nasogastric intubation

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

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Pemasangan NGT (dr. Efman, SpB-KBD)

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Page 1: Nasogastric Intubation

Nasogastric Intubation

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

Page 2: Nasogastric Intubation

GI Tract

•Oral cavity•Pharynx•Esophagus•Stomach

•Small Intestine•Large Intestine•Accessory Structures

Page 3: Nasogastric Intubation

Medical NCO Course

Page 4: Nasogastric Intubation

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

Esophagus • Peristaltic waves

Page 5: Nasogastric Intubation
Page 6: Nasogastric Intubation

Esophagus:

•Muscular canal

•About 24 cm long

•Extends from pharynx to stomach

Page 7: Nasogastric Intubation

Stomach

Structure• Layered muscular tube• Lined with mucous

membranes•Contains gastric glands

Page 8: Nasogastric Intubation

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

Page 9: Nasogastric Intubation

Gallbladder

•Secretes and stores bile produced by the liver

Page 10: Nasogastric Intubation

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

Page 11: Nasogastric Intubation

Pancreas•Exocrine gland•Secretes pancreatic juice

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

Page 12: Nasogastric Intubation

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

Page 13: Nasogastric Intubation

Nasogastric Intubation

Page 14: Nasogastric Intubation

NG Tube Indications

•Aspirate stomach contents• Diagnostic or

therapeutic

•Assessment of GI bleeding•Determine gastric acid content

Page 15: Nasogastric Intubation

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

Page 16: Nasogastric Intubation

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

Page 17: Nasogastric Intubation

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

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

Page 18: Nasogastric Intubation

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

Page 19: Nasogastric Intubation

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

Page 20: Nasogastric Intubation

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

S C10077/ES C10077/E--3 103 10--9898

Page 21: Nasogastric Intubation

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

Page 22: Nasogastric Intubation

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

resistance felt (nasopharynx)

Page 23: Nasogastric Intubation

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

As patient swallows, advance tube into and down esophagus.

S C10077/ES C10077/E--6 106 10--9898

Page 24: Nasogastric Intubation

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.

Page 25: Nasogastric Intubation

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

Page 26: Nasogastric Intubation

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

Page 27: Nasogastric Intubation

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

Page 28: Nasogastric Intubation

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

Page 29: Nasogastric Intubation

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

Page 30: Nasogastric Intubation

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

Page 31: Nasogastric Intubation

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

Page 32: Nasogastric Intubation

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