nasogastric tube

NASOGASTRIC TUBE

Purposes

1. To decompress stomach by removing fluids and/or gas to promote abdominal comfort2. To allow surgical anastamoses to heal without distention3. To decrease risk of aspiration4. To administer medications to clients who are unable to swallow5. To provide nutrition by acting as a temporary feeding tube6. To irrigate the stomach and remove toxic substances, such as poisoning

Place patient in a High Fowlers positionMeasure: NEX (usually 22-26 inches for adults)

plus 2 inches for tall patients. Lubricate with water solubleAsk the client to hyperextend the neck,

advancing the tube toward the nasopharynx Instruct client to tilt the head forward when the

tube is felt in the oropharynx(throat)Offer small sips of water from a glass with straw

and encourage to swallowStop if the patient gags, wait for few min.

before proceedingWithdraw if gagging continuesAssess for correct placement by:

Check pH: should be less than 4.0Inserting 5-10 ml of air into a stethoscope

placed over the stomach and listen for a swooshing sound

Taking X-ray: MOST RELIABLE METHODSecure tube to the bridge of the nose with tape

and to the gown

INSERTION

Usually up to 2 weeks use only (short term)

Clean but not sterile procedure

Mouth care neededReport coffee ground material (digested blood)

Check for placement and patency

Clamp tube when ambulating

Key points

Hold feeding if >50% residual from previous hour (adults) or >25% (children)

Flush tube with water before and after feeding

Use pump to control rate of tube feedingAdminister fluid at room temperatureChange bag Q8 hours for continuous feeding

Elevate head of bed while feeding is running

Check patency Q4 hoursGood mouth care

Nasogastric Tubes:

Linton-Nachlas—4-lumen, used for bleeding esophageal varices

Keofeed/Dobhoff—soft silicone, used for long-term feedings

Purpose Example of Use

Key Points

LEVIN TUBE

- Single lumen

Inserted into stomach to decompress by removing gastric contents and air Used for feeding when unable to swallow

Any abdominal or other sx after which peristalsis is absent for a few days GI hemorrhage CA of the esophagus Early post-op for pt who had laryngectomy or radical neck dissection

Low intermittent suction Irrigate prn with NSS

Purpose Example of Use

Key Points

SALEM – SUMP

- Double lumen air vented tube to provide constant inflow of athmos-pheric air, and to protect gastric mucosa from trauma of suctioning

Gastric decompression with continuous suction

Same as levin tube

•With continuous suction (25mmHg)•If leak occurs in the vent (blue tubing), instill 30 ml air into vent and irrigate main with NSS.•Do not clamp vent

NG Irrigation Tubing: Verify placement of tubeInsert 30-50 cc of normal saline into tubeIf feel resistance, change patient position, check for kinks

Withdraw solution or record amount as input

NG removal:Clamp tubeRemove tapeInstruct patient to exhaleRemove tube with smooth, continuous pull

Purpose Example of Use

Key Points

LAVACUATOR

• Orogastric w/ large suction lumen and smaller lavage vent• Removes toxic substances from stomach

Ingestion of poison

• Continuous suction• Irrigation solution enters the lavage lumen while stomach contents are removed through the suction lumen

LAVAGE TUBES

What is the position of the patient when inserting the NGT?Low Fowler’s positionSemi-Fowler’s positionTrendelenberg position

High Fowler’s position

What is the position of the patient when inserting the NGT?Low Fowler’s positionSemi-Fowler’s positionTrendelenberg position

High Fowler’s position

Rationale: D – Nurse Quick Check Skills 320

How do you measure the length of the NGT before inserting it to the patient?From the earlobe to the xiphoid process to the tip of the nose

From the xiphoid process to the tip of the nose to the earlobe

From the tip of the nose to the xiphoid process to the earlobe

From the tip of the nose to the earlobe to the xiphoid process

How do you measure the length of the NGT before inserting it to the patient?From the earlobe to the xiphoid process

to the tip of the noseFrom the xiphoid process to the tip of

the nose to the earlobeFrom the tip of the nose to the xiphoid

process to the earlobeFrom the tip of the nose to the earlobe

to the xiphoid process

Rationale: D – Nurse Quick Check Skills 320

What is the initial thing to do when administering a drug to a client with NGT?Wash your handsPut on glovesVerify the orderExplain the procedure the client

