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OROGASTRIC TUBE INSERTION

INDICATIONS By inserting a nasogastric tube, you are gaining access to the stomach and its contents. This enables you to drain gastric contents, decompress the stomach, obtain a specimen of the gastric contents, or introduce a passage into the GI tract. This will allow you to treat gastric immobility, and bowel obstruction. It will also allow for drainage and/or lavage in drug overdosage or poisoning. In trauma settings, NG tubes can be used to aid in the prevention of vomiting and aspiration, as well as for assessment of GI bleeding. NG tubes can also be used for enteral feeding initially.

Placement of the catheter can induce gagging or vomiting. Gloves must be worn while starting an NG. therefore suction should always be ready to use in the case of this happening. Equipment: All necessary equipment should be prepared. face and eye protection and gowns. assembled and available at the bedside prior to starting the NG tube. Trauma protocol calls for all team members to wear gloves. Basic equipment includes: Personal protective equipment NG/OG tube Catheter tip irrigation 60ml syringe Water-soluble lubricant. an orogastric tube may be inserted. Complications The main complications of NG tube insertion include aspiration and tissue trauma. .Contraindications Nasogastric tubes are contraindicated in the presence of severe facial trauma (cribriform plate disruption). preferably 2% Xylocaine jelly Adhesive tape Low powered suction device OR Drainage bag Stethoscope Cup of water (if necessary)/ ice chips Emesis basin pH indicator strips. due to the possibility of inserting the tube intracranially. In this instance. and if the risk of vomiting is high. Universal precautions: The potential for contact with a patient's blood/body fluids while starting an NG is present and increases with the inexperience of the operator. the operator should consider face and eye protection as well as a gown.

Examine nostrils for deformity/obstructions to determine best side for insertion 6. Gather equipment 2. rotate tube slowly with downward advancement toward closes ear. Mark measured length with a marker or note the distance 8. Do not force. sit patient upright for optimal neck/stomach alignment 5. Instruct the patient to swallow (you may offer ice chips/water) and advance the tube as the patient swallows.1. The pH should be below 6. past the pharynx into the esophagus and then the stomach. 10. Don non-sterile gloves 3. If possible. Swallowing of small sips of water may enhance passage of tube into esophagus. Obtain an x-ray to verify placement before instilling .Withdraw tube immediately if changes occur in patient's respiratory status. Do not inject an air bolus. if tube coils in mouth. aspirate sample of gastric contents.Advance tube until mark is reached 12. Pass tube via either nare posteriorly. Measure tubing from bridge of nose to earlobe. if the patient begins to cough or turns pretty colours 11. Lubricate 2-4 inches of tube with lubricant (preferably 2% Xylocaine).Check for placement by attaching syringe to free end of the tube. as the best practice is to test the pH of the aspirated contents to ensure that the contents are acidic. so a squirt of Xylocaine jelly in the nostril. and a spray of Xylocaine to the back of the throat will help alleviate the discomfort. Explain the procedure to the patient and show equipment 4. This procedure is very uncomfortable for many patients. If resistance is met. 9. then to the point halfway between the end of the sternum and the navel 7.

type & size of tube. the nature and amount of aspirate. 15.If for suction. connect to suction.any feedings/medications or if you have concerns about the placement of the tube.Document the reason for the tube insertion. the type of suction and pressure setting if for suction. . and the effectiveness of the intervention.Secure tube with tape or commercially prepared tube holder 14. the nature and amount of drainage. set machine on type of suction and pressure as prescribed. 13. remove syringe from free end of tube.