NGT INSERTION

1. How to insert ngt

- Check order
- cHECK nares of nose
- Measure xiphoid process kineme
- Lubricate
- Pasok
- To check for placement, lagay ng air, tas check thru auscultation tas dapat
may gurgling sound
- Tip of nose to earlobe then to xiphoid process (this will be the mark na hanggang
doon tayo mag insert)
- Check for patency by introducing air using asepto syringe, checking for gastric
contents or gastric aspiration, ph monitoring, submerge ngt to water; monitor
bubbling at the end of the tube, x ray is confirmatory or gold standard
- then anchor sa px if patent
- HOW TO DRAIN NGT:
- iV empty bottle ilagay doon ang tip, check for backflow or kung ano
lumalabas sa tube (if bago lang ngt, usually yellowish or whitish kasi
gastric contents pa ito; THIS IS THE NORMAL JUD, if coffee ground
output, possible for bleeding; need to drain, if bilious or greenish or dark
green - bile yon, bloody output, fecaloid or expect fecal matter, meaning
baka may bowel obstruction or blockage sa loob)
- What to instruct patient; instruct to sip and swallow water (sir mag insert
nako ngt, pag pasok ko, magtulon pud ka (if wala water, pwede laway
nalang)) — para wala resistance sa pag insert
- IV bolus - meaning single dose of a drug or other substance given over a
short period of time; kunwari may omeprazole na 80mg - ito muna ibigay
direct thru vein (loading dose) tas after, doon ka na mag bigay ng
maintenance dose or yung iv therapy

CATHETERIZATION
1. States the purpose of the procedure.
To monitor urinary function,prevent or
relieve bladder distention and provide a
means for irrigating the bladder with
fluids or medication.

2. Check the Physician’s order. Prevents potential errors.

3. Greets the client and introduces self. To gain trust of the client.

4. Identifies clients using two Which facilitates the procedure and is

identifiers. more comfortable for client.
 5. Explains the procedure to the client. Information facilitates acceptance and
compliance in the therapy.

6. Performs hand hygiene. Prevents transmission of

microorganisms.

7. Provides for client privacy. Preserves the client’s dignity.

8. Assessment: Allows you to clarify misunderstandings

8.1 Determines the most appropriate and promotes patient cooperation.
method of catheterization based on
the purpose.

9. Preparation: The materials in the kit are arranged in

9.1 If using a catheterization kit, read the sequence of use.
label carefully to ensure that all
necessary items are included.

9.2 Dons cleans gloves and performs Reduces microorganisms near urethral
routine perineal care. meatus and allows further opportunity to
visualize perineum and landmarks.

9.3 Locates the urinary meatus relative to Allows for visualization of the urinary
surrounding structures (for women). meatus.

9.3 Remove and discard gloves. Prevents transmission of

microorganisms.

9.4. Performs hand hygiene. To reduce the number of

microorganisms.
 10. Places the client in the appropriate The drape provides a large sterile field.
position and drape all areas except
the perineum.

Female: Supine with knees

flexed, feet about 2 feet
apart, and hips slightly

externally rotated, if
possible.
Male: Supine, thighs slightly
abducted or apart.

11. Establishes adequate lighting. Adequate lighting and correct positioning

Stands on the client’s right if are crucial for clear visualization of the
right-handed, on the client’s left urinary meatus.
left-handed.

12. Opens the drainage package and Prepares system for eventual connection
places the end of the tubing within with catheter.
reach.

13. If agency policy permits, dons Xylocaine Jelly are used to stop pain
gloves and inject 10-15mL of and used to ease pain from skin
Xylocaine gel into the urethra of irritations.
the male client. Wipe the underside
of the penile shaft to distribute the
gel up to the urethra and wait at
least 5 minutes for the gel to take
effect before inserting the catheter.

14. Removes and discards gloves. To prevent transmission of micro

organisms.

14.1 Performs hand hygiene. To reduce number of microorganisms.

15. Opens catheterization kit To create environment to prevent the

observing sterile technique. transfer of microorganisms during sterile
procedures.

16. Places a waterproof drape under the Maintains aseptic techniques during
buttocks for female and under penis for procedure.
male without contaminating the center of
the drape with your hands
 17. Dons sterile gloves. To prevent transmission of
microorganisms.

18. Organizes the remaining supplies: Retains sterility of inside of container

18.1. Remove specimen container and and prevents spillage of urine.
place it nearby with the lid loosely on top.

18.2 Opens lubricant package.

18. 3 Soaks cotton balls with antiseptic Maintains principles of surgical asepsis
solution. and organizes work area.

19. Attaches a prefilled syringe to the Note: Pretesting of balloon is no longer

indwelling catheter hub and pretest recommended because catheters are
the balloon. pretested during manufacturing and
inflation may distort the balloon leading
to increased trauma(Smith, 2006)

20. Lubricates the catheter 2.5cm-5cm Makes insertion of the catheter by

for females, 15 cm-17.5cm for males, decreasing friction.
and place it with the drainage end
inside the collection container.

