Nasogastric Tube Insertion

Nursing Guidelines and considerations

Gregor Alfonsin C. Pondoyo

Nasogastric (NG) intubation

Refers to the insertion of a tube to the nasopharynx into the stomach

Purposes

DecompressionRelieving nausea and vomiting after

surgery or traumatic eventsDiagnostic proceduresIrrigation (lavage) for active bleeding and

poisoning

Treatment for mechanical obstructionAdministering meds and food (gavage)Specimen procurement of gastric contents

for Lab studies when pyloric or intestinal obstruction is suspected.

Consider this!

Unconscious pt’s- advance tube between respiration1

a. Stroke the neck to facilitate passage of tube to esophagus

b. Watch out for cyanosis during procedure, it may indicate that the tube entered the trachea

Nasal obstructions- pass tube to the mouth instead.

a. Remove dentures, slide distal end over the tongue then proceed just like usual way of NGT insertion

b. Coil end of the tube, directing it downward the pharynx

Pain or vomiting- indicates obstruction or wrong placement

If NGT is not draining, reposition the tube (per physician’s order)

Assess the color, consistency, odor of gastric contents and report any unusualities2

Auscultate! Auscultate! Auscultate!Irrigate before and after giving

medicationsKnow the complications if tube stays for

prolonged periods:- nasal erosion and sinusitis- Esophagitis and esophagotracheal fistula- gastric ulceration, and pulmonary and oral

infections

Let’s Begin

Equipments (basic)

Nasogastric (NG) tube- usually single-lumen Levin

H20-soluble lubricantClamp for tubingTowel, tissues, emesis basinGlass of H2o and strawTape (preferably hypoallergenic)

Asepto syringe3

StetPenlightDisposable glovesNormal saline

Procedure: Preparation

1. Ask the patient if he has ever had nasal surgery, trauma, a deviated septum, or bleeding disorder4.

2. Explain procedure to the patient5

3. Place the patient in a sitting or high-Fowler's position and place a towel across chest6.

4. Determine with the patient what sign he might use, such as raising the index finger, to indicate “wait a few moments” because of gagging or discomfort7.

5. Remove dentures (if there’s any) place emesis basin and tissues within the patient's reach8.

6. Inspect the tube for defects; look for partially closed holes or rough edges9.

7. Place rubber tubing in ice-chilled water for a few minutes (if too stiff, dip in warm water)10.

8. Determine the length of the tube needed to reach the stomach11.

9. Have the patient blow nose to clear nostrils12.

10. Inspect the nostrils with a penlight, observing for any obstruction. Occlude each nostril, and have the patient breathe. This will help determine which nostril is more patent.

11. Wash your hands. Put on disposable gloves13.

12. Measure the patient's NEX (nose, earlobe, xiphoid), and mark the tube appropriately14.

Performance

1. Coil the first 3-4 inches (7-10 cm) of the tube around your fingers15.

2. Lubricate the coiled portion of the tube with water-soluble lubricant. Avoid occluding the tube's holes with lubricant16.

3. Tilt back the patient's head before inserting tube into nostril, and gently pass tube into the posterior nasopharynx, directing downward and backward toward the ear17.

4. When tube reaches the pharynx, the patient may gag; allow patient to rest for a few moments18.

5. Have the patient tilt head slightly forward. Offer several sips of water through a straw, or permit patient to suck on ice chips, unless contraindicated. Advance tube as patient swallows19.

6. Gently rotate the tube 180 degrees to redirect the curve20.

7. Continue to advance tube gently each time the patient swallows21.

8. If obstruction appears to prevent tube from passing, do not use force. Rotating tube gently may help. If unsuccessful, remove tube and try other nostril22.

9. If there are signs of distress such as gasping, coughing, or cyanosis, immediately remove tube23.

10. Continue to advance the tube when the patient swallows, until the tape mark reaches the patient's nostril24.

11. Check placement!!!

To check whether the tube is in the stomach:

Ask the patient to talk25. Use the tongue blade and penlight to

examine the patient's mouth (especially an unconscious patient)26.

Attach a syringe to the end of the NG tube. Place a stethoscope over the left upper quadrant of the abdomen, and inject 10 to 20 cc of air while auscultating the abdomen27.

Obtain aspirate with 30 to 60 mL syringe. If stomach contents cannot be aspirated, reposition the patient and repeat air insufflation. Attempt to aspirate again28.

X-rays may be done to confirm tube placement29.

12. After tube is passed and the correct placement is confirmed, attach the tube to suction or clamp the tube30.

13. Anchor tube with tape31.

14. Anchor the tubing to the patient's gown. Use a rubber band to make a slip-knot to anchor the tubing to the patient's gown. Secure the rubber band to the patient's gown using a safety pin32.

15. Clamp the tube until the purpose for inserting the tube takes place33.

Follow up phase

1. Assure the patient that most discomfort he feels will lessen as he gets used to the tube.

2. Irrigate the tube at regular intervals (every 2 hours unless otherwise indicated) with small volumes of prescribed fluid34.

3. Cleanse nares and provide mouth care every shift35.

4. Apply petroleum jelly to nostrils as needed, and assess for skin irritation or breakdown36.

5. Keep head of bed elevated at least 30 degrees37.

6. Record the time, type, and size of tube inserted. Document placement checks after each assessment, along with amount, color, consistency of drainage38.

NGT Removal

Equipments

- Towel- Disposable gloves- Mouth hygiene materials

Procedure: Preparation

1. Make sure that gastric or small bowel drainage is not excessive in volume.

2. Make sure, by auscultation, that audible peristalsis is present.

3. Determine whether the patient is passing flatus; this indicates peristalsis39.

4. Verify the health care provider's order for removal.

Performance phase

1. Place a towel across the patient's chest, and inform him that the tube is to be withdrawn40.

2. Apply disposable gloves41.3. Remove the tape from the patient's

nose.4. Instruct the patient to take a deep breath

and hold it42.

5. Slowly, but evenly, withdraw tubing and cover it with a towel as it emerges43. (As the tube reaches the nasopharynx, you can pull quickly.)

6. Provide the patient with materials for oral care and lubricant for nasal dryness44.

7. Dispose of equipment in appropriate receptacle.

8. Document time of tube removal and the patient's reaction.

9. Document tube removal and color, consistency, and amount of drainage in suction canister.

10. Continue to monitor the patient for signs of GI difficulties45.

TY!!!