nasogastric tube (ngt) insertion

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  • 8/8/2019 Nasogastric Tube (Ngt) Insertion

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    NORMAN V. VERDEFLOR, JR., RN, MN

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    NGT inserted through nostril passing thenasopharynx until the stomach.

    Levin tube

    NasoentericTube - longer, at least 40inches long

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    1. ADMINISTER TUBE FEEDINGS &MEDICATIONS in clients unable to eat by

    mouth or at risk of aspirationGAVAGE gastric feeding

    2. means of GASTRIC DECOMPRESSIONTo prevent gastric distention, nausea andvomiting

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    3. Diagnostic purposes for gastric contentanalysis

    Introduction of radiographic contrast for GIT

    4. To wash off the stomach of poisons or

    overdose in medications.LAVAGE gastric irrigation

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    Severe midface injuryRecent nasal surgery

    Coagulation abnormalityEsophageal varicesAlkaline ingestion

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    Large or small bore tubeGuidewire or stylet

    Solution basin with ice or warm waterHypoallergenic adhesive tapeClean gloves

    Water soluble lubricantFacial tissuesGlass of water with straw20-50 ml syringe with an adapter

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    BasinpH strip or Meter

    StethoscopeDisposable Pad/TowelClamp/Plug (Optional)Suction ApparatusGauze Square/Plastic Specimen Bag/ElasticbandSafety Pin

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    1. Assist to assume a High Fowler s position,with head supported on pillow if condition

    permits2. Explain procedure.3. Handwashing; observe universal blood andbody fluid precaution4. Provide privacy. Place disposablepad/towel across chest.

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    5. Assess client s nostrils.Hyperextend the head, with the use of a flashlight

    assess for tissue integrity of nares noting anyabrasions or irritations.Check for obstructions or deformities by askingclient to breathe on one nostril at a time.Select nostril with greater airflow.

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    6 . Prepare the tubeplace tube on ice for 5-10 min if rubber

    Warm water for plastic tube until it becomessofter/flexible.Use a stylet secured in position for small bore.

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    7. Determine how far to insert the tube.Measure from the tip of the client s nose to th etip

    of the earlobe to the tip of xiphoid process.Mark with tape if with no markings.

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    8 . Insert the tubeDon gloves

    Lubricate tipInsert tube with its natural curve toward client inhyperextension of the neck, gently advance towardnasopharynx.

    Direct tube along floor of nostril, toward ear onthat sideApply slight pressure in nasopharynx, tearing of eyes may occur. Offer tissues prn.

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    8 . Insert the tubeWithdraw tube if with resistance, relubricate and

    reinsert in the other nostril.Once it reaches the oropharynx, gagging mayhappen.Ask client to tilt head forward and encourage to

    drink and swallow.IF gagging is encountered, stop passing the tubemomentarily, have client rest take a few breathsand sips of water.

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    8 . Insert the tube]Pass the tube 5-10 cm(2-4 in) with each swallow.

    If gagging persists and the tube does not advance,withdraw it slightly, inspect the throat if tube iscoiled in mouth. Withdraw and reinsert again.

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    9 . Check for correct placement.Aspirate stomach contents, check for pH.

    Auscultate air insufflationPlace stethoscope over epigastrium after injecting10-30ml air listen for whooshing sound

    If placement is negative in the stomach, advancetube 5cm, repeat test.If small bore is used, leave stylet in place untilposition is verified in Xray

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    10. Secure the tube by taping it to the bridgeof the nose.

    Wipe skin with alcoholCut 7.5 cm (3in), split it lengthwise at one endleaving a 2.5 cm tab at the endPlace tape over the bridge of the nose, bring splitends under or around the tubing and back up overthe nose

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    11. Attach tube to suction or feedingapparatus, or clamp the end of tubing.

    It may be covered with a gauze or plasticspecimen bag and an elastic band.

    12. Secure the tube to client s gown with an elasticband and a safety pin. Or adhesive tape to thetube.

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    1. Inspect nostril for discharge and irritation.2. Clean nostril and tube with moistened

    cotton-tipped applicators.3. Apply water soluble lubricant if appearsdry.4. Change adhesive tape prn.5. Frequent mouth care.

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    Irrigate with 30ml normal saline at regularintervals, irrigations require order from

    doctor.Document client s input & output, as well asamount and characteristic of drainage.Note client s comfort and tolerance toprocedure.Chart date, time of insertion, means by whichplacement was checked and client s response.