What is the initial thing to do when administering a drug to a client with NGT?Wash your handsPut on glovesVerify the orderExplain the procedure the client

Rationale: C – Nurse Quick Check Skills 318

What is the important thing that you should advice a client when inserting the NGT?Don’t moveHold your breatheSwallowCough

What is the important thing that you should advice a client when inserting the NGT?Don’t moveHold your breatheSwallowCough

Rationale: C – Nurse Quick Check Skills 320

To minimize esophageal reflux what is the recommended position of the client?Flat in bed with head slightly elevatedRight lateral position with head slightly elevated

Left lateral position with head slightly elevated

High fowler’s position

To minimize esophageal reflux what is the recommended position of the client?Flat in bed with head slightly elevatedRight lateral position with head slightly elevated

Left lateral position with head slightly elevated

High fowler’s position

Rationale: B – Nurse Quick Check Skills 319

What is the best way to verify the position of the NGT?Auscultating airAspirate gastric contentX-rayPlace the end of the tube in the container with water.

What is the best way to verify the position of the NGT?Auscultating airAspirate gastric contentX-rayPlace the end of the tube in the container with water.

Rationale: C – Nurse Quick Check Skills 321

What is the measurement of the NGT to a child or to an infant?14 to 18 French5 to 10 French21 to 25 French11 to 13 French

What is the measurement of the NGT to a child or to an infant?14 to 18 French5 to 10 French21 to 25 French11 to 13 French

Rationale: B – Delmar’s Fundamentals and Advance Nursing Skills Second Edition 715

A 70 year old client with a Nasogastric tube (NGT) was given a continuous feeding. What position will the nurse place the client at all times?

Side LyingSemi Fowler’sHigh Fowler’sProne

A 70 year old client with a Nasogastric tube (NGT) was given a continuous feeding. What position will the nurse place the client at all times?

Side LyingSemi Fowler’sHigh Fowler’sProne Answer: B –Saunders 4th Edition Pg.252

A client asks the nurse what is the purpose of having a Nasogastric tube. The nurse knows that the purpose of NGT is: prioritize

To irrigate the stomachTo decrease the risk for aspirationTo provide nutritionTo decompress the stomachOrder the above according to prioritization:

A client asks the nurse what is the purpose of having a Nasogastric tube. The nurse knows that the purpose of NGT is: prioritize

1. To decompress the stomach2. To provide nutrition3. To decrease the risk for aspiration4. To irrigate the stomachOrder the above according to prioritization:

Answer: DCBA – Saunders 4th Edition Pg.252

While assessing the client’s double-lumen NGT the nurse noticed a leakage through the air vent. What should the nurse initially do?

Clamp the lumenCall the physicianIrrigate the main lumen with tap water

Instill 30 ml of water into the air vent

While assessing the client’s double-lumen NGT the nurse noticed a leakage through the air vent. What should the nurse initially do?

Clamp the lumenCall the physicianIrrigate the main lumen with tap waterInstill 30 ml of water into the air ventAnswer: D – Saunders 4th Edition Pg.252

Which of the following action/s is/are correct in NGT irrigation:

Instill 20-30mL of water or NS with an irrigation syringe

Instill 30-50mL of water or NS with an irrigation syringe

Perform irrigation every 8 hours to assess patency of the tube

Pull back on the syringe plunger to withdraw fluid, repeat if the tube flow is sluggish

Which of the following action/s is/are correct in NGT irrigation:

Instill 20-30mL of water or NS with an irrigation syringe

Perform Instill 30-50mL of water or NS with an irrigation syringe

irrigation every 8 hours to assess patency of the tube ---every 4 hours

Pull back on the syringe plunger to withdraw fluid, repeat if the tube flow is sluggish

Answer: BD – Saunders 4th Edition Pg.252

The nurse is about to give a bolus feeding to a client, what will indicate the nurse to withhold the feeding?

Residual amount of 100mLResidual amount of 120mLpH measuring 3.5pH measuring 2.5

The nurse is about to give a bolus feeding to a client, what will indicate the nurse to withhold the feeding?

