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Nasogastric intubation
 

Nasogastric intubation

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    Nasogastric intubation Nasogastric intubation Presentation Transcript

    • Nasogastric Intubation
    • GI Tract
      • Oral cavity
      • Pharynx
      • Esophagus
      • Stomach
      • Small Intestine
      • Large Intestine
      • Accessory Structures
    • Gastrointestinal System
      • Provides body with:
        • Water
        • Electrolytes
        • Other nutrients used by cells
    • Gastrointestinal System
      • Function
        • Breaks down ingested food
        • Propels food through the GI tract
        • Absorbs nutrients across wall of lumen of GI tract
        • Absorbs water and salts
        • Eliminates waste
    • Oral Cavity
      • Chemical Digestion
        • Salivary glands produce saliva
        • Contains digestive enzyme
          • Salivary amylase
          • Begins chemical breakdown of carbohydrates
    • Oral Cavity
      • Mechanical Digestion
        • Mastication facilitates swallowing and processing of food
        • Food swallowed by voluntary and involuntary mechanisms
        • Pharynx elevates to receive food from mouth
    • Oral Cavity
      • Mechanical digestion
        • Esophageal sphincter relaxes, opening esophagus
        • Food is pushed into esophagus
        • Epiglottis closes airway to prevent aspiration
    •  
    •  
    • The Gastrointestinal System
      • The Oral Cavity
      • Chemical digestion
      • Mechanical digestion
      • Esophagus
      • Peristaltic waves
    •  
    • Esophagus
      • Muscular canal (24 cm long)
      • Extends from pharynx to stomach
      • Begins below cricoid cartilage
      • Descends to sphincter of stomach
      • Esophagus:
      • Muscular canal
      • About 24 cm long
      • Extends from pharynx to stomach
    • Esophagus
      • Composition
      • Lined with mucous membrane
      • Peristaltic waves push food into stomach
    • Stomach
      • Structure
      • Layered muscular tube
      • Lined with mucous membranes
      • Contains gastric glands
    • Stomach
      • Function
        • Storage and mixing chamber
        • Secretes HCl, intrinsic factor, gastrin, pepsinogen
        • Produces chyme
        • Moves chyme into duodenum
    • Small Intestine
      • Begins at pyloric sphincter
      • Coils through abdominal cavity
      • Opens into large intestine
    • Small Intestine
      • 10 ft divided into 3 segments
        • Duodenum
        • Jejunum
        • Ileum
      • Mixing and propulsion of chyme
      • Absorption of fluid and nutrients
    • Small Intestine
      • Peristaltic contractions
        • Chyme moves through ileocecal valve
      • Chyme enters cecum
      • Cecum distends
        • Sphincter closes
        • Prevents contents from returning to ileum
    • Large Intestine
      • 1.2m (5ft) long
      • 6.2cm (2.2in) in diameter
      • Extends from ileum to anus
      • Attached to abdominal cavity by mesocolon
    • Large Intestine
      • Divided into four principal regions
        • Cecum
        • Colon
        • Rectum
        • Anal canal
    • Large Intestine
      • Absorbs water
      • Absorbs salts
      • Bacteria acts on undigested material
      • Converts chyme into feces
    • Liver
      • Largest gland in body
      • Upper right quadrant
      • Vascular organ with 2 sources of blood supply
        • Hepatic artery
        • Portal vein
      Liver Portal vein Hepatic Artery
    • Liver
      • Plays major role in:
      • Iron metabolism
      • Plasma-protein production
      • Detoxification
    • Liver
      • Secretes bile
        • 600 – 1000 ml each day
        • Dilutes stomach acid (no digestive enzymes)
        • Emulsifies fats
      • Bile salts
        • Reabsorbed in ileum
        • Carried back to liver in blood
        • Also lost in feces
    • Liver
      • Metabolism
        • Helps maintain blood glucose levels
        • Involved in fat and protein metabolism
        • Stores vitamins and minerals
      • Toxin Breakdown
        • Breaks down metabolism by-products
        • Can be toxic if accumulate in the body
    • Liver
      • Blood Protein Production
        • Albumin
        • Fibrinogen
        • Globulin
        • Clotting factors
    • Gallbladder
      • Pear shaped sac
      • 7-10 cm long (3-4”)
      • Located on posterior surface of liver
      • Hangs from anterior/inferior margin of liver
    • Gallbladder
      • Secretes and stores bile produced by the liver
    • Pancreas
      • Gland
      • 12-15 cm (5-6 in) long
      • 2.2 cm (1 in) thick
      • Posterior to the stomach
      • Connected to duodenum by 2 ducts
    • Pancreas
      • Exocrine gland
        • Secretes pancreatic juice
