nasogastric tube by lawrence aninag

NASOGASTRIC TUBENASOGASTRIC TUBE

Nasogastric intubationNasogastric intubation is a medical is a medical process involving the insertion of a plastic process involving the insertion of a plastic tube (tube (nasogastric tube,nasogastric tube, NG tubeNG tube) ) through the nose, past the throat, and through the nose, past the throat, and down into the stomach.down into the stomach.

BRIEF HISTORYBRIEF HISTORY

Fabricius ab Fabricius ab Aquapendente, who Aquapendente, who was born in Italy in was born in Italy in 1537 and died in 1537 and died in 1619, was a 1619, was a professor of professor of anatomy and anatomy and surgery (silver tube)surgery (silver tube)

BRIEF HISTORYBRIEF HISTORY

1790 that John 1790 that John Hunter successfully Hunter successfully fed a patient via a fed a patient via a flexible hollow flexible hollow leather tube leather tube inserted into the inserted into the stomach(tube was stomach(tube was made of eel skin)made of eel skin)

BRIEF HISTORYBRIEF HISTORY

Nasogastric tubes Nasogastric tubes were used first in were used first in humans for the humans for the sole purpose of sole purpose of administering administering nutritionnutrition

In 1800, Philip In 1800, Philip Physick, a surgeon Physick, a surgeon from Philadelphia, from Philadelphia, started to started to advocate in his advocate in his lectures the use of lectures the use of a stomach tube as a stomach tube as a form of stomach a form of stomach pump.pump.

BRIEF HISTORYBRIEF HISTORY

In 1822, Mr. Jukes, an English In 1822, Mr. Jukes, an English surgeon, published a description of surgeon, published a description of what he called "a stomach pump"what he called "a stomach pump"

BRIEF HISTORYBRIEF HISTORY

In 1921, the Levin In 1921, the Levin tube was introduced; tube was introduced; this flexible this flexible nasogastric tube was nasogastric tube was made of rubbermade of rubber

BRIEF HISTORYBRIEF HISTORY

In 1822, Mr. Jukes, an English In 1822, Mr. Jukes, an English surgeon, published a description of surgeon, published a description of what he called "a stomach pump"what he called "a stomach pump"

The improvement of acute care The improvement of acute care techniques eventually led to techniques eventually led to improved patient survival and many improved patient survival and many more people requiring nutritional more people requiring nutritional support, and this resulted in the support, and this resulted in the practical beginnings of modern practical beginnings of modern enteral nutrition enteral nutrition

BRIEF HISTORYBRIEF HISTORY

NASOGASTRIC TUBENASOGASTRIC TUBE

TYPES OF PROCEDURESTYPES OF PROCEDURES

GASTRIC GAVAGEGASTRIC GAVAGE

GASTRIC LAVAGEGASTRIC LAVAGE

INTRACRANIAL NGTINTRACRANIAL NGT

IndicationsIndications

Diagnostic Diagnostic – Evaluation of upper gastrointestinal (GI) Evaluation of upper gastrointestinal (GI)

bleed (ie, presence, volume) bleed (ie, presence, volume) – Aspiration of gastric fluid content Aspiration of gastric fluid content – Identification of the esophagus and Identification of the esophagus and

stomach on a chest radiographstomach on a chest radiograph– Administration of radiographic contrast Administration of radiographic contrast

to the GI tract to the GI tract

IndicationsIndications

TherapeuticTherapeutic– Gastric decompression, including maintenance Gastric decompression, including maintenance

of a decompressed state after endotracheal of a decompressed state after endotracheal intubation, often via the oropharynx intubation, often via the oropharynx

– Relief of symptoms and bowel rest in the setting Relief of symptoms and bowel rest in the setting of small-bowel obstructionof small-bowel obstruction

– Aspiration of gastric content from recent Aspiration of gastric content from recent ingestion of toxic material ingestion of toxic material

– Administration of medication Administration of medication – Feeding Feeding – Bowel irrigationBowel irrigation

ContraindicationsContraindications

Absolute contraindications Absolute contraindications – Severe midface trauma Severe midface trauma – Recent nasal surgeryRecent nasal surgery

Relative contraindications Relative contraindications – Coagulation abnormality Coagulation abnormality – Esophageal varices or stricture Esophageal varices or stricture – Recent banding or cautery of Recent banding or cautery of

esophageal varices esophageal varices – Alkaline ingestionAlkaline ingestion

EQUIPMENTSEQUIPMENTS

TYPES OF NASOGASTRIC TYPES OF NASOGASTRIC TUBESTUBES

The Levin Tube -The Levin Tube -is a one-lumen nasogastric is a one-lumen nasogastric tube tube

TYPES OF NASOGASTRIC TYPES OF NASOGASTRIC TUBESTUBES

The Salem-Sump Tube.The Salem-Sump Tube.

This tube is a two-lumen This tube is a two-lumen piece of equipment.piece of equipment.

It has a drainage lumen and a It has a drainage lumen and a smaller secondary tube smaller secondary tube that is open to the that is open to the atmosphere. atmosphere.

TYPES OF NASOGASTRIC TYPES OF NASOGASTRIC TUBESTUBES

The Miller-Abbott Tube.The Miller-Abbott Tube.

This tube is also a two-lumen This tube is also a two-lumen nasogastric tube. nasogastric tube.

There is a rubber balloon at There is a rubber balloon at the tip of one tube; the the tip of one tube; the other tube has holes near other tube has holes near its tip. its tip.

TYPES OF NASOGASTRIC TYPES OF NASOGASTRIC TUBESTUBES

The Cantor Tube -The Cantor Tube - has one lumen and a bag has one lumen and a bag on the end. on the end.

