ANATOMICAL MEASUREMENT & AIRWAY PATENCY CHECK: Assessment of bilateral nasal passages to identify the clearest airway, followed by precise external measurement from nose tip to earlobe to xiphoid process (NEX method) to gauge insertion depth.

ASEPTIC NASOGASTRIC TUBE INSERTION: Lubrication of medical-grade silicone or PVC Ryle's tube with water-soluble lignocaine jelly, followed by gentle transnasal advancement into the stomach while guiding the patient through synchronized swallowing.

TUBE PLACEMENT VERIFICATION: Verification of gastric placement using auscultatory epigastric air insufflation (whoosh test) and gastric juice aspiration/pH paper assessment prior to initiating any feeding.

SECURE FIXATION & MARKING: Anchoring the tube securely across the nasal bridge using hypoallergenic skin-friendly tape to prevent accidental dislodgement, followed by marking the external reference length.

CAREGIVER FEEDING TRAINING & FLUSHING DEMO: Clear instruction for family members on correct gravity-feeding posture (Fowler's position), feeding syringe handling, aspiration checking before meals, and sterile water flushing protocols.