Gastric aspiration and analysis are advanced nursing procedures used to relieve stomach distension, remove stomach contents, and collect samples for diagnostic purposes. Key steps include inserting a nasogastric tube and confirming proper placement in the stomach, then aspirating gastric fluid and collecting samples. Stimulants may be given to increase fluid production before additional samples are taken. Precautions are needed to monitor for potential risks like pain, bleeding, or perforation. Gastrostomy tube feeding involves surgically placing a tube directly into the stomach to deliver food or medications for those unable to eat normally. Equipment is used to administer prescribed fluids through the tube while positioning the patient correctly and monitoring for complications.

1. Provide advanced nursing care
(HLT NUR4 01222)
For Regular Nursing (Level Iv – TVET) Students
AAMBC, January 2023
Performing and assisting advanced nursing
procedures

3. Definition:
• Gastric Aspiration is the withdrawal of fluid or gas from gastric cavity by
sectioning.

4. Purpose
• To relieve stomach or intestinal distension following abdominal surgery
• In case of gastrointestinal obstruction to remove the stomach content
• To keep the stomach empty before an emergency abdominal operation is
done
• To aspirate the stomach contents for diagnostic purpose ,like
• Detect acid-fast bacillus in a client with undiagnosed tuberculosis,
• Total absence of hydrochloric acid is diagnostic of pernicious anaemia

5. Equipments
• Nasogastric tube (NGT)
• Syringe with needle((2)
• 50ml syringe
• Towel
• Water with kidney dish
• Specimen container
• Sphygmomanometer
• Litmus paper
• Adhesive tape
• Chart
• Tray
• Gauze
• Draw sheet rubber
sheet
• Spigot
• Stethoscope
• Water base lubricant
• Scissor
• Ink
• Histamine
• Cotton applicator
• Spatula

6. Procedure
1. Explain the procedure to the patient
2. Wash hand
3. Assemble the necessary equipments
4. Put on gloves and use the cotton and rubber sheet to cover the bed
5. Put up the client to high- fowler's (semi sitting) position by raising the bed
or with the help or back rest pillow
6. Place towel on the patient’s chest

7. 7. Examine the patency of nostrils by hyper extending the head.
Ask the client to breathe through each nostril while compressing the other nostril to
select the more patent one
Select the nostril through which air passes more easily
8. Select the appropriate distances mark on the tube
By measuring the distance on the tube from the client’s bridge of the nose to ear lobe
plus the distance form ear lobe to the bottom of the xiphistemu (xyphoid process).
9. Clean the nostril and lubricate 20-30 cm of the tip of the tube with water
soluble lubricant to reduce friction

8. 10. Gently insert the tube, with its natural curve toward the client, into the
selected nostril.
Have the client hyper extend the neck, and gently advance the tube toward the
nasopharynx.
And direct the tube along the floor of the nostril in dawn ward and back ward way.
If the tube meets resistance withdraw it, lubricate it, and insert in the other nostril.
Swallowing or sipping water through a straw may be helpful.
11. Once the tube reaches the throat / oropharynx/, have the client tilt the
head forward and tell him to swallow.
12. Instruct the client to open his/her mouth to make sure that the tube is not
coiled in the mouth and it is in the stomach

9. 13. Insert the tube until it reaches about 50 centimetres or until it reaches the
measured point
14. Determine that the tube is in client’s stomach
• Place the tip of the tube in the water in kidney dish; if you see gentle and continuous
bubbling happens it indicates that the tube is in respiratory system, immediately
remove the tube
• Or aspirate 20-30ml of the content of the stomach with syringe then test the content
by using Litmus paper
• Gastric content is yellow to green in colour and usually presents in amounts
greater than 10 ml
• Take 20 cc syringe aspirate air and administer the air through NG tube, place
stethoscope on epigastric area then listen to a gurgling sound
• If you hear the sound it means that the tube is wit in the stomach
• Chest x- ray

10. 15. After being sure that the tube is in the right position secure the tube by
taping to bridge of the client's nose
16. Aspirate gastric fluid using 20-50 ml syringe and collect specimen if
needed, or aspirate with suction machine or attach with bag or clamp end
of tubing as ordered
17. Histamine will be given subcutaneously to stimulate gastric secretions
18. Continuously monitor the blood pressure to detect hypotension

11. 19. Collect gastric specimen every 15 minutes for 1 hour.
20. Label the specimen to indicate specimen before and after histamine
injection
21. Comfort the patient
22. Clean or discard used equipments
23. Record

