Nasogastic ion New
Transcript of Nasogastic ion New
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NASOGASTIC INTUBATIONNASOGASTIC INTUBATIONLecture DemonstrationLecture Demonstration
Ariel R. Sinco, RN, MNAriel R. Sinco, RN, MN
Marivic M. Suguitan, RN, MNMarivic M. Suguitan, RN, MN
Leila C. Gutierrez, RNLeila C. Gutierrez, RN
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DEFINITIONDEFINITION
is a medicalis a medical
processprocess
involving theinvolving theinsertioninsertion
of a plastic tubeof a plastic tube
through thethrough the nosenose,,past thepast the throatthroat,,
and down intoand down into
thethe stomachstomach..
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INDICATIONS:INDICATIONS:
To decompress the abdomen beforeTo decompress the abdomen beforeand after surgery.and after surgery.
Liquid feedings (gavage) andLiquid feedings (gavage) and
medications for patient who cannotmedications for patient who cannotswallow and eat by mouth.swallow and eat by mouth.
To wash out (lavage) the stomach.To wash out (lavage) the stomach.
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Prevent or relieve nausea andPrevent or relieve nausea and
vomiting.vomiting.
Treat patient with mechanicalTreat patient with mechanical
obstruction and bleeding withinobstruction and bleeding withinthe GI tract.the GI tract.
Obtain a specimen from gastricObtain a specimen from gastric
secretions for diagnostic studiessecretions for diagnostic studies..
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CONTRAINDICATIONSCONTRAINDICATIONS
The use of nasogastric intubation isThe use of nasogastric intubation iscontraindicated (inadvisable) in patientscontraindicated (inadvisable) in patients
with base of skull fractures, severe facialwith base of skull fractures, severe facial
fractures especially to the nose andfractures especially to the nose andesophagitis with stricture and/oresophagitis with stricture and/or
obstructed airway.obstructed airway.
The use of an NG tube is alsoThe use of an NG tube is also
contraindicated in patients who have hadcontraindicated in patients who have hadgastric bypass surgery.gastric bypass surgery.
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Types ofTubes:Types ofTubes:
Levin tubeLevin tube-- single lumen gastric tube used tosingle lumen gastric tube used to
remove stomach contents and provide feedingremove stomach contents and provide feeding
SalemSalem--sump double lumen tubesump double lumen tube-- most frequentlymost frequently
used tube for decompression with suctionused tube for decompression with suction
Sengstaken blakemore tubeSengstaken blakemore tube-- 3 lumen gastric3 lumen gastric
tube with inflatable esophageal balloon, stomachtube with inflatable esophageal balloon, stomach
balloon and gastric suction lumen used forballoon and gastric suction lumen used for
bleeding esophageal varices.bleeding esophageal varices.
Esophageal balloon should be inflated for 48 hrs onlyEsophageal balloon should be inflated for 48 hrs only
to prevent tissue necrosis.to prevent tissue necrosis.
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Materials:Materials:
Nasogastric tube of appropriateNasogastric tube of appropriatesize (8 to 18 French)size (8 to 18 French)
StethoscopeStethoscope
Suction Apparatus(for irrigationSuction Apparatus(for irrigation
only)only) Glass of water with strawGlass of water with straw
Normal Saline SolutionNormal Saline Solution
Bath towelBath towel
Small basin filled with ice or warmSmall basin filled with ice or warmwater (optional)water (optional)
Asepto bulb syringe orToomeyAsepto bulb syringe orToomeysyringesyringe
Disposable glovesDisposable gloves
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Safety pin and Rubber band ClampSafety pin and Rubber band Clamp
Tape (1 inch wider)Tape (1 inch wider)
WaterWater--soluble lubricantsoluble lubricant
Emesis BasinEmesis Basin
Tongue bladeTongue blade
Flashlight (optional)Flashlight (optional)
TissuesTissues
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INSERTING NASOGASTRICINSERTING NASOGASTRIC
TUBETUBE1.1. Check physicians order for insertionCheck physicians order for insertion
of Nasogastric tube.of Nasogastric tube.