Residual amount of 100mLResidual amount of 120mLpH measuring 3.5pH measuring 2.5

Answer: A – Saunders 4th Edition Pg.252-254

Which of the following actions are correct in NGT insertion to a 2 year old client:

Place the infant in an infant seat or position the client with rolled towel or pillow under the head and shoulders

Do not hyperextend or hyper flex the patients neck

Restrain can be use during tube insertion

Tape the tube to the area between the end of the nares and upper lip as well as to the cheek

Which of the following actions are correct in NGT insertion to a 2 year old client:

Place the infant in an infant seat or position the client with rolled towel or pillow under the head and shoulders

Do not hyperextend or hyper flex the patients neck

Restrain can be use during tube insertionTape the tube to the area between the end of the nares and upper lip as well as to the cheek

Answer: ALL – Fundamentals of Nursing 7th Ed. Pg.1209

In NGT insertion, the neck should be:

ExtendedHyperextendedOn the sideNeutral position

In NGT insertion, the neck should be:ExtendedHyperextendedOn the sideNeutral position

Answer: B – Hyperextension of the neck reduces the curvature of the nasopharyngeal junction --- Fundamentals of Nursing 7th Ed. Pg.1206

While inserting a Nasogastric tube to an adult client, the client begins to have difficulty of breathing. What is the most appropriate nursing action?

Notify the physicianContinue to insert the tubeRemove the tube and reinsert immediately

Immediately withdraw and wait until DOB subsides

While inserting a Nasogastric tube to an adult client, the client begins to have difficulty of breathing. What is the most appropriate nursing action?

Notify the physicianContinue to insert the tubeRemove the tube and reinsert immediately

Immediately withdraw and wait until DOB subsides

Answer: D – Saunders 4th Edition Pg.254

A prioritize nursing diagnosis to a client receiving tube feeding is:

Risk for deficient fluid volume related to hypertonic dehydration

Deficient knowledge about home tube feeding regimen

Imbalanced Nutrition: Less than body requirements

Risk for diarrhea related to dumping syndrome

A prioritize nursing diagnosis to a client receiving tube feeding is:

Risk for deficient fluid volume related to hypertonic dehydration

Deficient knowledge about home tube feeding regimen

Imbalanced Nutrition: Less than body requirements

Risk for diarrhea related to dumping syndrome

Answer: C – Brunner & Suddarth’s Medical Surgical Nursing 10th Ed. Pg.994

Which of the following action/s is/are incorrect in providing oral and nasal hygiene to a client with NGT: SATA

Frequent mouth careClean the nose with moistened cotton-tipped swabs

Cleansing the nose using water soluble lubricant

Changing nasal tapes every 3-5 days

Which of the following action/s is/are incorrect in providing oral and nasal hygiene to a client with NGT: SATA

Frequent mouth careClean the nose with moistened cotton-tipped swabs

Cleansing the nose using water soluble lubricant

Changing nasal tapes every 3-5 days

Answer: D – Brunner & Suddarth’s Medical Surgical Nursing 10th Ed. Pg.991

In removing the NGT, the nurse should instruct the client to do which of the following action?

ExhaleInhale then hold breathExhale and hold breathInhale and exhale quickly

In removing the NGT, the nurse should instruct the client to do which of the following action?

ExhaleInhale then hold breathExhale and hold breathInhale and exhale quickly

Answer: C – Fundamentals of Nursing 7th Ed. Pg.1208

Which of the following actions are incorrect in removing a Nasogastric tube: SATA

Put on sterile gloves Pinch the tube with the gloved hand

Slowly and smoothly withdraw the tube

Observe the intactness of the tube

Which of the following actions are incorrect in removing a Nasogastric tube: SATA

Put on sterile gloves ---disposable

Pinch the tube with the gloved hand

Slowly and smoothly withdraw the tube --- quickly

Observe the intactness of the tube

Answer: A & C– Fundamentals of Nursing 7th Ed. Pg.1208

Before removing, the nurse may intermittently clamp and unclamp the NG tube for a trial period to ensure that the client does not experience N/V, or distention. How long is the trial period?

12 hours24 hours32 hours48 hours

Before removing, the nurse may intermittently clamp and unclamp the NG tube for a trial period to ensure that the client does not experience N/V, or distention. How long is the trial period?

