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Nasogastric Tube

You are being fed through a nasogastric tube. This feeding tube is positioned in the stomach and consequently feeding will start in your stomach.

Daily Care
It is important to keep your tube in optimal condition to avoid unnecessary replacement of the tube. Regular care and flushing of the tube will help to prevent the tube becoming blocked. > Wash your hands before every handling of the tube feed or your feeding system. > Check the position of the tube before starting a feed by measuring the pH value of stomach contents. Check at least three times a day or when you are in doubt about the position of your tube. Never start feeding before confirmation. > Flush the tube before and after feed and medication administration, and at least 3 times a day with ca. 20-40 ml of water to prevent your tube from blocking. > Use a new feeding set every 24 hours to avoid contamination of the feed or feeding set. > Care of the nose: change hypoallergenic tape every day, clean the skin carefully, place the tube into the other nostril in case of damaged skin. > Care of the mouth, teeth and lips: especially important when you are not able to eat. Brush teeth once a day, rinse the mouth several times a day, and apply cream on the lips. > Hanging time of tube feed is limited: follow the instructions on the label. > The tube should be replaced every 6-8 weeks.

Very slowly and carefully pull back on the plunger of the syringe until a small amount of fluid appears in the syringe. your tube is in the correct position (in the stomach). > water (tap water or as recommended by your health care professional). If the pH value remains above 5. If not.5 or less.5. If the pH value is more than 5. 2 If you are able. Place a little of the fluid onto pH indicator paper. and then try again. wait for a few minutes. take a little fluid. 1 2 3 4 5 Wash hands before and after checking your tube position. Position check nasogastric tube by pH measurement Equipment: > a syringe. Do not administer feeds or fluid via your tube. Remove end cap from the tube and attach a syringe to the end of the tube. then try again to test the tube. ?pH pH>5.Position check It is important to check the position of your tube to make sure that your feed goes directly where it should in your body.5 If the pH value is 5. Flush the tube with 20-40 ml of water. .5 pH<5. remembering to replace the end cap of the tube. Note: If it is not possible to obtain fluid for checking pH. contact your doctor or nurse. > pH indicator paper. Detach the syringe from the tube. and it is safe for you to do so. 3 If it is still not possible to obtain any fluid.5 contact your nurse. Check the pH value again in 30-60 minutes. intestinal inconveniences or potentially dangerous situations may occur. do not administer anything via your tube. you could try the following: 1 Lie on your left side.

> tape (to secure the tube). a marker pen. gloves. B ?cm C A Make sure you are in a comfortable sitting or semi-recumbent position. It is important that you always follow the training advice given to you so that your tube is placed safely and correctly. Advance the tube further and swallow to get the tube further down. Choose the nostril through which you breathe most easily. Equipment: > new nasogastric tube. 2 Fully insert the guide wire in the tube and ensure it is firmly attached to the connector. Bend forwards as soon as he feels the tube in his throat. this will facilitate the introduction of the tube. pH indicator paper. 4 cm✓ . Bend your head backwards and introduce the tube into the chosen nostril. > water. never force it. Sigh deeply to prevent retching. > 50 ml syringe. Measure the required length of the tube: the length between the ear.(Re)placement of a nasogastric tube Only perform placement if you have been taught how to place a nasogastric tube. Introduce the tube further until the previously applied mark reaches the nose. 3 Submerge the tip of the tube into a container with water. Push the tube gently. Mark the tube at this point with a pen or tape. potentially by drinking small sips of protect the patient’s skin. 1 > > > > clean scissors. Start with blowing your nose. dressing . the tip of the nose (A-B) and from the nose to the lowest point of the sternum (B-C).

as this may cause perforation of the gastro-intestinal tract. 8 Remove the guide wire. 9 Tape the tube to the nose. the charrière and the length of the tube.5. Never reinsert a guide wire. The tube is correctly placed in the stomach if the pH value measure is below 5. Record the brand name.5 Flush the tube with 20-40 ml water. This will avoid blocking of the tube. . avoid compression of the tube against nostrils. Removal of the tube The tube can be removed by gently pulling the tube out the nose. 7 ?pH>/<5. 6 Measure the pH value of the gastric contents. Never use syringes smaller than 20 ml as they provide too much pressure in the tube and may cause the tube to rupture.5 Confirm correct placement of the tube through aspiration of gastric contents. Never start feeding before confirmation of correct tube placement.

You should contact your doctor for further advice > Telephone the hospital to let them know you are coming in and that you need to . assemble the equipment as you have been taught and proceed to place a new nasogastric tube. > If you still cannot clear the blockage. you may need to attend the hospital emergency department. or suffer from the symptoms that your medication normally prevents or controls. If you have been trained how to place a nasogastric tube. do not force water into the tube. gently squeeze the tube between your fingers along the length of the tube as far as possible. > If you do not have a nurse or the nurse is unavailable. using a syringe. If you have not been trained to place a nasogastric tube do NOT attempt to place a new nasogastric tube. > Second. > If a blockage still exists. Follow the steps below. very gently draw back on the syringe and then attempt to flush as before. particularly if you are having a carefully calculated fluid balance. following the training advice you have been given.Trouble shooting nasal tubes My nasogastric tube has become blocked If you experience resistance when flushing the tube. using a 50 ml syringe. > If you are still unable to clear the blockage. > Contact your nurse and explain that your nasogastric tube has come out. My nasogastric tube has come out It is important that you have a new nasogastric tube placed in time for your next feed or medication. gently flush the tube using luke warm water. if possible. Note your next feeding time to your nurse. draw off all liquid on top of the blockage. Otherwise you may go hungry. become dehydrated. > First. > Remain calm. or if your medication has to be given at set times. A. If you have not got any of the necessary equipment follow the steps below. Do not use acidic solutions such as fruit juices or cola as they can curdle the tube feed. contact your nurse or doctor. B.

> Order a new nasogastric tube so that you have a spare ready in case your feeding tube comes out unexpectedly again. Remove the nasogastric tube at once if at any time during the placement of the patient’s nasogastric tube: > The patient coughs or vomits excessively. > If you have a spare nasogastric tube at home take it with you. > The tube curls in your patient’s mouth. > The patient goes more blue than usual. you can either: > Remove the tube and start again. as your type and size of tube may not be readily available in the emergency department. > Leave the tube in and contact your nurse for advice. Important notes: Never administer anything through the nasogastric tube until you are sure the tube is in the right place. This will give the department time to find your medical notes and to make sure that a member of staff is available who is able to place your nasogastric tube. but the patient seems comfortable and the tube seems to have passed smoothly. > Once the new nasogastric tube has been placed. 171082 / BP&MC 21100802 . If you are unable to confirm that the tube is in the correct position (the stomach). this will save time. > The tube comes out of your patients other nostril. Take the tube that has fallen out with you so the staff can identify which type of tube it is. inform the person who routinely changes your nasogastric tube.have a nasogastric tube placed.

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