21. Places the fenestrated drape over the Avoids unnecessary exposure of body
perineum, exposing the urinary meatus. parts and maintains patient’s comfort.

22. Cleanses the meatus:

22.1 Female:

22.1a. Uses a non-dominant hand to Full retraction prevents contamination of

spread the labia to expose meatus. urethral meatus during cleansing.

22.1b. Establishes firm but gentle Maintain position of non dominant hand
pressure on the labia. throughout procedure.

22.1c. Holds a cleansing ball with the Cleansing reduces number of

forceps in your dominant hand. microorganisms at urethral meatus.
 22.1d. Wipes side of the labia majora Cleansing for each of the three areas
one at a time with different cleansing proceeds from area of least
contamination to that most
ball in an anteroposterior contamination.
direction. Repeats for the labia
minora.

22.1e Uses the last cleansing ball to Use of single cotton for each wipe
cleanse directly over the meatus. prevents transfer of microorganisms.

22.2 Male

22.2a. Uses non-dominant hand to Straightens urethral canal to ease

grasp the penis just below the glans. catheter insertion.

22.2b. Holds the penis firmly upright Relaxation of urethral sphincter and
with slight tension. pelvic floor aids in insertion of catheter.

22.2c. Holds a cleansing ball with the Cleansing reduces number of

forceps in dominant hand. microorganisms at urethral canal.

22.2d. Wipes from the Cleansing for each of the three areas
center of the proceeds from area of least
meatus in the contamination to that most
circular motion contamination.
around the glans.
Uses a new
cleansing ball and
repeat three more
times.

23. Inserts the catheter:

23.1. Grasps the catheter Relaxation of urethral sphincter and

firmly 5cm-7.5cm from the pelvic floor aids in insertion of catheter
tip. Asks the client to take a
slow deep breath and insert
the catheter as the client
exhales. Slight resistance is
expected as the catheter
passes through the
sphincter.

22.2 Advances the catheter 5cm Appearance of urine indicates that the
farther after the urine begins catheter tip is in bladder or lower
to flow through it. urethra.Further advancement of
catheter ensures bladder placement.
 24. Holds the catheter with the
non-dominant hand.

25. Inflates the retention balloon with Catheter may be expelled accidentally
the designated volume. by bladder or sphincter contraction.
25.1 Without releasing
the catheter holds the
inflation valve between two
fingers of non-dominant hand
while attaching the syringe.

25.2 Inflates with Inflation of balloon anchors the catheter

dominant hand. If the client tip in place above the bladder outlet to
complains discomfort, prevent the catheter’s removal.
immediately withdraw the
instilled fluid, advance the
catheter farther, and attempt
to inflate the balloon again.

25.3 Pulls gently on the If resistance is felt, the catheter balloon

catheter until resistance is is properly inflated in the bladder.
felt to ensure that the balloon
has inflated and to place it in
the trigone of the bladder.

26. Collects urine specimen if

needed.
Note: As always, you should monitor the
Straight catheter. Allow 20-30mL. to flow client’s condition; if the vital signs
into the bottle without touching the catheter change or bleeding occurs, temporarily
to the bottle. Allows the remaining urine to stop the flow of urine and continue when
continue draining into the urine receptacle. the client’s condition warrants
In some cases, only 750-1,000mL. of urine
are to be drained from the bladder at one
time. Removes the straight catheter when
urine flow stops. Indwelling catheter.
Pre-attached to a drainage bag, a specimen
may be taken from the bag this initial time Allows sterile specimen to be obtained
only. for culture analysis.

27. Attaches the drainage end of an Attaching to the bed frame prevents
indwelling catheter to the accidental pulling of the catheter.
collecting tubing and bag.
 28. Examines and measures the It might contain infectious organisms.
urine.

29. Secures the catheter tubing to Anchoring the catheter to the lower
the thigh for female clients or to abdomen reduces pressure on the
the upper thigh or lower urethra, thus reducing the possibility of
abdomen for male clients to tissue injury.
prevent movement on the urethra
or excessive tension or pulling on
the retention balloon.

30. Hang the bag below the level of In-dwelling catheters the bladder by
the bladder. No tubing should fall gravity.
below the top of the bag.

31. Wipes any remaining antiseptic or Cleaning protects the area from
lubricant from the perineal area. contamination.
Replaces the foreskin if retracted
earlier.

32. Place the client to a comfortable Provides for client comfort.

position. Instruct the client on
positioning and moving with the
catheter in place.

33. Discards all used supplies in the Reduces transmission of

appropriate receptacle. microorganisms.

34. Remove and discard gloves. Reduces transmission of

microorganisms.

35. Performs hand hygiene. Reduces transmission of

microorganisms.

36. Documents the catheterization Maintains legal record and

procedure including size and communicates with members of health
relevant findings. care team