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Nasogastric Tube (NGT) insertion and removal

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Nasogastric Tube (NGT) insertion and removal

  1. 1. Nasogastric tube (NGT) insertion and removal Nursing Procedure
  2. 2. <ul><li>Usually inserted to decompress the stomach , a nasogastric tube (NG) tube prevent vomiting after major surgery . An NG typically is in place for 48-72 hours after surgery, by which time peristalsis usually resumes. </li></ul>
  3. 3. The NG tube can also be used to assess and treat: <ul><li>Upper GI bleeding </li></ul><ul><li>Collect gastric contents for analysis </li></ul><ul><li>Perform gastric lavage </li></ul><ul><li>Aspirate gastric secretions </li></ul><ul><li>Administer medications and nutrients </li></ul>
  4. 4. Equipments needed
  5. 5. Equipments needed <ul><li>Tube (usually #12, #14, #16 or #18 French for a normal adult. </li></ul>
  6. 6. Equipments needed <ul><li>Towel or linen-saver pad </li></ul>
  7. 7. Equipments needed <ul><li>Penlight </li></ul>
  8. 8. Equipments needed <ul><li>1” or 2” hypoallergenic tape or Opsite </li></ul>
  9. 9. Equipments needed <ul><li>Liquid skin barrier </li></ul>
  10. 10. Equipments needed <ul><li>Gloves </li></ul>
  11. 11. Equipments needed <ul><li>Water soluble lubricant </li></ul>
  12. 12. Equipments needed <ul><li>Cup or glass of water with straw (if appropriate) </li></ul>
  13. 13. Equipments needed <ul><li>Stethoscope </li></ul>
  14. 14. Equipments needed <ul><li>Tongue blade </li></ul>
  15. 15. Equipments needed <ul><li>Catheter-tip or bulb syringe or irrigation set </li></ul>
  16. 16. Equipments needed <ul><li>Safety pin </li></ul>
  17. 17. Equipments needed <ul><li>Ordered suction equipment </li></ul>
  18. 18. Equipments needed (optional) <ul><li>Metal clamp </li></ul>
  19. 19. Equipments needed (optional) <ul><li>Ice </li></ul>
  20. 20. Equipments needed (optional) <ul><li>Alcohol pad </li></ul>
  21. 21. Equipments needed (optional) <ul><li>Warm water </li></ul><ul><li>(in the picture is a hot water bag) </li></ul>
  22. 22. Equipments needed (optional) <ul><li>Large basin or plastic container </li></ul>
  23. 23. Equipments needed (optional) <ul><li>Rubber band </li></ul>
  24. 24. Preparation <ul><li>To ease insertion, increase a stiff tube’s flexibility by coiling it around your finger for a few seconds or by dipping it into warm water. </li></ul><ul><li>Stiffen a limp rubber tube by briefly chilling it in ice. </li></ul>
  25. 25. Procedure <ul><li>Provide privacy, wash your hands, and put on gloves. </li></ul>
  26. 26. Inserting an NG tube <ul><li>Explain the procedure to the patient. </li></ul><ul><li>Tell her that she may experience some discomfort and that swallowing will ease the tube’s advancement. </li></ul>
  27. 28. Inserting an NG tube <ul><li>Help the patient into high Fowler’s position unless contraindicated. </li></ul>
  28. 29. Inserting an NG tube <ul><li>Stand at the patient’s right side if you’re right-handed or at her left side if you’ left-handed to ease insertion . </li></ul>
  29. 30. Inserting an NG tube <ul><li>Drape the towel or linen-saver pad over the patient’s chest. </li></ul>
  30. 31. Inserting an NG tube <ul><li>To determine how long the NG tube must be to reach the stomach , hold the end of the tube at the tip of the patient’s nose. </li></ul><ul><li>Extend the tube to the patient’s earlobe and then down to the xiphoid process. </li></ul>
  31. 33. Inserting an NG tube <ul><li>Mark this distance on the tubing with tape. </li></ul>
  32. 34. Inserting an NG tube <ul><li>To determine which nostril will allow easier access , use a penlight and inspect for a deviated septum or other abnormalities. </li></ul>
  33. 36. Inserting an NG tube <ul><li>Lubricate the first 3” (7.6 cm) of the tube with a water-soluble gel. </li></ul>
  34. 38. Inserting an NG tube <ul><li>Instruct the patient to hold her head straight and upright. </li></ul>
  35. 39. Inserting an NG tube <ul><li>Grasp the tube with the end pointing downward, curve it if necessary, and carefully insert it into the more patient nostril. </li></ul>
  36. 41. Inserting an NG tube <ul><li>Aim the tube downward and toward the ear closest to the chosen nostril. </li></ul><ul><li>Advance it slowly to avoid pressure on the turbinates and resultant pain and bleeding. </li></ul>
  37. 42. Inserting an NG tube <ul><li>When the tube reaches the nasopharynx, you’ll feel resistance. </li></ul>
  38. 44. Inserting an NG tube <ul><li>Instruct the patient to lower her head slightly to close the trachea and open the esophagus. </li></ul>
  39. 46. Inserting an NG tube <ul><li>Then rotate the tube 180 degrees toward the opposite nostril to redirect it so that the tube wont enter the patient’s mouth. </li></ul>
