Gather supplies: appropriate-size nasogastric tube, water-soluble lubricant, syringe, pH strips, tape/securement device, stethoscope if used per protocol, gloves, towel, cup of water if allowed
Verify the order and patient identity
Explain the procedure to the patient
Perform hand hygiene and don gloves
Position the patient upright at 45 to 90 degrees
Assess for contraindications or nasal/oral abnormalities if required by protocol
Measure the tube from nose to earlobe to xiphoid process and mark the length
Lubricate the distal end of the tube
Ask the patient to tilt the head slightly forward
Gently insert the tube into the selected nostril along the floor of the nasal passage
Advance the tube slowly as the patient swallows if able
Stop if the patient coughs, chokes, or has difficulty breathing
If resistance is met, withdraw slightly and try again; do not force the tube
Advance to the marked length
Confirm placement according to facility protocol, usually by aspirate pH and other approved methods
Secure the tube to the nose and cheek
Connect to the ordered device or cap the tube as prescribed
Document tube size, insertion length, confirmation method, patient tolerance, and any complications