      • Endocrine gland
        • Secretes hormones (insulin) into blood
        • Cells need insulin to process glucose
    • Pancreas
      • Pancreatic juice
        • Most important digestive juice
        • Contains digestive enzymes, sodium bicarbonate and alkaline substances
        • Neutralizes HCl in juices entering small intestine
    • Nasogastric Intubation
    • NG Tube Indications
      • Aspirate stomach contents
        • Diagnostic or therapeutic
      • Assessment of GI bleeding
      • Determine gastric acid content
    • NG Tube Indications
      • Treat paralytic ileus
      • Treat intestinal obstruction
      • Recurrent vomiting likely
      • Trauma
      • Overdose
    • NG Tube Contraindications
      • Esophageal strictures
      • Alkali ingestion, caustic ingestions, esophageal burns
      • Comatose patients
    • NG Tube Contraindications
      • Trauma patients with:
        • Cervical or intracranial bleeding
        • Increased intracranial pressure
      • Recent surgery of the following types:
        • Oropharyngeal
        • Nasal
        • Gastric
    • Inserting NG Tube
      • Explain procedure
      • Position patient
        • High Fowler if alert
        • Drape
        • Emesis basin
        • Water and straw
    • Inserting NG Tube
      • Unconscious patient
        • Left lateral position
        • Head turned to downward side
        • Gag and cough reflexes absent or suppressed
        • NG tube easily misplaced (lung)
        • Inability to swallow
    • Inserting NG Tube
      • Check nares for patency
      • Select appropriate tube size
      • Determine length of insertion
        • Tip of nose, to ear, to xiphoid process
        • Mark tube
    • Inserting NG Tube
      • Lubricate tube
        • Lubricant must be water-soluble
        • May use topical anesthetic if available (ie, lidocaine)
      • Coil tube to shape it into curve
      • Have patient hold water and straw to mouth
    • Inserting NG Tube
      • Insert tube
        • Along floor of nose
        • Straight back
        • Advance until resistance felt (nasopharynx)
    • Inserting NG Tube
      • Ask patient to swallow sips of water and flex neck slightly.
      • As patient swallows, advance tube into and down esophagus.
    • Inserting NG Tube
      • When tube is in the esophagus:
        • Advance rapidly to the pre-marked distance
      • Excessive choking, gagging, coughing, change in voice or condensation inside the tube indicates possibility of placement in trachea. The tube should be withdrawn.
    • Confirm NG Tube Placement
      • X-ray
        • Most reliable if tube is radiopaque
        • Requires order from physician
      • Injecting air
        • 60 cc catheter syringe
        • Place stethoscope over LUQ of abdomen
        • Inject air into lumen of tube, NOT blue pigtail
        • Listen for “swoosh” sound
    • Confirm NG Tube Placement
      • Aspirate stomach contents
        • 60 cc catheter tip syringe
        • Pull back to check for gastric aspirate
        • Possibility for fluid to be from lungs or pleural space
    • Confirm NG Tube Placement
      • Test pH of gastric aspirate
        • 60 cc catheter-tip syringe and pH paper
        • pH < 4 = 95% chance that tip is in stomach
        • pH > 6 = may be in lung or pleural space; could be in stomach if patient takes antacids or some medications
    • Confirm NG Tube Placement
      • Non-radiopaque methods
        • Possibility of error
        • Use more than one method
        • Passage into lungs frequent; especially in comatose or demented patients
        • Aspiration of gastric contents more reliable
          • Especially if tested with pH paper
    • Securing the Tube
      • Secure to patient’s nose
        • Tape to nose and coil around tube
        • Avoid pressure to nares
        • Secure to patient’s clothing near shoulder area
        • Blue pigtail must be above level of patient’s stomach
    • Complications
      • Excessive coughing, motion, gagging may aggravate the following:
      • Neck injuries
        • Increased risk for C-spine injuries
      • Penetrating neck wounds
        • May increase hemorrhage
      • Tube misplacement
        • Pulmonary
        • Intracranial
    • Removing NG Tube
      • Disconnect from drainage container and suction (if applicable)
      • Attach syringe-tip catheter to lumen of tube
      • Flush tube with 20cc of air
        • Empties contents from tube to prevent aspiration into lungs
    • Removing NG Tube
      • Remove tape from patient’s nose
      • Unpin tube from gown
      • Have patient take deep breath and hold while tube is removed
      • Pull tube with quick and steady motion
      • Discard appropriately
      • Provide or instruct patient on oral and nasal care