NASOGASTRIC TUBE

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

NASOGASTRIC TUBE

TYPES OF PROCEDURES
GASTRIC GAVAGE GASTRIC LAVAGE

Indications
 Diagnostic

Evaluation of upper gastrointestinal (GI) bleed (ie, presence, volume) Aspiration of gastric fluid content Identification of the esophagus and stomach on a chest radiograph Administration of radiographic contrast to the GI tract

Indications


Therapeutic
Gastric decompression, including maintenance of a decompressed state after endotracheal intubation, intubation, often via the oropharynx Relief of symptoms and bowel rest in the setting of small-bowel obstruction small Aspiration of gastric content from recent ingestion of toxic material Administration of medication Feeding Bowel irrigation

Contraindications
 Absolute

contraindications

Severe midface trauma Recent nasal surgery

 Relative

contraindications

Coagulation abnormality Esophageal varices or stricture Recent banding or cautery of esophageal varices Alkaline ingestion

EQUIPMENTS

TYPES OF NASOGASTRIC TUBES

The Levin Tube -is a one-lumen nasogastric onetube

TYPES OF NASOGASTRIC TUBES

The Salem-Sump Tube. SalemThis tube is a two-lumen twopiece of equipment. It has a drainage lumen and a smaller secondary tube that is open to the atmosphere.

TYPES OF NASOGASTRIC TUBES

The Miller-Abbott Tube. MillerThis tube is also a two-lumen twonasogastric tube. There is a rubber balloon at the tip of one tube; the other tube has holes near its tip.

TYPES OF NASOGASTRIC TUBES

The Cantor Tube - has one lumen and a bag on the end. end.

SIZES
 Adult
Size Colour Code

- 16-18F 16FG-8 Blue FG-10 Black FG-12 White FG-14 Green FG-16 Orange FG-18 Red FG-20 Yellow

 Pediatric

- In pediatric patients, the correct tube size varies with the patients age.

Infection Control
Washing  Wear a set of gloves  Wearing face and eye protection  Wear disposable apron.
 Hand

IMPLEMENTATION
for physician order.  Identify Client & Introduce yourself  Explain the procedure  Assemble the Materials needed
 Verify

NURSING RESPONSIBILITY
and removing the tube  Assessing correct placement  Securing the tube  Meeting patient comfort needs  Monitoring patient responses
 Inserting

IMPLEMENTATION
Explain the procedure, benefits, risks, complications, and alternatives to the patient or the patient's representative. representative. Examine the patients nostril for septal deviation. deviation. To determine which nostril is more patent, ask the patient to occlude each nostril and breathe through the other. other.

POSITION
y Position the patient in a High Fowlers position.

MEASUREMENT
Adult Measure from the tip of the nose, around the ear, and down to the xyphoid process.

MEASUREMENT
Infant Measure from the tip of the nose, around the ear and down to the umbilicus.

INSERTION


Lubricate the distal end of the Tube

INSERTION


Instruct the Patient to drink while the tube is inserted

CHECKING FOR PLACEMENT

 Auscultation

of air insufflated through the tube of the Proximal end of in a glass of water.

 Immersion

CHECKING FOR PLACEMENT

 Aspiration

of fluid from the tube, with pH testing of the aspirate.

pH < 5 GIT pH > 6 - Respiratory

CHECKING FOR PLACEMENT

 Chest

XX-ray

NG OPTIMIZER

SECURE THE NG TUBE



Anchor the tube securely to the nose and cheek - keeping it out of the patients field of vision.

COMPLICATIONS


Minor complications - Nose Bleeds,Sinusitis, and sore throat More significant complications - Erosion of the nose where the tube is anchored, esophageal perforation, pulmonary aspiration, a collapsed lung, or intracranial placement of the tube.

DOCUMENTATION
Date and time of procedure  Indication for insertion  Type of tube used  Distance tube inserted (if appropriate)  The nature of the aspirate  Methods used to check location of the tube insertion  Any procedural comments


Transabdominal tube feeding and care

A

percutaneous endoscopic gastrostomy (PEG) or (PEJ) jejunostomy tube can be inserted endoscopically without the need for laparotomy or general anesthesia. Used for nutrition, drainage, and decompression.

Contraindications to endoscopic placement

 Obstruction

gastric surgery  Morbid obesity  Ascites

 Previous

Gastrostomy Feeding Tubes

Jejunostomy Feeding Tubes

Gastrojejunostomy Feeding Tubes

Nursing care
Providing skin care at the tube site Maintaining the feeding tube

Administering Feeding

Monitoring Patient Response

Adjusting Feeding schedules

Equipment: feeding
 Feeding

formula Large bulb or catheter tip syringe 120 ml of water 4 x 4 gauze pads Soap Skin protectant Hypoallergenic tape Gravity drip administration bags Mouthwash, toothpaste, or mild salt solution

Preparation of equipment


Always check the expiration date on commercially prepared feeding formulas. If the formula has been prepared by the dietitian or pharmacist, check the preparation time and date. Discard any opened formula thats more than 1 day old. Commercially prepared administration sets and enteral pumps allow continuous formula administration. 18

 Place

the desired amount of formula

into the gavage container and purge air

from the tubing. To avoid contamination, hang only a 4 to 6 hour supply of formula at a time.  Provide privacy, and wash your hands. Confirm the patients identity using two patient identifiers according to facility policy. Explain the procedure to the patient. Tell him, for example, that feedings usually start at a slow rate and increase as tolerated. After he tolerates continuous feedings, he may progress to intermittent feedings, as ordered.

Assess for bowel sounds with a stethoscope before feeding, and monitor for abdominal distention. Ask the patient to sit, or assist him into semi Fowlers position, for the entire feeding. This helps to prevent esophageal reflux and pulmonary aspiration of the formula. For an intermittent feeding, have him maintain this position throughout the feeding and for 1 hour afterward.

Put on gloves. Before starting the feeding, measure the residual gastric contents. Attach the syringe to the feeding tube and aspirate. If the contents measure more than twice the amount infused, hold the feeding and recheck in 1 hour.  If residual contents remain too high, notify the physician.  Chances are the formula isnt being absorbed properly.  Keep in mind that residual contents will be minimal with PEJ tube feedings.


Allow 30 ml of water to flow into the feeding tube to establish patency. Be sure to administer formula at room temperature. Cold formula may cause cramping. 24 Allow gravity to help the formula flow over 30 to 45 minutes. Faster infusions may cause bloating, cramps, or diarrhea. Begin intermittent feeding with a low volume (200 ml) daily, according to the patients tolerance increase the volume per feeding, as needed, to reach the desired calorie intake.

 When

the feeding finishes, flush the feeding tube with 30 to 60 ml of water to maintain patency and provide hydration. Cap the tube to prevent leakage. Rinse the feeding administration set thoroughly with hot water to avoid contaminating subsequent feedings. Allow it to dry between feedings.