Nasogastric Tube (NGT) insertion and removal

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Nasogastric tube (NGT) insertion and removal Nursing Procedure

<ul><li>Usually inserted to decompress the stomach , a nasogastric tube (NG) tube prevent vomiting after major surgery ....

The NG tube can also be used to assess and treat: <ul><li>Upper GI bleeding </li></ul><ul><li>Collect gastric contents for...

Equipments needed

Equipments needed <ul><li>Tube (usually #12, #14, #16 or #18 French for a normal adult. </li></ul>

Equipments needed <ul><li>Towel or linen-saver pad </li></ul>

Equipments needed <ul><li>Penlight </li></ul>

Equipments needed <ul><li>1” or 2” hypoallergenic tape or Opsite </li></ul>

Equipments needed <ul><li>Liquid skin barrier </li></ul>

Equipments needed <ul><li>Gloves </li></ul>

Equipments needed <ul><li>Water soluble lubricant </li></ul>

Equipments needed <ul><li>Cup or glass of water with straw (if appropriate) </li></ul>

Equipments needed <ul><li>Stethoscope </li></ul>

Equipments needed <ul><li>Tongue blade </li></ul>

Equipments needed <ul><li>Catheter-tip or bulb syringe or irrigation set </li></ul>

Equipments needed <ul><li>Safety pin </li></ul>

Equipments needed <ul><li>Ordered suction equipment </li></ul>

Equipments needed (optional) <ul><li>Metal clamp </li></ul>

Equipments needed (optional) <ul><li>Ice </li></ul>

Equipments needed (optional) <ul><li>Alcohol pad </li></ul>

Equipments needed (optional) <ul><li>Warm water </li></ul><ul><li>(in the picture is a hot water bag) </li></ul>

Equipments needed (optional) <ul><li>Large basin or plastic container </li></ul>

Equipments needed (optional) <ul><li>Rubber band </li></ul>

Preparation <ul><li>To ease insertion, increase a stiff tube’s flexibility by coiling it around your finger for a few sec...

Procedure <ul><li>Provide privacy, wash your hands, and put on gloves. </li></ul>

Inserting an NG tube <ul><li>Explain the procedure to the patient. </li></ul><ul><li>Tell her that she may experience som...

Inserting an NG tube <ul><li>Help the patient into high Fowler’s position unless contraindicated. </li></ul>

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-han...

Inserting an NG tube <ul><li>Drape the towel or linen-saver pad over the patient’s chest. </li></ul>

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 ...

Inserting an NG tube <ul><li>Mark this distance on the tubing with tape. </li></ul>

Inserting an NG tube <ul><li>To determine which nostril will allow easier access , use a penlight and inspect for a deviat...

Inserting an NG tube <ul><li>Lubricate the first 3” (7.6 cm) of the tube with a water-soluble gel. </li></ul>

Inserting an NG tube <ul><li>Instruct the patient to hold her head straight and upright. </li></ul>

Inserting an NG tube <ul><li>Grasp the tube with the end pointing downward, curve it if necessary, and carefully insert it...

Inserting an NG tube <ul><li>Aim the tube downward and toward the ear closest to the chosen nostril. </li></ul><ul><li>Ad...

Inserting an NG tube <ul><li>When the tube reaches the nasopharynx, you’ll feel resistance. </li></ul>

Inserting an NG tube <ul><li>Instruct the patient to lower her head slightly to close the trachea and open the esophagus. ...

Inserting an NG tube <ul><li>Then rotate the tube 180 degrees toward the opposite nostril to redirect it so that the tube...

Inserting an NG tube <ul><li>Unless contraindicated, offer the patient a cup of water with a straw. </li></ul><ul><li>Dir...

Ensuring proper tube placement <ul><li>Use a tongue blade and penlight to examine the patient’s mouth and throat for sign...

Ensuring proper tube placement <ul><li>As you carefully advance the tube and the patient swallows, watch for respiratory d...

Ensuring proper tube placement <ul><li>Stop advancing the tube when the tape mark reaches the patient’s nostril. </li></ul>

Ensuring proper tube placement <ul><li>Attach the catheter-tip or bulb syringe to the tube and try to aspirate stomach con...

Ensuring proper tube placement <ul><li>If you don’t obtain stomach contents, position the patient on her left side to mov...

Ensuring proper tube placement <ul><li>If you still can’t aspirate stomach contents, advance the tube 1” to 2” (2.5 - 5 cm...

Ensuring proper tube placement <ul><li>At the same time, auscultate for air sounds with your stethoscope placed over the e...

Ensuring proper tube placement <ul><li>If these test don’t confirm proper tube placement, you’ll need X-ray verification. ...

Example of a CXR showing a misplaced NG tube

Ensuring proper tube placement <ul><li>Secure the NG tube to the patient’s nose with hypoallergenic tape, (or other design...

