Fundamental of nursing for nursing students

1. Gastrointestinal Intubation
• Nasogastric intubation refers to insertion of a tube through
the nostril into the stomach.
• Nasoduodenal or nasojejunal intubation allows nasal
access to the duodenum and jejunum; it is done with a
longer tube and decreases the client’s risk of vomiting and
aspiration.

2. INDICATIONS of GI Intubation
• Prevention and/or treatment of nausea and vomiting
• Gastric decompression to facilitate some intra-abdominal surgical
procedures(to reduce pressure with in stomach)
• Enteral administration of drugs or radiographic material
• Evaluation of gastric pH/To aspirate gastric contents for analysis
• Enteral nutrition
• To lavage the stomach and remove ingested toxins

3. Nasogastric tube-size
Nasogastric tube-size
Distance from nose to earlobe to Xiphoid = NEX
formula for length of NGT
• adult patients -14 to 18 French(1F = 33 mm diameter)
 paediatric patients:
• In paediatric patients, the correct tube
size varies with the patient's age
• To find the correct size, add 16 to the patient's age in
years and then divide by 2 (e.g., [8 y + 16]/2 = 12F)

4. equipment
• NG Tube
• syringe, 30ml--50ml.
• Emesis basin.
• Paper tissues.
• Water soluble lubricant.
• Glass of water and straw.
• Stethoscope.
• Bath towel or pad.
• Clamp for tubing.
• Adhesive tape.
• Tongue blade

5. Cont…
• PPE( Disposable gloves, goggles, gown)
• Portable suction equipment
• pH chemstrip
• Penlight or flashlight
• Marker
• Safety pin
• Plaster
• Garbage(waste disposal container)
• Viscous lidocaine 2% Oral analgesic spray
(Benzocaine spray or other),Syringe, 10 mL

6. procedure
`1. Introduce your self to the patient
2. Explain the procedure to the patient.
3. Wash your hands and dry it
4.Collect the required equipment then
• Remove dentures, if any to prevent them from
dislodging or blocking the respiratory tract
• Place client in Fowler’s position, at least a 45° angle or
higher, with a pillow behind client’s
shoulders; Place comatose clients in semi-Fowler’s
position
• Explain the importance of not tilting the head
backwards.

7. Cont…
5. wash hands and put on gloves to reduce the risk of cross-infection
done examination glove
6. Place towel over chest, put tissues in reach
• . Examine nostrils and assess as client breathes through each nostril.
Use a flashlight to view the client’s nostril.
7.Determine the length of tube required to be inserted if the tip of the
tube is to lie in the stomach by:-
 Measure from bridge of client’s nose to earlobe to xiphoid process
of sternum.
 If tube is to go below stomach (nasoduodenal or nasojejunal), add an
additional 15 to 20 cm
 Place a small piece of tape on tube to mark length

8. FIGURE 1. Placing patient in semi- to
high Fowler’s position in

9. Figure 2: Measuring distance from
nose to earlobe and from earlobe
to xiphoid process of sternum

10. Procedure cont..
8. Lubricate first 4 inches of tube with water
soluble lubricant.
• Ask patient to blow his/her nose or clean
nostril gently
9. Introduce the tube into the nostril and
advance it forward. If obstruction is
encountered, withdraw slightly then advance
the tube at a slightly different angle

11. FIGURE 3. Beginning insertion with patient
positioned with
head up

12. FIGURE 4.Advancing tube while patient drops chin to
chest and swallows
10. If the patient can co-operate request that when the tip of the tube
is felt in the throat (oropharynx) he/she swallows tilting the chin
downward slightly at the same time. This process may also be aided
by sipping water through a straw.

13. FIGURE 5. Applying tape to patient’s
nose

14. FIGURE 6. Secure tube
with tape

15. PROCEDURE cont’d
11. CAUTION: Discontinue insertion immediately if the patient
coughs or chokes. Remove the tube completely. Allow the
patient to rest for a few minutes before attempting reinsertion.
Discontinue the procedure again if coughing, choking, or excessive
gagging occurs. Report two unsuccessful attempts to the professional
nurse
• Advance the tube forward maintaining a calm manner at all
time encouraging the patient to take slow even breaths

16. Cont…
12.When the mark on the tube reaches the nostril, tape the tube to the
cheek and check the position of the tip.
13. Check the position of the tube by :-
 Attach the syringe to the end of the tube for injecting 10 cc of air and
auscultate over the epigastric area (upper left quadrant).
 Aspirate sample gastric content and measure with chemstrip pH.
 Prepare the client for x-ray check-up, if prescribed.
 Observe bubbling sound in the kidneydish

17. Cont…
14. Secure the tube with rubber band and safety pin to client’s gown or
bed sheet.
• Provide oral hygiene and cleanse nares
15. Remove gloves, dispose of contaminated materials in proper
container, and wash hands.
16. Return material
• Position client comfortably and place the call light in easy reach.

18. Cont…
17. Document procedure.
• The reason for the tube insertion
• The type of tube inserted
• The nature and amount of aspirate and drainage
• The client’s tolerance of the procedure
• The effectiveness of the intervention, such as nausea relieved

19. CONTRAINDICATIONS of NGT insertion
• Basilar skull fracture
• Nasal or other trauma that might affect insertion
• Sinus surgery
• Nasopharyngeal tumors
• Esophageal varices
• Recent esophageal surgery
• Esophageal stricture
• Patient refusal

20. The complications of nasogastric intubation may
include:
• aspiration of the stomach contents leading to asphyxia,
abscess or aspiration pneumonia;
• trauma injury including perforation of the nasal,
pharyngeal, esophageal or gastric tissue
• pulmonary hemorrhage, empyema, pneumothorax, pleural
effusion or pneumonitis from a malpositioned tube
• Nosebleeds
• Esophageal perforation

21. The complications of nasogastric intubation may include
cont’d:
• secondary infection in the sinus, throat,
esophagus or stomach
• development of a tracheal-esophageal fistula
• erosion and/or necrosis of nasal, pharyngeal,
esophageal or gastric tissue