A) If less than 5 - 10 cc of mucous returns, re-position the tube and/or the child in order to look for the pool of mucous. While continuing to gently aspirate with the syringe, pass the tube further along several inches and try rolling the child up onto his/her side.
B) If still < 5 - 10 cc of gastric contents have been aspirated, put any yield into your cup or tube.
C) Prepare to instill water into the tube. BEFORE instilling anything into a nasogastric tube, always check the position of the tube. Instill 10 cc of air quickly into the tube while listening with a stethoscope directly over the stomach. If the tube is properly positioned in the stomach, a loud gurgling sound will be heard. If you do not hear the air or if the child has any respiratory distress, remove the tube immediately.
D) If you hear the air go into the stomach, instill 20 - 30 cc of sterile water into the tube.
(Note: the organism is most viable when not exposed to saline or preservatives).
E) Quickly re-aspirate. If you still have no significant yield, try advancing or withdrawing the tube and changing the child's position in order to find mucous. Continue to aspirate syringe as you withdraw tube.