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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. o