  40. 47. Inserting an NG tube <ul><li>Unless contraindicated, offer the patient a cup of water with a straw. </li></ul><ul><li>Direct her to sip and swallow as you slowly advance the tube. </li></ul><ul><li>This helps the tube pass to the esophagus. (If you aren’t using water, ask the patient to swallow.) </li></ul>
  41. 49. Ensuring proper tube placement <ul><li>Use a tongue blade and penlight to examine the patient’s mouth and throat for signs of a coiled section of tubing. </li></ul>
  42. 50. Ensuring proper tube placement <ul><li>As you carefully advance the tube and the patient swallows, watch for respiratory distress signs, which may mean the tube is in bronchus and must be removed immediately. </li></ul>
  43. 51. Ensuring proper tube placement <ul><li>Stop advancing the tube when the tape mark reaches the patient’s nostril. </li></ul>
  44. 52. Ensuring proper tube placement <ul><li>Attach the catheter-tip or bulb syringe to the tube and try to aspirate stomach contents. </li></ul>
  45. 54. Ensuring proper tube placement <ul><li>If you don’t obtain stomach contents, position the patient on her left side to move the contents into the stomach’s greater curvature, and aspirate again. </li></ul>
  46. 55. Ensuring proper tube placement <ul><li>If you still can’t aspirate stomach contents, advance the tube 1” to 2” (2.5 - 5 cm). </li></ul><ul><li>Then inject 10cc air into the tube. </li></ul>
  47. 56. Ensuring proper tube placement <ul><li>At the same time, auscultate for air sounds with your stethoscope placed over the epigastric region. </li></ul><ul><li>You should hear a whooshing sound if the tube is patent and properly positioned in the stomach. </li></ul>
  48. 58. Ensuring proper tube placement <ul><li>If these test don’t confirm proper tube placement, you’ll need X-ray verification. </li></ul>
  49. 60. Example of a CXR showing a misplaced NG tube
  50. 61. Ensuring proper tube placement <ul><li>Secure the NG tube to the patient’s nose with hypoallergenic tape, (or other designated tube holder). </li></ul><ul><li>If the patient’s skin is oily, wipe the bridge of her nose with an alcohol pad and allow to dry. </li></ul>
  51. 64. Ensuring proper tube placement <ul><li>Apply liquid skin barrier to make the tape more adherent to the skin. </li></ul>
  52. 65. Ensuring proper tube placement <ul><li>You’ll need about 4” (10 cm) of 1”tape. </li></ul><ul><li>Split one end of the tape up the center about 1 ½” (3.8 cm). </li></ul><ul><li>Make tabs on the split ends (by folding sticky sides together). </li></ul>
  53. 66. Ensuring proper tube placement <ul><li>Stick the uncut tape end on the patient’s nose so that the split in the tape starts about ½” (1.3 cm) to 1 ½” from the tip of her nose. </li></ul>
  54. 67. Ensuring proper tube placement <ul><li>Crisscross the tabbed ends around the tube. </li></ul><ul><li>Then apply another piece of tape over the bridge of the nose to secure the tube. </li></ul>
  55. 68. Ensuring proper tube placement <ul><li>Alternatively, stabilize the tube with Opsite or a prepackaged product that secures and cushions it at the nose. </li></ul>
  56. 69. Ensuring proper tube placement <ul><li>To reduce discomfort from the weight of the tube, tie a slipknot around the tube with a rubber band, and then secure the rubber band to the patient’s gown with a safety pin, or wrap another piece of tape around the end of the tube and leave a tab. </li></ul><ul><li>Then fasten the tape tab to the patient’s gown. </li></ul>
  57. 70. Ensuring proper tube placement <ul><li>Attach the tube to suction equipment, if ordered, and set the designated suction pressure. </li></ul>
  58. 71. Ensuring proper tube placement <ul><li>Provide frequent nose and mouth care while the tube is in place. </li></ul><ul><li>An NG tube may be inserted or removed at home. </li></ul>
  59. 72. *Confirming NG tube placement <ul><li>When confirming NG tube placement, never place the tube’s end in a container of water. </li></ul><ul><li>If the tube is malpositioned in the trachea, the patient may aspirate water. </li></ul>
  60. 73. *Confirming NG tube placement <ul><li>Besides, water without bubbles doesn’t confirm proper placement. </li></ul><ul><li>Instead, the tube may be coiled in the trachea or the esophagus. </li></ul>
  61. 74. Removing an NG tube <ul><li>Explain the procedure to the patient and that it may cause some discomfort. </li></ul>
  62. 76. Removing an NG tube <ul><li>Assess bowel function by auscultating for peristalsis or flatus. </li></ul>
  63. 78. Removing an NG tube <ul><li>Help the patient into semi-Fowler’s position. </li></ul><ul><li>Then drape a towel or linen-saver pad across her chest to protect her from spills. </li></ul>