2.2. Explain procedure to client.Explain procedure to client.3.3. Gather equipment.Gather equipment.
4.4. If nasogastric tube is rubber, place itIf nasogastric tube is rubber, place it
in a basin with ice for 5 to 10 minutesin a basin with ice for 5 to 10 minutesor place a plastic tube in warm water.or place a plastic tube in warm water.
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5.5. Assess clients abdomen.Assess clients abdomen.
6.6. Wash your hands. Don disposableWash your hands. Don disposable
gloves.gloves.
7.7. Assist the client to high FowlersAssist the client to high Fowlers
position, and drape his chest with bathposition, and drape his chest with bath
towel or disposable pad. Have emesistowel or disposable pad. Have emesis
basin and tissues handy.basin and tissues handy.
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8.8. Check the nares for patency byCheck the nares for patency by
asking the client to occlude oneasking the client to occlude onenostril and breathe normally throughnostril and breathe normally through
the other. Select the nostril throughthe other. Select the nostril through
which air passes more easily.which air passes more easily.
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9.9. Measure the distance to insert theMeasure the distance to insert the
tube by placing tip of tube attube by placing tip of tube at
clients nostril and extending to tipclients nostril and extending to tip
of earlobe and then to tip of theof earlobe and then to tip of the
xyphoid process. Mark tube with axyphoid process. Mark tube with apiece of tape.piece of tape.
10.Lubricate the first 1010.Lubricate the first 10 20 cm. (420 cm. (4
8 inches) of the tube with a water8 inches) of the tube with a water--soluble lubricant.soluble lubricant.
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11.Ask the client to lift his head,11.Ask the client to lift his head,
and insert the tube into the nostriland insert the tube into the nostril
while directing the tube downwardwhile directing the tube downwardand backward. The client mayand backward. The client may
gag when the tube reaches thegag when the tube reaches the
pharynx.pharynx.
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12. Instruct the client to keep head in12. Instruct the client to keep head in
upright or normal eating position.upright or normal eating position.Encourage the patient to swallow evenEncourage the patient to swallow even
if no fluids are permitted or with theif no fluids are permitted or with the
help of drinking in a glass of waterhelp of drinking in a glass of waterusing a straw.using a straw.
Advance the tube in a downward andAdvance the tube in a downward and
backward direction when the clientbackward direction when the clientswallows. Stop when the clientswallows. Stop when the client
breathesbreathes
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Provide tissues for tearing or watering ofProvide tissues for tearing or watering of
eyes. If gagging and coughing persist,eyes. If gagging and coughing persist,
check placement of tube with a tonguecheck placement of tube with a tongue
blade and flashlight.blade and flashlight.
Keep advancing the tube until the tapeKeep advancing the tube until the tapemarking is reached. Do not use force.marking is reached. Do not use force.
Rotate the tube if it meets resistance.Rotate the tube if it meets resistance.
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13. Discontinue the procedure and13. Discontinue the procedure and
remove the tube if there are signs ofremove the tube if there are signs ofdistress, such as gasping, coughing,distress, such as gasping, coughing,
cyanosis, and the inability to speak orcyanosis, and the inability to speak or
hum.hum.
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NGT gone WRONGNGT gone WRONG
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14. Determine that the tube is in the14. Determine that the tube is in the
client's stomach (these methods areclient's stomach (these methods are
appropriate for largeappropriate for large--bore tubes butbore tubes butmay be ineffective to checkmay be ineffective to check
placement of small bore tube.)placement of small bore tube.)
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a. Put a 10a. Put a 10 20 ml. of air in syringe and20 ml. of air in syringe and
inject air into the tube. Simultaneouslyinject air into the tube. Simultaneously
auscultate over the epigastric area with aauscultate over the epigastric area with a
stethoscope.stethoscope.
Attach the syringe to the end of the tubeAttach the syringe to the end of the tubeand aspirate 10 to 20 ml. of stomachand aspirate 10 to 20 ml. of stomach
contents. Measure the pH of aspirated fluid.contents. Measure the pH of aspirated fluid.
