NG Tube Insertion: OSCE Station Checklist

Of the 20 skills, NG insertion carries the most safety weight, because the failure mode is a national Never Event: feed delivered into a lung through a misplaced tube. The examiners mark the insertion, but they’re watching the confirmation.

The sequence:

1. Check the prescription/indication, and screen for contraindications the station may plant: base of skull fracture, recent nasal surgery, oesophageal varices per local policy.
2. Hand hygiene, identity, explanation, consent. Agree a stop signal (a raised hand) with the patient.
3. Position: sitting upright, head slightly forward. Check nostril patency, choose the clearer side.
4. Measure NEX: nose, around the earlobe, to the xiphisternum. Note the length.
5. Lubricate the tip. Pass along the floor of the nose. As the tube reaches the pharynx, ask for swallows (sips of water if safe) and advance with each swallow to the NEX mark.
6. Coughing, distress, or the stop signal: withdraw, recover, retry.
7. Secure the tube. Then the step the station exists for.

Confirmation: pH first, X-ray second, nothing else

Aspirate a small amount with a syringe and test on pH indicator paper (not litmus). pH 1 to 5.5 confirms gastric placement. Above 5.5, or no aspirate obtainable after repositioning and waiting, means chest X-ray before the tube is used for anything.

Two things are banned and the exam knows candidates trained elsewhere may have learned them: the whoosh test (air injection with auscultation) and litmus paper. Naming either as an acceptable method is a safety-critical error. If a station examiner asks “is there any other way to check?”, the correct answer is X-ray, full stop.

Medicines that suppress acid complicate the picture: a patient on a PPI may not produce aspirate below 5.5. That’s not a workaround invitation; it’s an X-ray.

Documentation with numbers in it

This station’s record has more required fields than most: tube size, NEX length, which nostril, the pH obtained, confirmation method, and the external length marking (so later shifts can spot migration). The pH value goes in the notes as a number. Writing “position confirmed” without the value is the documentation miss the checklist looks for.

The wrap-around marks are unchanged: hand hygiene moments, dignity (this procedure is unpleasant; narrate and pause), and closing the loop with the patient settled and the record complete.

Five questions below, then a gentler station: blood glucose monitoring.