12 hours24 hours32 hours48 hoursAnswer: B – Brunner & Suddarth’s Medical Surgical Nursing 10th Ed. Pg.991

In removing the NG tube, the tube is gently withdrawn for:

5-10 cm10-15 cm15-20 cm20-25 cm

In removing the NG tube, the tube is gently withdrawn for:

5-10 cm10-15 cm15-20 cm20-25 cm

Answer: C – Brunner & Suddarth’s Medical Surgical Nursing 10th Ed. Pg.991

a) Lubricate the first 3”(7.6cm) of the tube with petroleum jelly

b) have the patient take sips of water and swallow as you advance the tube

c) Watch for signs of respiratory distress

d)Keep an emesis basin and tissues available for the patient

When inserting a NG tube, do all of the following, except:

a) Lubricate the first 3”(7.6cm) of the tube with petroleum jelly

b) have the patient take sips of water and swallow as you advance the tube

c) Watch for signs of respiratory distress

d)Keep an emesis basin and tissues available for the patient

When inserting a NG tube, do all of the following, except:

RationaleOnly water soluble lubricants are used for NG tube insertion because of the risk of pneumonia when it enters the respiratory cavity

Saunders 2004

Lubricate the first 3”(7.6cm) of the tube with petroleum jelly

a) Measure the residual contents in the stomach every morning

b)Clean and lubricate the external naresc) Administer the feeding over 1 to 2

hoursd)Check the patient’s blood glucose

level before each feeding

An important nursing action for a patient with a nasogastric feeding tube is to:

a) Measure the residual contents in the stomach every morning

b)Clean and lubricate the external naresc) Administer the feeding over 1 to 2

hoursd)Check the patient’s blood glucose

level before each feeding

An important nursing action for a patient with a nasogastric feeding tube is to:

Rationale Measure the residual every

before feeding, the time 1 to 2 hours is too long for feeding and the question doesn't state that the patient has problems with sugar levels.

Nurse should maintain a clean and unobstructed nares because of the presence of tube it may irritate the nasal lining

Clean and lubricate the external nares

a) Confirm proper NGT placement

b)Determine patency of the tube

c) Assess fluid and electrolyte status

d)Evaluate absorption of the last feeding

A nurse is preparing to administer an intermittent tube feeding through a nasogastric tube. The nurse assesses a gastric residual before administering the feeding to:

a) Confirm proper NGT placement

b)Determine patency of the tube

c) Assess fluid and electrolyte status

d)Evaluate absorption of the last feeding

A nurse is preparing to administer an intermittent tube feeding through a nasogastric tube. The nurse assesses a gastric residual before administering the feeding to:

RationaleAspirating the residual content

evaluates the gastrointestinal absorption rate.

Kozier nutrition

a) Feeding bag is hung 1 foot higher than tube’s insertion point into the client

b) Nurse administers the next feeding only if there is less than 25 ml of residual volume from the previous feeding

c) Client is placed in the left lateral position to promote feeding flow into the intestines

d) Feeding is administered at a refrigerated temperature to reduce bacterial growth during feeding

What is the proper technique with the gravity tube feeding?

a) Feeding bag is hung 1 foot higher than tube’s insertion point into the client

b) Nurse administers the next feeding only if there is less than 25 ml of residual volume from the previous feeding

c) Client is placed in the left lateral position to promote feeding flow into the intestines

d) Feeding is administered at a refrigerated temperature to reduce bacterial growth during feeding

What is the proper technique with the gravity tube feeding?

RationaleFeeding bag is hung 1 foot higher than tube’s insertion point into the client too low height of feeding bottle may lead to slow feeding and high may cause increase tube emptying

a) Assist the client in sitting positionb) Explain the procedure to the clientc) If the client has a denture, make sure

that they are in place in the clients mouth

d) Have the stethoscope available to listen for the proper placement

The client is admitted with anorexia nervosa. A nasogastric tube is to be inserted. Which of the following is the best nursing approach to prepare the client for the procedure?

a) Assist the client in sitting positionb) Explain the procedure to the clientc) If the client has a denture, make sure

that they are in place in the clients mouth

d) Have the stethoscope available to listen for the proper placement

The client is admitted with anorexia nervosa. A nasogastric tube is to be inserted. Which of the following is the best nursing approach to prepare the client for the procedure?