Gastric phGastric ph-- usually 4
Respiratory phRespiratory ph-- usually > 5.5usually > 5.5
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15.Secure the tube with a tape to15.Secure the tube with a tape to
the clients face. Be careful not tothe clients face. Be careful not to
pull the tube too tightly against thepull the tube too tightly against the
nose:nose:
a. Cut a 4a. Cut a 4--inch piece of tape and splitinch piece of tape and split
bottom 2 inches.bottom 2 inches.
b. Place unsplit end over bridge ofb. Place unsplit end over bridge of
clients nose.clients nose.
c. Wrap split ends under the tubingc. Wrap split ends under the tubingand up and over onto the nose.and up and over onto the nose.
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16. Attach tube to suction or16. Attach tube to suction or
clamp the tube with a screwclamp the tube with a screw--
type clamp, according to thetype clamp, according to the
physicians orders.physicians orders.
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17. Secure tube to the clients17. Secure tube to the clients
gown by using a rubber bandgown by using a rubber bandor tape and a safety pin. Ifor tape and a safety pin. If
doubledouble--lumen tube is used,lumen tube is used,secure vent above stomachsecure vent above stomach
level. Attach at shoulder level.level. Attach at shoulder level.
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18. Wash hands. Remove all18. Wash hands. Remove all
equipment and make clientequipment and make client
comfortable.comfortable. 19. Record the insertion19. Record the insertion
procedure, type and size ofprocedure, type and size of
tube, description of gastrictube, description of gastriccontents, and clients response.contents, and clients response.
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ADMINISTERING A TUBEADMINISTERING A TUBE
FEEDINGFEEDING
Equipments:Equipments:
Tube Feeding at room temperatureTube Feeding at room temperature
StethoscopeStethoscope
Asepto orToomey syringe, feeding bagAsepto orToomey syringe, feeding bagor prefilled tube feeding , Enteralor prefilled tube feeding , Enteralfeeding pump (ifIV pole ordered)feeding pump (ifIV pole ordered)
ClampClamp
Disposable pad or towel
Disposable pad or towel
WaterWater
Sterile gauzeSterile gauze
Rubber bandRubber band
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Procedure:Procedure:1.1. Explain procedure to client.Explain procedure to client.
2.2. Assemble equipment. CheckAssemble equipment. Check
amount, concentration, type andamount, concentration, type and
frequency of tube feeding on clientsfrequency of tube feeding on clientschart.chart.
3.3. Wash your hands. Warm the feedingWash your hands. Warm the feeding
to room temperature.to room temperature.
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4.4. Position client with head of bedPosition client with head of bedelevated at least 30 degrees or aselevated at least 30 degrees or asnear as normal position for eating asnear as normal position for eating aspossible.possible.
5.5. Unpin tube from clients gown andUnpin tube from clients gown andcheck to see that the nasogastriccheck to see that the nasogastric
tube is properly located in thetube is properly located in thestomach using the 3 waysstomach using the 3 waysmentioned earlier.mentioned earlier.
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6.Aspirate all gastric contents with6.Aspirate all gastric contents with
syringe and measure. Returnsyringe and measure. Return
immediately through tube andimmediately through tube andproceed with feeding if amount ofproceed with feeding if amount of
residual does not exceed policy ofresidual does not exceed policy of
agency or physicians guideline.agency or physicians guideline.Disconnect syringe from tubingDisconnect syringe from tubing
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Intermittent FeedingsIntermittent Feedings
7. When using Asepto orT
oomey7. When using Asepto orT
oomeysyringe:syringe:
Remove plunger or bulb from syringeRemove plunger or bulb from syringeand attach syringe to tube that hasand attach syringe to tube that hasbeen pinched with finger andbeen pinched with finger and
introduce the prescribed amountintroduce the prescribed amountslowly.slowly.
Hold the syringe about 12 inchesHold the syringe about 12 inchesabove the stomach. Allow solution toabove the stomach. Allow solution to
run in by gravity. Raise the syringe torun in by gravity. Raise the syringe toincrease the rate of flow, and lowerincrease the rate of flow, and lowerthe syringe to decrease the rate ofthe syringe to decrease the rate offlow.flow.
