5.5 Checklist: Remove an NG Tube

*Disclaimer: Always follow agency policy and manufacturer recommendations

Checklist: Remove an NG Tube^[1],[2]

Note: An NG tube should be removed if it is no longer required. The removal process is typically quick. Prior to removing an NG tube, verify the provider’s orders for removal. If the NG tube was ordered to remove gastric content, the provider’s order may include a “trial” clamping of the tube for a specified number of hours to verify the client can tolerate its removal. During the trial, the client should not experience any nausea, vomiting, or abdominal distension.^[3]

• Verify the provider’s orders to remove the NG tube.
• Gather the necessary supplies:
  • Fluid-impermeable pads
  • 20-60 mL syringe
  • Nonsterile gloves
  • Stethoscope
  • Oral hygiene supplies
  • Tissues
  • Garbage bag
• Verify the client using two patient identifiers.
• Explain the procedure to the client.
• Place the client in high Fowler’s position.
• Perform hand hygiene.
• Assess the client’s gastrointestinal function prior to removing the NG tube.
• Place a fluid impermeable pad on the client’s chest.
• Disconnect the tube from feeding and suctioning if present.
• Remove the tape or securement device from the nose.
• Unclip the NG tube from the client’s gown.
• Verify tube placement and then clear the NG tube by inserting 10 to 20 mL of air into the tube to prevent aspiration of any remaining gastric contents.
• Instruct the client to take a deep breath and hold it.
  • Holding one’s breath closes the epiglottis and prevents aspiration.
• Kink the NG tube near the nare and gently pull out the tube in a swift, steady motion, wrapping it in your hand as it is being pulled out. Inspect the tube for intactness. Dispose of the tube in the garbage bag.
  • Kinking the tubing prevents any residual gastric contents from flowing out of the tube upon removal.
• Offer tissue and/or clean the nares for the client.
• Offer oral care for client comfort and to prevent transmission of microorganisms.
• Discard used supplies, remove gloves, and perform hand hygiene.
• In an inpatient setting, help the patient into a comfortable position and place personal items, the tray table, and the call light within easy reach. Make sure the patient knows how to use the call light to summon assistance. To ensure the patient’s safety, raise the appropriate number of side rails and lower the bed to the lowest position. Ensure the bed is locked.
• Perform hand hygiene.
• Document the procedure and assessments.
• After tube removal, continue to monitor the client for signs of gastrointestinal (GI) dysfunction, including nausea, vomiting, abdominal distention or discomfort, and food intolerance. Notify the provider of GI dysfunction because reinsertion of the NG tube may be required.

Documentation Cues:

• Client’s GI assessment and status before tube removal
• Date and time of NG tube removal; the color, consistency, and any amount of gastric drainage
• Visual inspection and intactness of the tube upon removal
• Client tolerance of the procedure
• Client and family (if applicable) education, their understanding of that teaching, and any need for follow-up teaching.
• Any type of unexpected outcome and the interventions performed