube
insertion and subsequent care
Recognises own limitations and knows
when to call for more senior assistance
Knows how to access and has read the
Cornwall Community Guidelines on
Nasogastric tubes
Pass/Fail Signature of
Assessor
Date
16

Feedback sheet for Core Knowledge and Understanding Performance Criteria
Comments
Action Plan
Signature of Trainee
Signature of Assessor
Date
CORNWALL COMMUNITY NASOGASTRIC POLICY VERSION 1 17

Part 1- Assessment for the insertion and confirming position of Nasogastric
Tubes
To be assessed as competent the trainee must carry out the procedure under observation at
least 3 times.
Ensure the trainee has access to guidelines 1st 2nd 3rd
Pre- Procedure
Check identity of the patient
Y/N Y/N Y/N
Explains the procedure to the patient and gains consent
Ensures the patient is give an agreed signal to stop the procedure if
unable to tolerate
Decontaminates hands and abides by infection control policy
Prepares the correct equipment
Positions the patient correctly
Cleans each nostril and chooses most appropriate
Procedure
Measures tube correctly using the NEX method
Examines the tube and end of guide wire
Lubricates tube with water
Inserts the tube at the correct angle and advances tube gently but
continuously asking patient to swallow until tube has entered
oesophagus and reaches correct position
Withdraws tube if an obstruction is felt, retries in opposite nostril or
stops if the patient shows signs of respiratory distress
Secures tube using method described in policy
Confirms Tube Is In Correct Position
Confirms by X-ray if patient is:
Is unconscious
Has absent or unsafe swallow
Has head or neck tumour
Uses pH indicator strips as appropriate and withdraws aspirate to
confirm correct position if pH 5.5 or less.
Undertakes correct measure if not able to withdraw aspirate first time
Attaches Flag at entrance to nostril to indicate movement
For fine bore tubes only
Once position confirmed, flushes tube with 10mls of water to lubricate
wire and removes guide wire gently (or amount of water suggested in
manufactures guide)
Post Procedure
Abides by infection control policy and procedures
Records procedure using correct documentation, includes type and
length of tube and Ph of aspirate obtained
Completes entry in patient notes
Disposes of waste correctly
18

Feedback sheet for Part 1
Comments
Action Plan
Signature of Trainee
Signature of Assessor
Date
CORNWALL COMMUNITY NASOGASTRIC POLICY VERSION 1 19

Part 2- Assessment form for the care of the patient with a Nasogastric tube
inserted
Prior to clinical assessment, the trainee must demonstrate knowledge and
understanding of the procedure and successfully complete the core performances at
page 4 of this document
To be assessed as competent, the trainee must carry out the procedure under
observation at least 3 times to satisfy the requirements of the assessment form
Ensure the trainee has access to guidelines 1st 2nd 3rd
Communicates with the patient effectively and gains their consent?
Y/N Y/N Y/N
Check the tube position and length in relation to the flag marker
at the nostril in the notes and on the patient?
Demonstrates the correct method to aspirate the tube and uses
pH indicator strips before moving on
Describes indication when the tube may have been displaced
and procedure to check positioning
Before recommencing feed or medicines administration
Violent coughing or vomiting
After interruption of feeding regime
If it is suspected the tube has moved
Checks the tube is secure or demonstrates correct re -securing
using method in policy
For wide bore Ryles tubes only sets up free drainage system
as appropriate. Check nature of aspirate and documents
amount
For fine bore feeding tubes only demonstrates ability to attach
feed giving set, runs through using button on feed pump or
demonstrates using without, can set feed pump correct volume
and rate.
For fine bore feeding tubes only administers medication
through appropriate port using correct mode as per BAYPEN
instructions, using correct oral enteral feed syringe according to
NPSA guidelines.
Takes correct action to ensure patency of tube and abides by
Cornwall Community NG policy for dealing with a blocked tube.
Demonstrates clear and accurate records using correct
documentation contained in policy
Demonstrates action to be taken for vomiting, distension,
diarrhoea
Demonstrates the special needs for a patient with diabetes
requiring enteral feeding
Abides by all infection control policies and procedure
20

Feedback sheet for Part 2
Comments
Action Plan
Signature of Trainee
Signature of Assessor
Date
CORNWALL COMMUNITY NASOGASTRIC POLICY VERSION 1 21

Certificate of Competency
This is to certify that
…………………………………………………………..
Has been assessed as competent to carry out insertion
and confirming position of Nasogastric tubes in
accordance with NPSA safety advice and local policy
and is deemed competent to care for a patient receiving
enteral feed with a nasogastric tube inserted
Signed………………………..
Designation…………………
22

Certificate of Competency
This is to certify that
…………………………………………………………..
Has been assessed as competent to care for a patient
with a Nasogastric tube inserted in accordance with
NPSA safety advice and local policy guidelines
Signed………………………..
Designation…………………
CORNWALL COMMUNITY NASOGASTRIC POLICY VERSION 1 23

Appendix 4 Equality Impact Assessment Tool
1. Does the document/guidance affect one
group less or more favourably than another
on the basis of:
Race X
Ethnic origins (including gypsies and
travellers)
Nationality X
Gender X
Culture X
Religion or belief X
Sexual orientation including lesbian, gay,
transgender and bisexual people
Age X
Disability - learning disabilities, physical
disability, sensory impairment and mental
health problems
2. Is there any evidence that some groups are
affected differently?
3. If you have identified potential
discrimination, are there any exceptions
valid, legal and/or justifiable?
4. Is the impact of the document/guidance
likely to be negative?
5. If so, can the impact be avoided?
6. What alternative is there to achieving the
document/guidance without the impact?
Can we reduce the impact by taking
different action?
Yes √
No X
X
X
X
X
X
X
X
Comments
24