SIZESSIZES

Adult - 16-18FAdult - 16-18F

Pediatric - In pediatric patients, the Pediatric - In pediatric patients, the correct tube size varies with the correct tube size varies with the patient’s age. patient’s age.

Size FG-8 FG-10 FG-12 FG-14 FG-16 FG-18 FG-20

Colour Code Blue Black White Green Orange Red Yellow

Infection ControlInfection Control

Hand WashingHand Washing Wear a set of glovesWear a set of gloves Wearing face and eye protectionWearing face and eye protection Wear disposable apron. Wear disposable apron.

IMPLEMENTATIONIMPLEMENTATION

Verify for physician order.Verify for physician order. Identify Client & Introduce yourselfIdentify Client & Introduce yourself Explain the procedureExplain the procedure Assemble the Materials neededAssemble the Materials needed

NURSING RESPONSIBILITYNURSING RESPONSIBILITY

Inserting and removing the tubeInserting and removing the tube Assessing correct placementAssessing correct placement Securing the tubeSecuring the tube Meeting patient comfort needsMeeting patient comfort needs Monitoring patient responses Monitoring patient responses

IMPLEMENTATIONIMPLEMENTATION

Explain the procedure, benefits, risks, Explain the procedure, benefits, risks, complications, and alternatives to complications, and alternatives to the patient or the patient's the patient or the patient's representative. representative.

Examine the patient’s nostril for septal Examine the patient’s nostril for septal deviation. To determine which nostril deviation. To determine which nostril is more patent, ask the patient to is more patent, ask the patient to occlude each nostril and breathe occlude each nostril and breathe through the other. through the other.

POSITIONPOSITION Position the patient in a High Fowler’s Position the patient in a High Fowler’s

position.position.

AdultAdult

– – Measure from Measure from the tip of the the tip of the nose, around the nose, around the ear, and down to ear, and down to the xyphoid the xyphoid process.process.

MEASUREMENTMEASUREMENT

InfantInfant

– – Measure from Measure from the tip of the the tip of the nose, around the nose, around the ear and down to ear and down to the umbilicus. the umbilicus.

MEASUREMENTMEASUREMENT

INSERTIONINSERTION

Lubricate the distal end of the TubeLubricate the distal end of the Tube

INSERTIONINSERTION

Instruct the Patient to drink while Instruct the Patient to drink while the tube is insertedthe tube is inserted

Auscultation of air Auscultation of air insufflated through insufflated through the tubethe tube

CHECKING FOR PLACEMENTCHECKING FOR PLACEMENT

Immersion of the Immersion of the Proximal end of in a Proximal end of in a glass of water.glass of water.

Aspiration of fluid from the tube, with Aspiration of fluid from the tube, with pH testing of the aspirate. pH testing of the aspirate. pH pH << 5 – GIT 5 – GIT

pH pH >> 6 - Respiratory 6 - Respiratory

CHECKING FOR PLACEMENTCHECKING FOR PLACEMENT

Chest X-rayChest X-ray

CHECKING FOR PLACEMENTCHECKING FOR PLACEMENT

NG OPTIMIZERNG OPTIMIZER

SECURE THE NG TUBESECURE THE NG TUBE Anchor the tube securely to the nose and Anchor the tube securely to the nose and

cheek - keeping it out of the patients field cheek - keeping it out of the patients field of vision. of vision.

COMPLICATIONSCOMPLICATIONS

Minor complicationsMinor complications

- Nose Bleeds,Sinusitis, and sore throat- Nose Bleeds,Sinusitis, and sore throat

More significant complicationsMore significant complications

- Erosion of the nose where the tube is - Erosion of the nose where the tube is anchored, esophageal perforation, anchored, esophageal perforation, pulmonary aspiration, a collapsed lung, or pulmonary aspiration, a collapsed lung, or intracranial placement of the tube.intracranial placement of the tube.

INTRACRANIAL PLACEMENT OF INTRACRANIAL PLACEMENT OF THE TUBETHE TUBE

Inadvertent Intracranial Placement of Inadvertent Intracranial Placement of a Nasogastric Tube in a Patient With a Nasogastric Tube in a Patient With Severe Craniofacial Trauma Severe Craniofacial Trauma

INTRACRANIAL PLACEMENT OF THE TUBEINTRACRANIAL PLACEMENT OF THE TUBE

INTRACRANIAL PLACEMENT OF THE TUBEINTRACRANIAL PLACEMENT OF THE TUBE

INTRACRANIAL PLACEMENT OF THE TUBEINTRACRANIAL PLACEMENT OF THE TUBE

INTRACRANIAL PLACEMENT OF THE TUBEINTRACRANIAL PLACEMENT OF THE TUBE

INTRACRANIAL PLACEMENT OF THE TUBEINTRACRANIAL PLACEMENT OF THE TUBE

Complications include:

- Hemiparesis- Intracranial bleeding- Decerebrate posturing- Respiratory arrest- Suctioning of brain parenchyma- Blindness- Loss of the sense of smell- Meningitis- Decreased mental status- Persistent cerebrospinal fluid fistula.

INTRACRANIAL PLACEMENT OF THE TUBEINTRACRANIAL PLACEMENT OF THE TUBE

35 cases of intracranial nasogastric tube insertion have been reported in the international literature.

A complex craniofacial fracture is the most common predisposing factor.

Mortality rate of 64%.

Decerebrate PosturingDecerebrate Posturing

Decerebrate PosturingDecerebrate Posturing

DOCUMENTATIONDOCUMENTATION

Date and time of procedureDate and time of procedure Indication for insertionIndication for insertion Type of tube usedType of tube used Distance tube inserted (if appropriate)Distance tube inserted (if appropriate) The nature of the aspirateThe nature of the aspirate Methods used to check location of the tube Methods used to check location of the tube

insertioninsertion Any procedural comments Any procedural comments