larger and stiffer tubes include nasopharyngeal

SKILL 5: erosions/ necrosis, sinusitis and otitis media.

NGT INSERTION ND REMOVAL  For short term usage, PVC feeding tubes have
adequate efficacy and are more cost-effective
- Usually inserted to decompress the stomach, a
nasogastric tube (NG) tub prevent vomiting after Inserting an NG tube:
major surgery. An NG typically is in place for 48-72 - To determine which nostril will allow easier access,
hours after surgery, by which time peristalsis usually use a penlight and inspect for a deviated septum or
resumes. other abnormalities.
- Help the patient into High Fowler’s position unless
Purpose of NGT Insertion: contraindicated.
 To feed with fluids when oral intake not possible - Stand at the patient’s right side if you’re right-
 To dilute and remove consumed position handed or at her left side if you left-handed to ease
 To instil ice cold solution to control gastric bleeding insertion
 To prevent stress on operated site by decompressing - Drape the towel or linen-saver pad over the patient’s
 To relieve vomiting and distention chest
- To determine how long the NG tube must be to
 To collect gastric juice for diagnostic purposes.
reach the stomach, the end of the tube at the tip of
the patient’s nose
Assess and Treat:
- Extend the tube to the patient’s earlobe and then
- Upper GI bleeding
down to the xiphoid process
- Collect gastric contents for analysis
- Mark this distance on the tubing with tape.
- Perform gastric lavage
- When the tube reaches the nasopharynx, you’ll feel
- Aspirate gastric secretions
resistance
- Administer medications and nutrients
- Instruct the patient to lower her head slightly to
close the trachea and open the esophagus
Equipment Needed:
- Unless contraindicated, offer the patient a cup of
- Towel or linen-saver pad
water with a straw.
- Water soluble lubricant
- Direct her to sip and swallow as you slowly advance
- Gloves
the tube
- 1” or 2” hypoallergenic tape or opsite
- This helps the tube pass to the esophagus. (If you
- Cup or glass of water with straw (if appropriate)
aren’t using water, ask the patient to swallow)
- Stethoscope
- Tube (usually #12, #14, #16, or #18 French for a
Ensuring Proper Tube Placement
normal adult
- Use a tongue blade and penlight to examine the
- Catheter-tip or bulb syringe
patient’s mouth and throat for signs of a coiled
- Large basin or plastic container
section of tubing
Preparation:
ALERT!
- To ease insertion, increase a stiff tube’s flexibility by
- Persistent gagging – prolonged intubation and
coiling it around your finger for a few seconds or by
stimulation of the gag reflex can result in vomiting
dipping it into warm water
and aspiration.
- Stiffen a limp rubber tube by briefly chilling in in ice
- Coughing may indicate presence of tube in the
airway
Selection of Nasogastric Tube:
 Select the feeding based on the tube’s composition,
Termination of NGT if:
intended use, estimated length of time required,
- Coughing
cost-effectiveness and tube features
- Gagging
 Soft, flexible, small diameter tube (8 FR to 12 Fr) is
- Cyanotic
recommended for nasogastric feeding
 Use Polyurethane or silicone tubes for anticipated
Ask PT if:
long term feeding rather than polyvinylchloride
- Taking blood thinners
tubes
 Polyvinylchloride (PVC) tubes should be used for a
Contraindication:
short period of time usually for gastric drainage, - Hypotensive
decompression, lavage or diagnostic procedures.
 Smaller size feeding tube improves patient comfort.
Common complications associated with the use of
IMPLEMENTATION:
1. Checks physician’s order. Checks hospital
protocol.
2. Explains procedure and purpose to the client.
3. Gathers equipment:
a. NGT Insertion: appropriate size
nasogastric tube, lubricant placed
on sterile gauze or on glove of
nondominant hand, gloves, plaster,
kidney basin, tissues, asepto or bulb
syringe, stethoscope.
b. NGT Removal: clean gloves, tissues,
kidney basin
4. Provides privacy. Closes bed curtains or room
curtains.
5. Positions client in fowler’s position. Places
bath towel across client’s chest. Have client
hold kidney basin or places kidney basin on
bedside table near the client for use in case
of vomiting. Provides tissues to client for
wiping tears or saliva.
NGT Insertion:
6. Washes hands. Wears gloves
7. Checks nares for patency by asking client to
occlude one nostril and breathe normally
through the other. Selects the nostril through
which air passes
8. Measures the length of the tube to be inserted
from tip of client’s nostril to tip of earlobe and
then to tip of xiphoid process. Marks the tube
with tape more easily.
9. Lubricates tip of tube about 3 inches
10. Inserts tube into client’s nostril directing the
tube downward and backward until the mark is
reached.
11. Client may gag when tube reaches the pharynx.
Instructs client to swallow while tube is being
advanced.
12. Discontinues the procedure and removes the
tube if gagging or coughing persists and signs of
distress as gasping, cyanosis and inability to
speak occurs
13. Determines tube placement in the stomach by:
a. Gently introduces a little air into the
tube using the bulb or asepto
syringe and listens for a gurgling
sound with a stethoscope on the
epigastric area.
b. Aspirates for 10 ml of stomach
contents by applying negative
pressure using the bulb or plunger
of the asepto syringe and measuring
pH of aspirated fluids. Re-instills
aspirated fluid afterwards, unless
the aspirated fluid characteristic
appears abnormal (bloody, coffee
ground).
14. Refer for any abnormalities
15. Removes gloves.
16. Secures tube to the tip of the nose using plaster
by:
a. Cuts about 4 inch long of
plaster and splits the bottom 4
inches.
b. Places the unsplit end over the
bridge of the nose.
c. Wraps split ends under the
tubing and up and over the
nose.
17. Secures tube to client’s gown with a tape or pin.
18. Assists client to comfortable position.
NGT Removal
19. Unpins or removes tube from client’s gown.
Removes plaster from client’s nose.
20. Instructs client to take deep breath and hold it.
21. Clamps tube with fingers by folding/doubling
tube on itself.
22. Quickly and carefully pulls out tube while client
holds his breath. Coil the tube around the hand
while removing it.
23. Places tube on kidney basin or disposes
properly.bn
24. Assists in mouth care. Makes client
comfortable.
Post-Procedure:
25. Cleanses equipment. Disposes used supplies.
26. Washes hands.
27. Documents time and date of insertion/removal,
type and size of tube, client’s response,
characteristic and amount of aspirate.