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Naso-Gastric Tube Insertion Steps
- 1. RYLES TUBE INSERTION BY NAVEED PASHA A
- 2. R.T.INSERTION DEFINITION: - NASOGASTRIC TUBE INSERTION MEANS THE INTRODUCTION OF A TUBE INTO THE STOMACH FOR THERAPEUTIC OR DIAGNOSTIC PURPOSES. GASTRIC GAVAGE – IS A ARTIFICIAL METHOD OF GIVING FLUID AND NUTRIENT THROUGH A TUBE, THAT HAS PASSED THROUGH THE NOSE.
- 3. INDICATION – PERFORMING A GAVAGE – FORARTIFICIAL FEEDING THE PATIENT ADMINISTRATION OF ORAL MEDICATIONS THAT CANNOT BE SWALLOWED. ASPIRATION OF GASTRIC CONTENT (LAVAGE) – FLUID, FOOD, OR GAS. TO CORRECT FLUID AND ELECTROLYTE IMBALANCE.
- 4. ALLEVIATES DISCOMFORT DUE TO NAUSEA, VOMITING & REDUCES THE POSSIBILITY OF ASPIRATION OBTAINING A SAMPLE OF SECRETION FOR DIAGNOSTIC TESTING. CONTROLLING GASTRIC BLEEDING A PROCESS CALLED COMPRESSION. ON TAMPONADE ( PRESSURE
- 5. EQUIPMENT: - NASOGASTRIC TUBE (E.G. LEVIN, SALEM) 14, OR 16 FT. NG TUBE SYRINGE WATER SOLUBLE LUBRICANT TOWEL EMESIS BASIN STETHOSCOPE GLASS OF WATER CLEAN GLOVE FLASHLIGHT TAPE SCISSOR BOWEL WITH WATER
- 6. PREPARATION OF PATIENT— EXPLAIN THE PROCEDURE TO THE PATIENT AND ASK FOR PATIENT’S CO-OPERATION PROVIDE PRIVACY PLACE THE PATIENT IN FOWLER’S POSITION, MAKE THE PATIENT COMFORTABLE PLACE MACKINTOSH AND TOWEL ACROSS THE CHEST AND UNDER THE CHIN GIVE A MOUTH WASH AND HELP HIM TO CLEAN THE TEETH. CLEAN THE NOSTRILS, IF THERE IS SECRETION OR CRUST FORMATION, USING SWAB STICK DIPPED IN SALINE OR SODA BICARB SOLUTION. www.drjayeshpatidar.blogspot.in
- 7. PREPARATION OF UNIT— ARRANGE THE ARTICLES CONVENIENTLY ON THE BEDSIDE LOCKER. ROOM SHOULD BE WELL VENTILATED SEND VISITORS AWAY FROM THE ROOM
- 12. PROCEDURE STEPS WASH HANDS ELEVATE HEAD END OF BED TO 45ºANGLE PLACE THE TOWEL OVER CLIENTS CHEST AND EMESIS BASIN WITH IN REACH RATIONALE TO PREVENT CROSS INFECTION HEAD ELEVATION PROMOTES SAFETY DURING TUBE INSERTION. CLIENT MAYEXPERIENCE DISCOMFORT OR MAY GAG OR VOMIT DURING TUBE INSERTION. AND AVOID SOILING OF CLOTHES
- 13. STEPS RA TIONALE INSPECT CLIENTS NOSE TO DETERMINE LENGTH OF TUBE TO BE INSERTED, MEASURE FROM TIPOF CLIENTS NOSE TO EARLOBE AND FROM EARLOBE TO XIPHOID PROESS OF STERNUM MARK DETERMINED DISTANCE ON TUBE WITH TAPE OR PEN. CHECK FOR NASAL INFECTION OR ANY DEVIATION. THIS LENGTH SHOULD BE SUFFICIENT TO ADVANCE TUBE INTO CLIENT’S STOMACH.
- 14. STEPS RA TIONALE LUBRICATE THE 6 TO 8 INCH OF TUBE WITH WATER SOLUBLE LUBRICANTS WITH CLIENTS HEAD UPRIGHT OR SLIGHTLY EXTENDED, CAREFULLY INSERT TUBE INTO CLIENTS NOSTRIL AIM IT TOWARDS CLIENT’S EAR AND DOWNWARDAND GENTLYADVANCE IT TOWARDS CLIENT’S NOSOPHARYNX THIS FACILITITATES ADVANCEMENT THROUGH NASAL PASSAGE, AND PREVENTS DAMAGE TO MUCOSA TURNING AND DIRECTING TUBE, IT CONFORMS TOANATOMIC PASSAGEWORK WHEN TUBE REACHES NASOPHARUNX RESISTANCE WILL BE FELT.
