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Nasogastric Intubation

Nasogastric Intubation

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Published by marie
Nasogastric intubation is a medical process involving the insertion of a plastic tube (nasogastric tube, NG tube) through the nose, past the throat, and down into the stomach.
Nasogastric intubation is a medical process involving the insertion of a plastic tube (nasogastric tube, NG tube) through the nose, past the throat, and down into the stomach.

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Published by: marie on Aug 06, 2009
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03/30/2013

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Nasogastric IntubationEQUIPMENTNasogastric (NG) tube—usually single-lumen Levin or double-lumen Salemsump tubeWater-soluble lubricantSuction equipment if orderedClamp for tubing Towel, tissues, and emesis basinGlass of water and straw Tincture of benzoinHypoallergenic tape: ½ inch and 1 inchBio-occlusive transparent dressingIrrigating set with 20-mL syringe or a 50-mL catheter-tip syringeStethoscope Tongue bladePenlightDisposable glovesNormal salinePROCEDURE
Nursing ActionRationalePreparatory phase
1.Ask the patient if he has ever hadnasal surgery, trauma, a deviatedseptum, or bleeding disorder.1.Nasogastric tubes may becontraindicated in patients withnasopharyngeal or esophagealobstruction, severe uncontrolledcoagulopathy, or severemaxillofacial trauma.2.Explain procedure to the patient,and tell how mouth breathing,panting, and swallowing will help inpassing the tube.2.Improves comfort and compliance.3.Place the patient in a sitting or high-Fowler's position; place a towelacross chest.3.Facilitates passage of tube intoesophagus.4.Determine with the patient whatsign he might use, such as raisingthe index finger, to indicate “waita few momentsâ€
because of gagging or discomfort.4.Provides a method of communication, which is reassuringto the patient.5.Remove dentures; place emesisbasin and tissues within the patient'sreach.5.Dentures may become loose andinterfere with tube insertion.6.Inspect the tube for defects; look forpartially closed holes or rough6.Irrigation and suction may beaffected by defective tube.
 
edges.7.Place rubber tubing in ice-chilledwater for a few minutes to make thetube firmer. Plastic tubing mayalready be firm enough; if too stiff,dip in warm water.7.A firm tube that is not too rigid willpass easiest, without causingtrauma.8.Determine the length of the tubeneeded to reach the stomach (seeaccompanying figure).8.To prevent coiling of tube instomach or tube ending inesophagus.9.Have the patient blow nose to clearnostrils.9.To facilitate passage through thenose.10.Inspect the nostrils with a penlight,observing for any obstruction.Occlude each nostril, and have thepatient breathe. This will helpdetermine which nostril is morepatent. 11.Wash your hands. Put on disposablegloves.11. To protect nurse from patient'ssecretions.12.Measure the patient's NEX (nose,earlobe, xiphoid), and mark the tubeappropriately. Some tubes may bepremarked to indicate length, butthis may not correlate exactly withthe measurement obtained.a. The distance from the nose to theearlobe is the first mark on thetube. This measurement representsthe distance to the nasal pharynx.b.When the tube reaches the xiphoidprocess (tip of the breast bone) asecond mark is made on the tube. This measurement represents thelength required to reach thestomach.12. The measurement will help ensurethat the end of tube reaches thestomach.
Performance phase
1.Coil the first 3-4 inches (7-10 cm) of the tube around your fingers.1.This curves tubing and facilitatestube passage.2.Lubricate the coiled portion of thetube with water-soluble lubricant.Avoid occluding the tube's holes withlubricant.2.Lubrication reduces frictionbetween the mucous membranesand tube and prevents injury to thenasal passages. Using a water-soluble lubricant prevents oilaspiration pneumonia if the tube
 
accidentally slips into trachea.3.Tilt back the patient's head beforeinserting tube into nostril, and gentlypass tube into the posteriornasopharynx, directing downwardand backward toward the ear.3.The passage of the tube isfacilitated by following the naturalcontours of the body. The slowerthe advancement of the tube atthis point, the less likelihood of putting pressure on the turbinates,which could cause pain andbleeding.4.When tube reaches the pharynx, thepatient may gag; allow patient torest for a few moments.4.Gag reflex is triggered by thepresence of the tube.5.Have the patient tilt head slightlyforward. Offer several sips of waterthrough a straw, or permit patient tosuck on ice chips, unlesscontraindicated. Advance tube aspatient swallows.5.Flexed head position partiallyoccludes the airway, and the tubeis less likely to enter trachea.Swallowing closes the epiglottisover the trachea and facilitatespassage of tube into theesophagus. Actually, when the tubepasses the cricopharyngealsphincter into the esophagus, it canbe slowly and steadily advancedeven if the patient does notswallow.6.Gently rotate the tube 180 degreesto redirect the curve.6.This prevents the tube fromentering the patient's mouth.7.Continue to advance tube gentlyeach time the patient swallows.7.Facilitates forward movement.8.If obstruction appears to preventtube from passing, do not use force.Rotating tube gently may help. If unsuccessful, remove tube and tryother nostril.8.Avoid discomfort and trauma topatient.9.If there are signs of distress such asgasping, coughing, or cyanosis,immediately remove tube.9.May have entered the trachea.10.Continue to advance the tube whenthe patient swallows, until the tapemark reaches the patient's nostril.10. This is the reference point wherethe tube was measured.11. To check whether the tube is in thestomach:11. a.Ask the patient to talk. a.If the patient cannot talk, the tubemay be coiled in throat or passedthrough vocal cords.b.Use the tongue blade andpenlight to examine theb.If the patient is choking or hasdifficulty breathing, the tube has

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