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Do not let the syringe emptyDo not let the syringe empty
while introducing thewhile introducing the
nourishment.nourishment.
Introduce 30Introduce 30 60 ml. (160 ml. (1 2 oz.)2 oz.)
of water into the tube after theof water into the tube after the
nourishment is introduced.nourishment is introduced.
Clamp the tube immediatelyClamp the tube immediately
after the nourishment and waterafter the nourishment and water
are instilled. Disconnect theare instilled. Disconnect the
syringe and cover end of tubingsyringe and cover end of tubingwith gauze secured with rubberwith gauze secured with rubber
band.band.
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8. When using a feeding bag:8. When using a feeding bag:
Hang bag on IV pole and adjust toHang bag on IV pole and adjust toabout 12 inches above the stomach.about 12 inches above the stomach.
Clamp tubing and pour formula intoClamp tubing and pour formula into
the bag. Release clamp enough tothe bag. Release clamp enough to
allow formula to run through theallow formula to run through thetubing. Close clamp.tubing. Close clamp.
Attach tubing to feeding tube, openAttach tubing to feeding tube, open
clamp, and regulate drip according toclamp, and regulate drip according to
physicians order.physicians order.
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Add 30Add 30 60 ml. (160 ml. (1 2 oz.) of2 oz.) of
water to feeding bag whenwater to feeding bag whenfeeding is almost completed andfeeding is almost completed and
allow to run through tube.allow to run through tube.
Clamp the tubing immediatelyClamp the tubing immediately
after water has been instilled.after water has been instilled.
Disconnect from tube. ClampDisconnect from tube. Clamp
tube and cover end with gauzetube and cover end with gauze
secured with a rubber band.secured with a rubber band.
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REMOVING A NASOGASTRIC TUBEREMOVING A NASOGASTRIC TUBE
Materials:Materials:
TissuesTissues
Normal saline solution for irrigation (optional)Normal saline solution for irrigation (optional) Bath towel disposable padBath towel disposable pad
Clean disposable glovesClean disposable gloves
Disposable plastic bagDisposable plastic bag 50 ml. syringe (optional)50 ml. syringe (optional)
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Procedure:Procedure:
1.1. Check physicians order for removal ofCheck physicians order for removal of
nasogastric tube.nasogastric tube.
2.2.Ex
plain procedure to client and assist toEx
plain procedure to client and assist tosemisemi--Fowlers positionFowlers position
3.3. Gather equipment.Gather equipment.
4.4. Wash your hands. Do clean disposableWash your hands. Do clean disposable
gloves.gloves.
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5.5. Place towel or disposable pad acrossPlace towel or disposable pad across
clients chest. Give tissues to client.clients chest. Give tissues to client.6.6. If present, turn off the suction andIf present, turn off the suction and
disconnect the tube . Unpin tube fromdisconnect the tube . Unpin tube from
clients gown and carefully removeclients gown and carefully remove
adhesive tape from clients nose.adhesive tape from clients nose.
7.7. Attach syringe and flush with 10 ml. normalAttach syringe and flush with 10 ml. normal
saline solution or clear with 30 to 50 cc ofsaline solution or clear with 30 to 50 cc of
air (optional).air (optional).
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8.8. Instruct client to take a deep breathe andInstruct client to take a deep breathe and
hold it.hold it.
9.9. Clamp tube with fingers by doubling tube inClamp tube with fingers by doubling tube in
itself. Quickly and smoothly withdraw theitself. Quickly and smoothly withdraw the
tube while clients holds breathe.tube while clients holds breathe.
10.10.Place tube in disposable plastic bag.Place tube in disposable plastic bag.
Remove gloves and place in bag.Remove gloves and place in bag.
11.11.Offer mouth care to client and make clientOffer mouth care to client and make client
comfortable.comfortable.