- 15. STEPS RA TIONALE HAVE CLIENT OPEN MOUTH AND CHECK WITH LIGHT TO VISUALIZE TUBE. SW ALLOW. TO VERIFY THATTUBE IS ATBACK OF THROAT, AND NOT COILED UP IN MOUTH. ENCOURAGE CLIENT TO ADVANCE TUBEAS CLIENT SWALLOWS. SWALLOWING OPENS UPPER ESOPHAGEAL SPHINCTER ANDALLOWS TUBE TO ENTER ESOPHAGUS.
- 16. STEPS RA TIONALE ONCE TUBE ISADVANCED TOWARD BACK OF THROAT, HAVE CLIENT FLEX HEAD FORWARD, THEN ROTATE TUBE 180ºINWARD. ASPIRATE 20 TO 30 ML OF AIR INTO SYRINGE, ATTACH SYRINGE TO FREE END OF NASOGASTRIC TUBE, TO CHECK FOR TUBE POSITION THIS HELPS DIRECT TUBE PAST NASOPHANYNX TUBE MUST BE PLACED IN CLIENT’S ALIMENTARY CANAL NOT RESPIRATORY TRACT.
- 17. STEPS RATIONALE PLACE STETHOSCOPE THIS INDICATE OVER CLIENT’S THAT TUBE HAS EPIGASTRIC REGION, PROBABLY REACHED THEN INJECT AIRAND STOMACH THEN LISTEN FOR SWOOSHING SOUND. TUBE INADVERTENTLY AUSCULTATION IS NO PLACED IN THE LONGER. CONSIDERED A LUNGS, PHARYNX, OR RELIABLE METHOD FOR ESOPHAGUS CAN VERIFICATION OF TUBE TRANSMIT ASOUND PLACEMENT. SIMILAR TO THAT ENTERING THE STOMACH.
- 18. STEPS RATIONALE KEEPING SYRINGE SECRETION MAY BE ATTACHED, PULL OBTAINED FROM TUBE BACK ON PLUNGER INADVERTENTLY PLACED TO ASPIRATE GASTRIC IN CLIENT’S AIRWAYOR CONTENT. CHECK FOR PLEURAL SPACE PH COLOR AND PH OF TESTING OF ASPIRATED CONTENTS. SECRETION HELPS DETERMINE WHERE TUBE WRAP THE SECURING TAPE HAS BEEN PLACED. TO STABILIZE TUBE AROUND NASOGASTIC TUBE.
- 19. STEPS RATIONALE PIN TAPE OR RUBBER BAND TO CLIENT’S GOWN TO SECURE TUBE ABOVE CLIENT’S STOMACH. PLUG END OF TUBE, OR CONNECT END OF TUBE TO INTERMITTED/ CONTINUOUS SUCTION DEVICE IF THE TUBE IS PULLED TENSION WILL BE PLACED AT PINNED SITE RATHER THAN CLIENTS NAIRS. FOR DECOMPRESSION.
- 20. RECORDING AND REPORTING RECORD AND REPORT TYPE AND SIZE OF TUBE PLACED, CLIENTS TOLERANCE OF PROCEDURE CONFIRMATION OF TUBE POSITION BY X- RAY. CHECKING PLACEMENT – ASPIRATION FLUID – ASPIRATED FLUID APPEARS CLEAR, BROWNISH – YELLOW ON GREEN.
- 21. AUSCULTATION OF ABDOMEN – NURSE I INSTILLS 10 ML OF AIR WHILE LISTENING WITH THE STETHOSCOPE OVER THE ABDOMEN, IF A SWOOSHING SOUND IS HEARD THE NURSE CAN REFER THAT IT WAS CAUSED BY THE AIR ENTERING THE STOMACH. BLEACHING OFTEN INDICATES THAT THE TIP IS STILL IN THE ESOPHAGUS CONTINUES BUBBLE SHOWS PLACEMENT OF TUBE IN LUNGS
- 22. TESTING PH OF ASPIRATED FLUID ASPIRATE SMALL VOLUME OF FLUID FROM THE TUBE WITH A CLEAN SYRINGE DROP A SAMPLE OF GASTRIC FLUID ONTO AN INDICATION STRIP. COLOUR OF TEST STRIP CHANGES ACCORDING TO THE HYDROGEN ION CONCENTRATION OF LIQUID . STOMACH FLUID USUALLY HAS PH OF 1 – 3 ACIDIC IF PH 5 TO 6 , PATIENT RECEIVING MEDICATION TO DECREASE GARTNIC ACIDITY OF FLUID MAY BE FROM DUODENUM PH OF 7, OR GREATER INDICATES THAT TUBE IS IN RESPIRATORY TRACT.
- 23. Thank you