NG insertion is another skill added to NMC OSCE skill station. These are the steps to be followed while doing this procedure. The time limit for demonstration of this skill is 12 minutes.

NG tube insertion procedure for NMC OSCE 2021

As always, we will discuss this skill in four phases which are Introduction phase, pre procedural phase, procedural phase and post procedural phase.

Introduction Phase

– Check the area for safety and wash hands
– Introduce giving your name and role
– Confirm identity of patient and what they would like to be called
– Check with the patient has known allergies including any dressing or adhesive
– Explain the procedure and rationale and gain full informed consent
– Offer patient opportunity to ask questions and give clear answers
– Provide privacy and dignity to patient as appropriate
– Arrange signal with patient so that they can communicate if they wish to stop or hold for eg. Raising hand or tapping arm gently

Pre Procedural Phase

– Cleans hands, assembles required equipment, cleaning if necessary and checking items for integrity and expiry date
– Return to the patient, don ppe

Procedural Phase

– Assess the patient to sit in a semi upright position and use pillows to ensure there is no head tilt forwards or backwards
– Using the nasogastric tube to measure, check the length of insertion from the patient’s ear lobe to the bridge of the nose. Then from the ear lobe to the bottom of the xiphisternum and note the measurement on the tube.
– Check the nostrils of the patent by asking the patient to sniff with one nostril closed and repeat with the other nostril
– Lubricate approximately 15 – 20 cm of the insertion end of the tube with lubricating gel or warm water and ensure you have receiver placed beneath the end of tube.
– Insert the proximal end of the tube into the clearer nostril, slide backwards and inwards along the floor of the nose through the nasopharynx. Stop if there is any obstruction and try again adjusting positioning slightly or use the other nostril.
– If the patient is able, ask them to start swallowing as the tube passes down the nasopharynx into the esophagus
– Advance the tube through the pharynx whilst the patient swallows until the measured indicator reaches the entrance of the nostril.
– Recognize any signs of distress such as coughing or breathlessness, in which case remove the tube immediately
– Uses tape to secure the tube to the nostril and cheek
– Aspirate a small approximately 0.5 to 1ml of the stomach content using a 50 ml enteral syringe confirming the tube is correctly positioned by using a ph indicator strip to confirm the presence of acid. The ph should be less than 5.5. Uses sphigot or integral cap to cap the tube.

Post Procedural phase

– Disposes of equipments including personal protective equipments appropriately and clean hands.
– Ensure the patient is comfortable post procedure.
– State additional checks that may be undertaken to check tube position before commencing feeding (x – ray, further ph tests)
– Act professionally throughout in accordance with the NMC code.

What will make you fail?

Candidate does not recognize the significance of a displaced tube, ie not able to state what ph should be to confirm tube positioning.
Candidate does not recognize the significance of additional checks prior to commencing feeding.