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12.12.Measure nasogastric drainage. RemoveMeasure nasogastric drainage. Remove
all equipments and dispose according toall equipments and dispose according to
agency policy. Wash your hands.agency policy. Wash your hands.
13.Record removal of tube, clients13.Record removal of tube, clients
response, and measurement of drainage.response, and measurement of drainage.
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NursingManagement of patientNursingManagement of patient
with NGT in placewith NGT in place
Provide patient as much comfort asProvide patient as much comfort aspossible.possible.
Tubes should be properly cleaned beforeTubes should be properly cleaned beforeand after feeding to remove crystals thatand after feeding to remove crystals thatlater form into dried mucus.later form into dried mucus.
The teeth should be brushed even if
The teeth should be brushed even ifpatient is not eating to prevent bacterialpatient is not eating to prevent bacterial
action in the mouth.action in the mouth.
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Provide anesthetic lozenges or garglesProvide anesthetic lozenges or gargles
to prevent sore throat from the presenceto prevent sore throat from the presence
of the tube.of the tube.
Frequent oral hygiene will also increaseFrequent oral hygiene will also increase
the patients comfort by removing debristhe patients comfort by removing debris
and stimulating salivation.and stimulating salivation.
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Additional TIPSAdditional TIPS
about tube feedings:about tube feedings:
Position the person so that hePosition the person so that he
or she is sitting up, or at leastor she is sitting up, or at leastso the upperso the upper--body is abovebody is above
the level of the stomach.the level of the stomach.
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Additional TIPSAdditional TIPS
about tube feedings:about tube feedings:Practice good sanitation. Wash yourPractice good sanitation. Wash your
hands before handling the feedinghands before handling the feeding
equipment. Wash feeding bags withequipment. Wash feeding bags with
water. Do not use soap, as it willwater. Do not use soap, as it will
stick to the inside of the bag and getstick to the inside of the bag and getinto the formula. This can causeinto the formula. This can cause
diarrhea and other unpleasantdiarrhea and other unpleasant
consequences.consequences.
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Additional TIPSAdditional TIPS
about tube feedings:about tube feedings:Feedings should be given at roomFeedings should be given at room
temperature to minimize risk of crampingtemperature to minimize risk of cramping
and/or diarrhea. Open cans of formulaand/or diarrhea. Open cans of formulacould be kept in the refrigerator, andcould be kept in the refrigerator, and
discarded if not used within 24 hours.discarded if not used within 24 hours.
They should be taken out 15They should be taken out 15--20 minutes20 minutesbefore a feeding and allowed to warm upbefore a feeding and allowed to warm up
to room temperature.to room temperature.
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Additional TIPSAdditional TIPS
about tube feedings:about tube feedings:
Always flush the feeding tubeAlways flush the feeding tube
with water after a feeding.T
hiswith water after a feeding.T
hiswill help to prevent the patientwill help to prevent the patient
from getting dehydrated. It willfrom getting dehydrated. It will
also prevent the food fromalso prevent the food fromgetting clogged.getting clogged.
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Additional TIPSAdditional TIPS
about tube feedings:about tube feedings:
If medications are to be run downIf medications are to be run down
the feeding tube, always be surethe feeding tube, always be surethey are finely crushed. Flush thethey are finely crushed. Flush the
tube with water to wash themtube with water to wash them
down.down.
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Additional TIPSAdditional TIPS
about tube feedings:about tube feedings: If the tube seems to be clogged and a smallIf the tube seems to be clogged and a small
flush of water isn't effective, a flush of aboutflush of water isn't effective, a flush of about
100cc of cola may do the trick. You can also100cc of cola may do the trick. You can alsotry dissolving a quarter teaspoon of meattry dissolving a quarter teaspoon of meat
tenderizer in a teaspoon of water and placingtenderizer in a teaspoon of water and placing
it into the tube. Wait five minutes beforeit into the tube. Wait five minutes before
flushing again. If none of these strategiesflushing again. If none of these strategies
work, contact your health care provider(s) forwork, contact your health care provider(s) for
advice.advice.
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Thank you for listeningThank you for listeningHave a nice dayHave a nice day