Rationale

Explaining the procedure to the client will prepare him/her not only physically but holistically. Also the nurse will gain cooperation when inserting the NG tube.

Explain the procedure to the client

A patient with cancer receives his bolus tube feeding. Which of the following is the most appropriate position to decrease the risk of aspiration?A. Sitting upright in a chair for 1 hourB. Supine in bed with head elevated at 60 degrees for 2 hoursC. Placing on his left side with head of bed elevated at 45 degrees for 15 minutesD. Supine with head of bed elevated to 30 degrees for 20 minutes

A patient with cancer receives his bolus tube feeding. Which of the following is the most appropriate position to decrease the risk of aspiration?A. Sitting upright in a chair for 1 hourB. Supine in bed with head elevated at 60 degrees for 2 hoursC. Placing on his left side with head of bed elevated at 45 degrees for 15 minutesD. Supine with head of bed elevated to 30 degrees for 20 minutesRationale: A. As long as the patient can get out of bed, the preferred position and time frame for preventing aspiration after a bolus tube feeding is sitting upright out of bed for 30 to 60 minutes.

A post gastrectomy patient ask the nurse when will his NG tube will be removed. The nurse tell the patient A. After the fourth post-operative dayB. Thirty-six hours after the cessation of bloody drainageC. When the patient already gains weightD. When patient is able to pass flatus or stool

A post gastrectomy patient ask the nurse when will his NG tube will be removed. The nurse tell the patient A. After the fourth post-operative dayB. Thirty-six hours after the cessation of bloody drainageC. When the patient already gains weightD. When patient is able to pass flatus or stoolRationale: D. NGT is removed after bowel sound is reestablished (usually after 3 days) and after pt has passed flatus or stool.

A patient with NGT after gastric resection complains of severe nausea and absence of drainage for the past 4 hours is noticed. The most appropriate nursing action would be toA. Repositioning the patientB. Irrigating the tube with NSSC. Notifying the physicianD. Giving antiemetic medication

A patient with NGT after gastric resection complains of severe nausea and absence of drainage for the past 4 hours is noticed. The most appropriate nursing action would be toA. Repositioning the patientB. Irrigating the tube with NSSC. Notifying the physicianD. Giving antiemetic medicationRationale: C. N&V is not a normal observation after NGT insertion. The most appropriate action is to notify the physician. Positioning the tube or irrigating is not prescribed because the NGT is placed directly in the suture line and may cause pressure on it.

Which statement by the nurse accurately describes the Levin tube?A. A double lumen tube with one lumen leading to the inflatable balloon and other luman used for aspiration.B. A single lumen plastic or rubber tube with holes near its tip facilitating withdrawal of fluids from the stomach.C. A single lumen, saline, air or water-weighted tube approximately 6 feet longD. A 10 foot long rubber tube with a saline, air, or water bag at its end.

Which statement by the nurse accurately describes the Levin tube?A. A double lumen tube with one lumen leading to the inflatable balloon and other luman used for aspiration.B. A single lumen plastic or rubber tube with holes near its tip facilitating withdrawal of fluids from the stomach.C. A single lumen, saline, air or water-weighted tube approximately 6 feet longD. A 10 foot long rubber tube with a saline, air, or water bag at its end.Rationale: B. Choice A refers to a Miller-Abbot tube; choice C is a Harris tube ; and choice D is a Cantor tube used for intestinal decompression.

Which statement accurately describes a Salem sump tube?A. A short double-lumen tube with small vent used for stomach decompressionB. A double-lumen tube with an inflatable balloon used for stomach decompressionC. A single-lumen tube used to evacuate stomach contentD. A large-bore tube used to evacuate stomach content.

Which statement accurately describes a Salem sump tube?A. A short double-lumen tube with small vent used for stomach decompressionB. A double-lumen tube with an inflatable balloon used for stomach decompressionC. A single-lumen tube used to evacuate stomach contentD. A large-bore tube used to evacuate stomach content.Rationale: A. Choice B refers to a Miller-Abbot tube; choice C is a Levin tube; and choice D is an Ewald tube.