Ensuring proper tube placement <ul><li>Apply liquid skin barrier to make the tape more adherent to the skin. </li></ul>

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 tap...

Ensuring proper tube placement <ul><li>Stick the uncut tape end on the patient’s nose so that the split in the tape starts...

Ensuring proper tube placement <ul><li>Crisscross the tabbed ends around the tube. </li></ul><ul><li>Then apply another p...

Ensuring proper tube placement <ul><li>Alternatively, stabilize the tube with Opsite or a prepackaged product that secures...

Ensuring proper tube placement <ul><li>To reduce discomfort from the weight of the tube, tie a slipknot around the tube wi...

Ensuring proper tube placement <ul><li>Attach the tube to suction equipment, if ordered, and set the designated suction pr...

Ensuring proper tube placement <ul><li>Provide frequent nose and mouth care while the tube is in place. </li></ul><ul><li>...

*Confirming NG tube placement <ul><li>When confirming NG tube placement, never place the tube’s end in a container of wate...

*Confirming NG tube placement <ul><li>Besides, water without bubbles doesn’t confirm proper placement. </li></ul><ul><li>I...

Removing an NG tube <ul><li>Explain the procedure to the patient and that it may cause some discomfort. </li></ul>

Removing an NG tube <ul><li>Assess bowel function by auscultating for peristalsis or flatus. </li></ul>

Removing an NG tube <ul><li>Help the patient into semi-Fowler’s position. </li></ul><ul><li>Then drape a towel or linen-s...

Removing an NG tube <ul><li>Put on gloves. </li></ul><ul><li>Using a catheter-tip syringe, flush the tube with 10ml of no...

Removing an NG tube <ul><li>Untape the tube from the patient’s nose, and then unpin it from her gown. </li></ul>

<ul><li>Please wear gloves!!! </li></ul>

Removing an NG tube <ul><li>Clamp the tube by folding it in your hand. </li></ul>

Removing an NG tube <ul><li>Ask the patient to hold her breath to close the epiglottis. </li></ul><ul><li>Then withdraw t...

<ul><li>Please wear gloves!!! </li></ul>

Removing an NG tube <ul><li>Assist the patient with thorough mouth care, and clean the tape residue from her nose with adh...

Removing an NG tube <ul><li>Monitor the patient for signs of GI dysfunction. </li></ul>

Pointers <ul><li>If the patient has a nasal condition that prevents nasal insertion, pass the tube orally after removing...

Pointers <ul><li>First coil the end of the tube around your hand. </li></ul><ul><li>This helps curve and direct the tube ...

Pointers <ul><li>While advancing the tube. </li></ul><ul><li>Observe for signs that it is entered the trachea, such as cho...

Pointers <ul><li>If these signs occur, remove the tube immediately. </li></ul><ul><li>Allow the patient time to rest; then...

Pointers <ul><li>After tube placement, vomiting suggest tubal obstruction or incorrect position. </li></ul><ul><li>Assess ...

Complications of NG intubation <ul><li>Although nasogastric (NG) intubation is a common procedure, it does carry risk. </l...

Complications of NG intubation (Long-term concerns) <ul><li>Potential complications of prolonged intubation includes: </li...

Complications of NG intubation (Suction reactions) <ul><li>Additional complications include: </li></ul><ul><ul><li>Electro...

Complications of NG intubation (Suction reactions) <ul><li>Vigorous suction ,ay damage the gastric mucosa and cause signif...

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 ins...

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 perf...

Using an NG tube at home <ul><li>Use this checklist to prepare teaching topics: </li></ul><ul><ul><li>How and where to obt...

Using an NG tube at home <ul><ul><li>How to verify tube placement by aspirating stomach contents. </li></ul></ul><ul><ul><...

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 ...

Using an NG tube at home <ul><ul><li>How to use the NG tube for gastric decompression, if appropriate. </li></ul></ul><ul>...

“ Nurses Informations” http://nursesinformations.blogspot.com

<ul><li>All rights reserved 2008 </li></ul><ul><li>“ Nurses Informations” </li></ul>

Share Slideshare

LinkedIn
Facebook
Twitter

Embed

Size (px)

Show related Slideshows at end

WordPress Shortcode

Link

Share
Email

Anaesthetic problems of open chest ... by aratimohan 8718 views
Nasogastrik tube by AKADEMI KEBIDANAN... 17261 views
Nasogastric intubation by Roughllen Heiljhe... 7498 views
Catheter care by Amanda Johnson 97775 views
Reusable resuscitator by Sarthak Jain 4096 views
Airway suctioning by Siva Nanda Reddy 28881 views

View on Slideshare

1 of 107 Ad

View on Slideshare

1 of 107 Ad