  64. 80. Removing an NG tube <ul><li>Put on gloves. </li></ul><ul><li>Using a catheter-tip syringe, flush the tube with 10ml of normal saline solution to ensure that the tube doesn’t contain stomach contents that could irritate tissues during tube removal. </li></ul>
  65. 82. Removing an NG tube <ul><li>Untape the tube from the patient’s nose, and then unpin it from her gown. </li></ul>
  66. 83. <ul><li>Please wear gloves!!! </li></ul>
  67. 84. Removing an NG tube <ul><li>Clamp the tube by folding it in your hand. </li></ul>
  68. 85. Removing an NG tube <ul><li>Ask the patient to hold her breath to close the epiglottis. </li></ul><ul><li>Then withdraw the tube gently and steadily. (when the distal end of the tube reaches the nasopharynx, you can pull it quickly.) </li></ul>
  69. 86. <ul><li>Please wear gloves!!! </li></ul>
  70. 87. Removing an NG tube <ul><li>Assist the patient with thorough mouth care, and clean the tape residue from her nose with adhesive remover. </li></ul>
  71. 88. Removing an NG tube <ul><li>Monitor the patient for signs of GI dysfunction. </li></ul>
  72. 90. Pointers <ul><li>If the patient has a nasal condition that prevents nasal insertion, pass the tube orally after removing any dentures, if necessary. </li></ul>
  73. 91. Pointers <ul><li>First coil the end of the tube around your hand. </li></ul><ul><li>This helps curve and direct the tube downward at the phaynx. </li></ul>
  74. 92. Pointers <ul><li>While advancing the tube. </li></ul><ul><li>Observe for signs that it is entered the trachea, such as choking or breathing difficulties in a conscious patient and cyanosis in an unconscious patient or a patient without a cough reflex. </li></ul>
  75. 94. Pointers <ul><li>If these signs occur, remove the tube immediately. </li></ul><ul><li>Allow the patient time to rest; then try to reinsert the tube. </li></ul>
  76. 95. Pointers <ul><li>After tube placement, vomiting suggest tubal obstruction or incorrect position. </li></ul><ul><li>Assess immediately to determine the cause. </li></ul>
  77. 96. Complications of NG intubation <ul><li>Although nasogastric (NG) intubation is a common procedure, it does carry risk. </li></ul>
  78. 97. Complications of NG intubation (Long-term concerns) <ul><li>Potential complications of prolonged intubation includes: </li></ul><ul><ul><li>Esophagitis </li></ul></ul><ul><ul><li>Esophagotracheal fistula </li></ul></ul><ul><ul><li>Gastric ulceration </li></ul></ul><ul><ul><li>Pulmonary and oral infection </li></ul></ul><ul><ul><li>Sinusitis </li></ul></ul><ul><ul><li>Skin erosion at the nostril </li></ul></ul>
  79. 98. Complications of NG intubation (Suction reactions) <ul><li>Additional complications include: </li></ul><ul><ul><li>Electrolyte imbalances </li></ul></ul><ul><ul><li>Dehydration </li></ul></ul>
  80. 99. Complications of NG intubation (Suction reactions) <ul><li>Vigorous suction ,ay damage the gastric mucosa and cause significant bleeding, possibly interfering with endoscopic assessment and diagnosis. </li></ul>
  81. 100. Using an NG tube at home <ul><li>If your patient will have a nasogastric (NG) tube in place at home, find out who will insert the tube. </li></ul><ul><li>If he will have a home care nurse, tell him to expect her. </li></ul>
  82. 101. Using an NG tube at home <ul><li>Make a list; check it twice </li></ul><ul><li>If the patient or a family member will perform the procedure, you’ll need to provide additional instruction and supervision. </li></ul>
  83. 102. Using an NG tube at home <ul><li>Use this checklist to prepare teaching topics: </li></ul><ul><ul><li>How and where to obtain equipment needed for home intubation. </li></ul></ul><ul><ul><li>How to insert the tube. </li></ul></ul>
  84. 103. Using an NG tube at home <ul><ul><li>How to verify tube placement by aspirating stomach contents. </li></ul></ul><ul><ul><li>How to correct tube misplacement. </li></ul></ul><ul><ul><li>How to prepare formula for tube feeding. </li></ul></ul><ul><ul><li>How to store formula, if appropriate. </li></ul></ul>
  85. 104. Using an NG tube at home <ul><ul><li>How to administer formula through the tube. </li></ul></ul><ul><ul><li>How to remove and dispose of an NG tube. </li></ul></ul><ul><ul><li>How to clean and store a reusable NG tube. </li></ul></ul>
  86. 105. Using an NG tube at home <ul><ul><li>How to use the NG tube for gastric decompression, if appropriate. </li></ul></ul><ul><ul><li>How to set up and operate suctioning equipment. </li></ul></ul><ul><ul><li>How to troubleshoot suctioning equipment. </li></ul></ul><ul><ul><li>How to perform mouth care and other hygenic procedures. </li></ul></ul>
  87. 106. “ Nurses Informations” http://nursesinformations.blogspot.com
  88. 107. <ul><li>All rights reserved 2008 </li></ul><ul><li>“ Nurses Informations” </li></ul>

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