Name: ___________________________

Columbus State Community College
Nursing Department
Critical Item Checklist

NG Insertion (Levine Tube)

_____1.	Wash hands.
_____2.	Read Order.
_____3.	Gather appropriate equipment
a.	(choose appropriate size tube – 14 Fr. (adult)
b.	lubricant
c.	tape
d.	syringe
e.	drinking straw
f.	chux
g.	emesis basin
h.	glass with water
_____4.	Place patient in high Fowler’s position. Explain procedure.
_____5.	* Measure using tip of patient’s nose to the earlobe to the lower end of the sterum (N-E-X).
_____6.	Put on clean gloves.
_____7.	Lubricate tube with water-soluble lubricant.
_____8.	* Insert tube to proper position.  Have patient sip water with straw.
_____9.	Tape securely to patient’s nose using appropriate technique, and with test tape.
_____10.	* Check for placement using air technique.
_____11.	Attach tube to suction source or as indicated.
_____12.	Fasten tube to patient’s gown.
_____13.	Clean up area, dispose of used supplies, wash hands.
_____14.	Chart procedure.

 

S __________

U __________

Faculty Signature ________________________

Referral ________________________________