INSERTING A NASOGASTRIC TUBE

Before inserting the nasogastric tube determine the size of tube to be inserted and whether or not the tube is to be attached to suction. Purposes: • To administer the feedings and medications to clients unable to eat by mouth or swallow a sufficient diet without aspirating food or fluids into the lungs. To establish a means for suctioning stomach contents to prevent gastric distention, nausea and vomiting. To remove stomach contents for laboratory analysis To lavage (wash) the stomach in case of poisoning or overdose of medications

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Equipments: •

Large- or small –bone tube ( plastic or rubber) Solution basin filled with warm water ( if a plastic tube is being used ) or (if a rubber tube is being used) Nonallergenic adhesive tape, 2.5 cm (1 in) Disposable Gloves Water- soluble lubricant Facial tissues Glass of water and drinking straw or medicine cup with water 20to 50 ml syringe with an adapter Basin Stethoscope Clamp( optional)

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Suction apparatus if required Gauze square or plastic specimen bag and elastic band 5ml or 12 ml syringe

Procedure: 1. Prepare the client • Explain to the client what you plan to do. The passage of gastric tube is not painful, but it is unpleasant because the gag reflex is activated during insertion Assist the client to have a high fowlers position if health permits and support the head or a pillow

2. Assess the client nares

Ask the client to hyperextend the head and using a flashlight observe the intactness of the tissues of the nostrils, including any irritations or abrasions Examine the nares for any obstructions or deformities by asking the client to breathe through one nostril while occluding the other Select the nostril that has the greater airflow.

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3. Prepare the tube 4. Determine how far to insert the tube

Use the tube to marked off the disturbance from top mark off the distance from the tip of the clients nose from the tip of the earlobe to the tip of the sternum

For infants and young children , measure from the nose to the point of the earlobe and then to the point midway between the umbilicus and the xiphoid process ( NEX TECHNIQUE ) -50 cm

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INSERT THE TUBE Don gloves Lubricate the top of the tube with water soluble lubricant. To reduce friction. Do not use oil. Oil may cause lipoid pneumonia Insert the tube with its natural curve toward the client, into the selected nostril. Ask the client to hyperextend the neck, and gently advance the tube toward the nasopharynx. Once the tube reaches the oropharynx (throat) the client will feel the tube in the throat and may gag and retch. -Ask the client o tilt the head head forward and encourage the client to drink and swallow

6. Ascertain correct placement of the tube • Auscultate air insufflations

7. Secure the tube by taping it to the bridge of the client’s nose.

Cut 7.5 cm (3 in) of tape, and split it lengthwise at one end leaving a 2.5 cm (1 in) tab at the end. Place the tape over the bridge of the client’s nose, and bring the split ends under the tubing and back up over the nose.

INDICATIONS: Use of a nasogastric tube is indicated to: 1. Decompress the stomach by aspiration of gastric contents (fluid, air, blood).

2. Introduce fluids (lavage fluid, tube feedings, and activated charcoal) into the stomach. 3. Assist in the clinical diagnosis through analysis of substances found in gastric contents. CONTRAINDICATIONS: Nasogastric tubes are contraindicated or used with extreme caution in people with particular predispositions to injury from tube placement. These may include:

Patients with sustained head trauma, maxillofacial injury, or anterior fossa skull fracture. Inserting a NG tube blindly through the nose has potential of passing through the cribriform plate, thus causing intracranial penetration of the brain.

Patients with a history of esophageal stricture, esophageal varices, alkali ingestion at risk for esophageal penetration. Comatose patients have the potential of vomiting during a NG insertion procedure, thus require protection of the airway prior to placing a NG tube.

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