nasogastric intubation

Nasogastric Intubation

Dr.Efman.E.U.Manawan Mkes.,SpB-KBD

GI Tract

•Oral cavity•Pharynx•Esophagus•Stomach

•Small Intestine•Large Intestine•Accessory Structures

Medical NCO Course

The Gastrointestinal System The Oral Cavity • Chemical digestion• Mechanical digestion

Esophagus • Peristaltic waves

Esophagus:

•Muscular canal

•About 24 cm long

•Extends from pharynx to stomach

Stomach

Structure• Layered muscular tube• Lined with mucous

membranes•Contains gastric glands

Small Intestine•Begins at pyloric sphincter•Coils through abdominal cavity•Opens into large intestine

Gallbladder

•Secretes and stores bile produced by the liver

Pancreas

•Gland •12-15 cm (5-6 in) long•2.2 cm (1 in) thick•Posterior to the

stomach•Connected to

duodenum by 2 ducts

Pancreas•Exocrine gland•Secretes pancreatic juice

•Endocrine gland•Secretes hormones (insulin) into blood•Cells need insulin to process glucose

Pancreas•Pancreatic juice•Most important digestive juice•Contains digestive enzymes, sodium bicarbonate and alkaline substances•Neutralizes HCl in juices entering small intestine

Nasogastric Intubation

NG Tube Indications

•Aspirate stomach contents• Diagnostic or

therapeutic

•Assessment of GI bleeding•Determine gastric acid content

NG Tube Indications•Treat paralytic ileus •Treat intestinal obstruction•Recurrent vomiting likely•Trauma•Overdose

NG Tube Contraindications•Esophageal strictures•Alkali ingestion, caustic ingestions, esophageal burns•Comatose patients

NG Tube Contraindications•Trauma patients with:•Cervical or intracranial bleeding• Increased intracranial pressure

•Recent surgery of the following types:•Oropharyngeal•Nasal•Gastric

Inserting NG Tube•Explain procedure•Position patient•High Fowler if alert•Drape•Emesis basin•Water and straw

Inserting NG Tube•Unconscious patient• Left lateral position •Head turned to downward side•Gag and cough reflexes absent or suppressed•NG tube easily misplaced (lung)• Inability to swallow

Inserting NG Tube•Check nares for patency•Select appropriate tube size•Determine length of insertion•Tip of nose, to ear, to

xiphoid process•Mark tube

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Inserting NG Tube•Lubricate tube • Lubricant must be water-soluble•May use topical anesthetic if available (ie,

lidocaine)•Coil tube to shape it into curve•Have patient hold water and straw to mouth

Inserting NG Tube• Insert tube• Along floor of nose• Straight back• Advance until

resistance felt (nasopharynx)

Inserting NG TubeAsk patient to swallow sips of water and flex neck slightly.

As patient swallows, advance tube into and down esophagus.

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Inserting NG Tube

•When tube is in the esophagus:•Advance rapidly to the pre-marked distance

Excessive choking, gagging, coughing, change in voice or condensation inside the tube indicates possibility of placement in trachea. The tube should be withdrawn.

Confirm NG Tube Placement•X-ray•Most reliable if tube is radiopaque•Requires order from physician

•Injecting air•60 cc catheter syringe•Place stethoscope over LUQ of abdomen• Inject air into lumen of tube, NOT blue pigtail• Listen for “swoosh” sound

Confirm NG Tube Placement•Aspirate stomach contents•60 cc catheter tip syringe •Pull back to check for gastric aspirate•Possibility for fluid to be from lungs or pleural space

Confirm NG Tube Placement•Test pH of gastric aspirate•60 cc catheter-tip syringe and pH paper•pH < 4 = 95% chance that tip is in stomach•pH > 6 = may be in lung or pleural space; could be in stomach if patient takes antacids or some medications

Confirm NG Tube Placement•Non-radiopaque methods•Possibility of error•Use more than one method •Passage into lungs frequent; especially in

comatose or demented patients•Aspiration of gastric contents more reliable• Especially if tested with pH paper

Securing the Tube•Secure to patient’s nose•Tape to nose and coil

around tube•Avoid pressure to nares•Secure to patient’s

clothing near shoulder area•Blue pigtail must be

above level of patient’s stomach

Complications Excessive coughing, motion, gagging may

aggravate the following:•Neck injuries• Increased risk for C-spine injuries

•Penetrating neck wounds•May increase hemorrhage

•Tube misplacement•Pulmonary• Intracranial

Removing NG Tube•Disconnect from drainage container and suction (if applicable)•Attach syringe-tip catheter to lumen of tube•Flush tube with 20cc of air•Empties contents from tube to prevent aspiration

into lungs

Removing NG Tube•Remove tape from patient’s nose •Unpin tube from gown•Have patient take deep breath and hold while tube is removed•Pull tube with quick and steady motion•Discard appropriately•Provide or instruct patient on oral and nasal care