A Licensed Practical Nurse (LPN) provides basic medical care under the direction of a Registered Nurse (RN) or physician. A Nasogastric (NG) tube is a flexible tube inserted through the nose into the stomach, used for feeding, medication administration, or removing stomach contents. Whether an LPN can insert this device is complex because regulation is not uniform across the United States. The answer depends almost entirely on the state’s Nurse Practice Act (NPA), the primary legal statute governing nursing activities, combined with specific employer policies. This variability means NG tube insertion may be within the LPN’s scope in one state or facility but prohibited in another.
State-by-State Insertion Rules
The legal authority for an LPN to insert an NG tube is determined by the state’s Nurse Practice Act (NPA), which often classifies the procedure as an advanced or specialized skill. In some states, such as Nevada, placing an NG tube is within the LPN’s scope, provided the LPN meets facility competencies and policies allow it. Kentucky explicitly permits LPNs to insert and remove NG tubes for patients with normal anatomy when used for common purposes like gavage or medication administration.
This permission often requires direction or supervision, depending on the state’s specific legal language. For instance, in Mississippi, the LPN must have documented training, and the facility must have a written policy delineating the safe limits of the procedure. Conversely, many states reserve NG tube insertion exclusively for Registered Nurses, considering it an invasive procedure that carries a significant risk of complications, such as misplacement into the lungs. Delegation is central here, as an RN or physician may only transfer the responsibility if the NPA permits the LPN to perform that function within their license.
Prerequisites for Competency
Even where the state Nurse Practice Act permits LPNs to insert NG tubes, the nurse must demonstrate specialized training and documented competency before performing the procedure. A legal allowance does not automatically grant clinical permission to an individual LPN. Healthcare facilities are legally entitled to adopt policies that are more restrictive than the state’s NPA, meaning an LPN may be prohibited from the task by their employer until specific skill verification is completed.
LPNs typically must complete a formal post-graduate course or receive extensive on-the-job training that is formally documented and approved by the facility. This training must cover the proper technique for measuring the tube, safely inserting it, and confirming correct placement, as improper placement can have severe consequences. Competency is often validated through a combination of didactic learning, a skills checklist, and supervised practice, sometimes requiring successful insertions under the observation of an experienced RN. This verification process ensures the LPN understands potential complications and can recognize signs of respiratory distress or tube misplacement.
LPN Duties for Existing NG Tubes
While the initial act of insertion is often restricted, the ongoing management and maintenance of an existing NG tube are widely within the standard scope of LPN practice. LPNs routinely verify the tube’s continued correct placement by observing the external length marking at the nostril and performing pH testing of aspirated gastric contents. Stomach contents typically have a highly acidic pH of 1 to 5.5, which helps differentiate them from lung or intestinal contents.
The LPN is responsible for administering prescribed enteral feedings and medications through the tube, ensuring the correct formula or drug is given at the ordered rate. Flushing the NG tube with water (often 30 milliliters) is performed before and after feedings or medication administration to prevent tube occlusion. LPNs also monitor the patient for complications, such as signs of aspiration, nausea, or vomiting, and provide site care to the nostril to prevent skin irritation or breakdown. LPNs are typically permitted to perform the removal of the NG tube once the healthcare provider orders its discontinuation.