Nasogastric Tube

Insertion, Feeding
and Removal
BY: LUZELLE JOY A. DEMINGOY, RN
 Describe the purposes and
types of GI intubation.

Discuss nursing
OBJECTIVES: management of the patient
who has a nasogastric tube.

Use the nursing process as

AFTER THE a framework for care of the
LECTURE- patient receiving an enteral
DISCUSSION THE feeding.

STUDENTS
Demonstrate the proper
SHOULD BE ABLE
insertion, feeding and
TO: removal according to
nursing standards.
Breaks down food
into nutrients
Chewing breaks
and eliminates the
down food
materials that
-Enzymes then
cannot be
chemically digest
used
food into nutrients

Essential for providing

the body with the energy
and building blocks it
requires to maintain life.
ANATOMY

THE DIGESTIVE
SYSTEM
FUNCTIONS

THE DIGESTIVE
SYSTEM
1 Ingestion.

2 Propulsion.

3 Food breakdown: mechanical digestion.

4 Food breakdown: chemical digestion.

5 Absorption

6 Defecation.
PHYSIOLOGY
UPPER G.I.
THE DIGESTIVE
SYSTEM
 Activities in the Mouth,
Pharynx, and Esophagus

Food Ingestion and

1 Breakdown

Food Propulsion –
2 Swallowing and
Peristalsis
 Activities in the Mouth,
Pharynx, and Esophagus
1 Food Ingestion and Breakdown

Physical breakdown.

Chewing
Passageways.
Chemical breakdown.
P and E
Salivary amylase - starch - maltose

Stimulation of saliva.
Larger amounts of saliva pour out
PHYSIOLOGY
UPPER G.I.
THE DIGESTIVE
SYSTEM
 Activities in the Mouth,
Pharynx, and Esophagus
2 Food Propulsion – Swallowing and Peristalsis

Deglutition. Food routes. .

Distal routes are blocked
Swallowing *Tongue
*Soft Palate
Buccal phase of deglutition.
*Epiglottis
Voluntary
Stomach entrance.
Pharyngeal-esophageal phase. Cardioesophageal sphincter
Involuntary
Activities of the Stomach
1 Food Breakdown

2 Food Propulsion
Activities of the Stomach
1 Food Breakdown

Gastric Juice Food entry.

*Neural and hormonal factors. *Stomach wall begins to stretch
*Gastric Juice released

Pepsinogen.
*hydrochloric acid - activates Stomach wall activation.
pepsinogen to pepsin
* Three muscle layers activated
*Active protein-digesting enzyme
*Pummel the food
* Mixing the food with the enzyme-
containing gastric juice = semifluid
Rennin. chyme
*Protein-digesting enzyme
*Milk protein
Activities of the Stomach
2 Food Propulsion

Peristalsis.
begins in the upper half of the
stomach

Pyloric passage.
*Pylorus - 30ml Chyme
*Only liquids and very small particles

Enterogastric reflex.
*Duodenum
*“Puts the brakes on”
DEFINITION

GASTOINTESTINAL
INTUBATION
GASTOINTESTINAL
INTUBATION
Insertion of a rubber or plastic
tube into the stomach,
duodenum or the intestine.
May be inserted through the
mouth, the nose, or the
abdominal wall
TYPES OF G.I
TUBES
GASTOINTESTINAL
INTUBATION
NASOGASTRIC
TUBES

NASODUODENAL
TUBES

NASOENTERIC
TUBES
NASODUODENAL
TUBE
GASTOINTESTINAL
INTUBATION
NASODUODENAL
TUBES
Long-term
NO BOLUS FEEDING

Slow feeding titration

Guided insertion -
preferred
DO NOT decrease the feed
rate based on gastric
residual volumes
NASODUODENAL
TUBES
NASOJEJUNAL
TUBE
GASTOINTESTINAL
INTUBATION
 NASOJEJUNAL
TUBES

Dual purpose tube

For short term gastric
decompression and jejunal
feeding/medicating
With Endoscopy and/or
Fluoroscopy
Unique hollow bolus weighted tip
NASOJEJUNAL
TUBES
TYPES OF NGT

