Nasogastric Tube

NASOGASTRIC TUBE
Nasogastric intubation is a medical process involving the insertion of a plastic tube (nasogastric tube, NG tube) tube) through the nose, past the throat, and down into the stomach. stomach.
NASOGASTRIC TUBE
TYPES OF PROCEDURES
GASTRIC GAVAGE GASTRIC LAVAGE
Indications
Diagnostic
Evaluation of upper gastrointestinal (GI) bleed (ie, presence, volume) Aspiration of gastric fluid content Identification of the esophagus and stomach on a chest radiograph Administration of radiographic contrast to the GI tract
Indications

Therapeutic
Gastric decompression, including maintenance of a decompressed state after endotracheal intubation, intubation, often via the oropharynx Relief of symptoms and bowel rest in the setting of small-bowel obstruction small Aspiration of gastric content from recent ingestion of toxic material Administration of medication Feeding Bowel irrigation
Contraindications
Absolute
contraindications
Severe midface trauma Recent nasal surgery

Relative
contraindications
Coagulation abnormality Esophageal varices or stricture Recent banding or cautery of esophageal varices Alkaline ingestion
EQUIPMENTS
TYPES OF NASOGASTRIC TUBES

The Levin Tube -is a one-lumen nasogastric onetube

The Salem-Sump Tube. SalemThis tube is a two-lumen twopiece of equipment. It has a drainage lumen and a smaller secondary tube that is open to the atmosphere.

The Miller-Abbott Tube. MillerThis tube is also a two-lumen twonasogastric tube. There is a rubber balloon at the tip of one tube; the other tube has holes near its tip.

The Cantor Tube - has one lumen and a bag on the end. end.
SIZES
Adult
Size Colour Code
- 16-18F 16FG-8 Blue FG-10 Black FG-12 White FG-14 Green FG-16 Orange FG-18 Red FG-20 Yellow
Pediatric
- In pediatric patients, the correct tube size varies with the patients age.
Infection Control
Washing Wear a set of gloves Wearing face and eye protection Wear disposable apron.
Hand
IMPLEMENTATION
for physician order. Identify Client & Introduce yourself Explain the procedure Assemble the Materials needed
Verify
NURSING RESPONSIBILITY
and removing the tube Assessing correct placement Securing the tube Meeting patient comfort needs Monitoring patient responses
Inserting
IMPLEMENTATION
Explain the procedure, benefits, risks, complications, and alternatives to the patient or the patient's representative. representative. Examine the patients nostril for septal deviation. deviation. To determine which nostril is more patent, ask the patient to occlude each nostril and breathe through the other. other.
POSITION
y Position the patient in a High Fowlers position.
MEASUREMENT
Adult Measure from the tip of the nose, around the ear, and down to the xyphoid process.
MEASUREMENT
Infant Measure from the tip of the nose, around the ear and down to the umbilicus.
INSERTION

Lubricate the distal end of the Tube
INSERTION

Instruct the Patient to drink while the tube is inserted
CHECKING FOR PLACEMENT

Auscultation
of air insufflated through the tube of the Proximal end of in a glass of water.
Immersion

Aspiration
of fluid from the tube, with pH testing of the aspirate.

pH < 5 GIT pH > 6 - Respiratory

Chest
XX-ray
NG OPTIMIZER
SECURE THE NG TUBE

Anchor the tube securely to the nose and cheek - keeping it out of the patients field of vision.
COMPLICATIONS

Minor complications - Nose Bleeds,Sinusitis, and sore throat More significant complications - Erosion of the nose where the tube is anchored, esophageal perforation, pulmonary aspiration, a collapsed lung, or intracranial placement of the tube.
DOCUMENTATION
Date and time of procedure Indication for insertion Type of tube used Distance tube inserted (if appropriate) The nature of the aspirate Methods used to check location of the tube insertion Any procedural comments