GASTOINTESTINAL
INTUBATION
NASOGASTRIC TUBE TYPES
COMMON BRANDS
OF NGT

GASTOINTESTINAL
INTUBATION
 COMMON BRANDS

D R YL E S
I TE CH PO L Y M E
SU RG S IM PL EX LEVIN

SALEM SUMP SENGSTAKEN BLAKEMORE MOSS

INDICATIONS

GASTOINTESTINAL
INTUBATION
 INDICATIONS:
DRAINING TOXIC
DECOMPRESS
INGESTION

NUTRITION DYSPHAGIA
GASTROPARESIS

MEDICATION HEAD NECK SMALL BOWEL

TRAUMA OBSTRUCTION

I.B.D. UPPER GI
DIAGNOSTIC
BLEEDING

ALTERED E.T.
MENTAL INTUBATION G.I. SURGERY
STATUS
CONTRAINDICATIONS

GASTOINTESTINAL
INTUBATION
CONTRAINDICATIONS
RECENT NASAL
COAGULOPATHY
SURGERY

SINUSITIS ESOPHAGIAL
VARICES

FACE TRAUMA ALKALINE

INGESTION

DEVIATED DEVIATED
SEPTUM SEPTUM

ESOPHAGEAL ESOPHAGEAL
SURGERY SURGERY
POSSIBLE RISKS

GASTOINTESTINAL
INTUBATION
POSSIBLE RISKS
ASPIRATION CRAMPING DISLODGEMENT

DISCOMFORT SWELLING BLOCKAGE

TRAUMA REGURGITATION SINUSITIS

WRONG DIARRHEA ULCERATION

PLACEMENT

ALTERED TEAR INFECTION

MENTAL
STATUS
POSSIBLE
COMPLICATIONS

GASTOINTESTINAL
INTUBATION
POSSIBLE COMPLICATIONS
Epistaxis Hyperglycemia

Perforation of
cribriform Otitis Media
plate

Esophageal Esophageal
perforation ulcers

Dumping
Pneumothorax
Syndrome

Pulmonary Cranial
intubation Intubation
POSSIBLE COMPLICATIONS
DEFINITION

NGT
INSERTION
DEFINITION

REFERS TO PLACING A TUBE THROUGH

ONE SIDE OF THE NOSE, PASSING
THROUGH THE NASOPHARYNX INTO THE
ESOPHAGUS AND FINALLY INTO THE
STOMACH
INDICATION

NGT
INSERTION
INDICATIONS:
TO ESTABLISH A METHOD FOR DRAINING THE
STOMACH OR INTESTINES
INTERVENE IN PRE-EXISTING OR IMPENDING
NUTRITIONAL DEPLETION
FOR DIAGNOSTIC PROCEDURES/PURPOSES
DECOMPRESS THE STOMACH BEFORE AND AFTER
SURGERY
TO MAINTAIN FLUIDS AND ELECTROLYTES
ROLE OF A
NURSE
NGT
INSERTION
ROLE OF A NURSE
INFORM ABOUT THE PURPOSE
DESCRIBE THE SENSATION
CONFIRM THE ORDER
CONFIRM THE PLACEMENT
MONITOR AND MAINTAIN TUBE FUNCTION
MONITOR FOR POTENTIAL COMPLICATIONS
ORAL AND NASAL HYGIENE
HOW TO CHECK
PLACEMENT
NURSING
MANAGEMENT
CHEST X-RAY - GOLD STANDARD
PLACE A STETHOSCOPE OVER THE
PATIENT’S EPIGASTRUM

SYRINGE TEST

PH TEST
ASK THE PATIENT TO HUM OR TALK
LOWER THE OPEN END OF THE NG
TUBE INTO A CUP OF WATER
NGT FEEDING

NURSING
MANAGEMENT
FEEDINGS ARE GIVEN TO MEET NUTRITIONAL
REQUIREMENTS WHEN ORAL INTAKE IS INADEQUTE
OR NOT POSSIBLE AND THE GI TRACT IS
FUNCTIONING NORMALLY.

DELIVERED TO THE STOMACH OR TO THE DISTAL

DUODENUM OR PROXIMAL JEJUNUM.
INDICATIONS:
TO RESTORE OR MAINTAIN NUTRITIONAL STATUS

ADMINISTER MEDICATIONS
ROLE OF NURSE
TEMPERATURE AND VOLUME OF THE FEEDING
THE FLOW RATE, AND THE TOTAL FLUID INTAKE

MAINTAIN THE SCHEDULE OF TUBE FEEDINGS,

INCLUDING THE QUANTITY AND FREQUENCY.
TO ENSURE PATENCY; REGULAR FLUSHING OF TUBE
DECREASE THE CHANCE OF BACTERIAL GROWTH,
CRUSTING, OR OCCLUSION OF THE TUBE
FEEDING
PREPARATION
NURSING
MANAGEMENT
CHECK THE EXPIRATION DATE.
ALLOW THE FORMULA TO REACH ROOM
TEMPERATURE BEFORE USE.
SHAKE THE CAN THOROUGHLY
FOR POWDERED FORMULA, MIX ACCORDING TO THE
INSTRUCTIONS ON THE PACKAGE. PREPARE JUST
ENOUGH FOR THE NEXT 24 HOURS AND
REFRIGERATE UNUSED FORMULA.
VERIFY DOCTORS ORDER
NGT REMOVAL

NURSING
MANAGEMENT
THE REMOVAL OF TUBE DONE ONCE THE REASON
FOR THE NASOGASTRIC TUBE HAS BEEN RESOLVED
AND THE PHYSICIAN ORDERS THE TUBE TO BE
REMOVED.
ROLE OF NURSE
FACILITATE REMOVAL AND CHECK DOCTORS ORDER

ASSESS FOR BOWEL SOUNDS

CHECK FOR INTACTNESS OF THE TUBE

PROPER DOCUMENTATION
RECORD DATE OF REMOVAL OF NASOGASTRIC
TUBE.
RECORD CLIENT’S RESPONSE.
RECORD MEASUREMENT OF DRAINAGE.