Transabdominal tube feeding and care

A
percutaneous endoscopic gastrostomy (PEG) or (PEJ) jejunostomy tube can be inserted endoscopically without the need for laparotomy or general anesthesia. Used for nutrition, drainage, and decompression.
Contraindications to endoscopic placement

Obstruction
gastric surgery Morbid obesity Ascites

Previous
Gastrostomy Feeding Tubes
Jejunostomy Feeding Tubes
Gastrojejunostomy Feeding Tubes
Nursing care
Providing skin care at the tube site Maintaining the feeding tube
Administering Feeding
Monitoring Patient Response
Adjusting Feeding schedules
Equipment: feeding
Feeding
formula Large bulb or catheter tip syringe 120 ml of water 4 x 4 gauze pads Soap Skin protectant Hypoallergenic tape Gravity drip administration bags Mouthwash, toothpaste, or mild salt solution
Preparation of equipment

Always check the expiration date on commercially prepared feeding formulas. If the formula has been prepared by the dietitian or pharmacist, check the preparation time and date. Discard any opened formula thats more than 1 day old. Commercially prepared administration sets and enteral pumps allow continuous formula administration. 18
Place
the desired amount of formula
into the gavage container and purge air

from the tubing. To avoid contamination, hang only a 4 to 6 hour supply of formula at a time. Provide privacy, and wash your hands. Confirm the patients identity using two patient identifiers according to facility policy. Explain the procedure to the patient. Tell him, for example, that feedings usually start at a slow rate and increase as tolerated. After he tolerates continuous feedings, he may progress to intermittent feedings, as ordered.
Assess for bowel sounds with a stethoscope before feeding, and monitor for abdominal distention. Ask the patient to sit, or assist him into semi Fowlers position, for the entire feeding. This helps to prevent esophageal reflux and pulmonary aspiration of the formula. For an intermittent feeding, have him maintain this position throughout the feeding and for 1 hour afterward.
Put on gloves. Before starting the feeding, measure the residual gastric contents. Attach the syringe to the feeding tube and aspirate. If the contents measure more than twice the amount infused, hold the feeding and recheck in 1 hour. If residual contents remain too high, notify the physician. Chances are the formula isnt being absorbed properly. Keep in mind that residual contents will be minimal with PEJ tube feedings.

Allow 30 ml of water to flow into the feeding tube to establish patency. Be sure to administer formula at room temperature. Cold formula may cause cramping. 24 Allow gravity to help the formula flow over 30 to 45 minutes. Faster infusions may cause bloating, cramps, or diarrhea. Begin intermittent feeding with a low volume (200 ml) daily, according to the patients tolerance increase the volume per feeding, as needed, to reach the desired calorie intake.
When
the feeding finishes, flush the feeding tube with 30 to 60 ml of water to maintain patency and provide hydration. Cap the tube to prevent leakage. Rinse the feeding administration set thoroughly with hot water to avoid contaminating subsequent feedings. Allow it to dry between feedings.

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NASOGASTRIC TUBE

Severe midface trauma Recent nasal surgery

TYPES OF NASOGASTRIC TUBES

TYPES OF NASOGASTRIC TUBES

TYPES OF NASOGASTRIC TUBES

TYPES OF NASOGASTRIC TUBES

Lubricate the distal end of the Tube

Instruct the Patient to drink while the tube is inserted

CHECKING FOR PLACEMENT

CHECKING FOR PLACEMENT

of fluid from the tube, with pH testing of the aspirate.

CHECKING FOR PLACEMENT

SECURE THE NG TUBE

Transabdominal tube feeding and care

Contraindications to endoscopic placement

gastric surgery  Morbid obesity  Ascites

Gastrostomy Feeding Tubes

Jejunostomy Feeding Tubes

Gastrojejunostomy Feeding Tubes

Monitoring Patient Response

Adjusting Feeding schedules

the desired amount of formula

into the gavage container and purge air

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gastric surgery Morbid obesity Ascites