12. Contraindications
Same with NGT insertion
• Absolute contraindications:
• Severe midface trauma
• Recent nasal surgery
• Relative contraindications:
• Coagulation abnormality
• Esophageal varices or stricture
• Recent banding of esophageal varices
• Anastomosis in the esophagus and the stomach

13. Possible Risks & Complications
• Pain and discomfort while the tube is being inserted
• Bleeding from the nose due to trauma (epistaxis)
• Vomiting
• Nausea
• A gagging feeling
• Trauma to the vocal cords
• Perforation of the oesophagus
• Anxiety, especially in younger children

15. Definition
• Gastric analysis is a method to measure secretion of hydrochloric acid under
basal (Baseline) and augmented (stimulated) conditions.
• Gastric analysis consists of a series of tests used to analyze the contents of
the stomach . The complete series involves:
• Collecting residual gastric fluid from a fasting patient
• Collecting basal secretions every 15 minutes for four hours
• Intramuscular administration of a drug that stimulates gastric acid output
• Collecting stomach secretions every 15 minutes for 90 minutes

16. Purpose and Indications
• To evaluate gastric function by measuring the contents of a fasting patient's
stomach the for acidity, appearance, and volume.
• The basal gastric secretion test is indicated for patients with obscure
gastric pain , loss of appetite, and weight loss.
• To confirm suspected peptic ulcer and severe gastritis
• To confirm suspected Zollinger Ellison syndrome
• To demonstrate achlorohydria
• To estimate or reflect parietal cell mass

17. • The gastric acid stimulation test is indicated when abnormalities are found
during the basal secretion test
• These abnormalities can be caused by a number of disorders, including
duodenal ulcer, pernicious anemia, and gastric cancer
• While this test will detect abnormalities, x rays and other studies are
necessary to obtain a definitive diagnosis

18. Equipments
A radio-opaque stomach tube 16 French size
Emesis basin
50 ml plastic or glass syringe
100 ml graduated cylinder

19. 1 ml. tuberculin syringe
Adhesive tape
Lubricant
Indicator solution like phenol red

20. Preparation of the Patient
• Patient should be fasting 10 to 12 hours (preferably since bed time night
before)
• Patient should have not received any medi. cations specially anticholinergic
agent, H2 blocker, Antacids since night before as they are liable to alter the
results
• Weigh the patient prior to procedure
• Procedure should be explained to the patient in simple words

21. PROCEDURE:
1. Ask consent from the patient
2. Explain the procedure to the patient
3. Place the patient into a comfortable position
4. Assemble all necessary equipments needed for the procedure
5. Begin intubation by gently pushing the tube, the patient is instructed to
swallow and continue to swallow throughout the intubation period.

22. 6. Tape the tube to the patient’s nose with adhesive tape
7. At this point patient is sent to the X-ray for fluoroscopy to check position.
8. Empty the stomach of its contents with a 50 cc. syringe
9. After emptying stomach of the residual volume, collection of gastric juice is
begun under Basal conditions
• At least four samples are collected each 15 minutes apart in separate containers
• Collection may be carried out either manually with the syringe or by using a suction
pump

23. 10. After having collected gastric juice under basal conditions augmented or
stimulated gastric analysis may be carried out as indicated
• Give a stimulant (Pentagastrin 6 mg per kg or Betazole 1.5 mg per kg) sub cutaneously
• Medical supervision needed
• After injection of pentagastrin or Histolog collection of gastric acid is begun under
stimulated conditions again 15 minutes a part total of four to eight times
• After completion of basal and stimulated gastric juice collection, specimen are sent to
the laboratory for evaluation

24. Precautions
• Neither test is recommended for patients with
• Esophageal problems, aortic aneurysm, severe gastric hemorrhage, or
congestive heart failure .
• The gastric acid stimulation test is also not recommended in patients who
are sensitive to pentagastrin (the drug used to stimulate gastric acid output).

26. Before the procedure
• Explain about the procedure, the significance of the preparation, and any
significant post-procedural sequelae
• Secure consent
• Assure maintenance of NP for 8-10 hours prior to the test.
• Implementing general care and precautions associated with gastric
intubation
• If ordered by the physician, withdraw the stomach contents and save for lab
analysis
• Allow the patient to rest for 20 to 30 minutes after insertion of the tube
before beginning the test
• This allows time for the patient's body to return to a rested, basal state

27. During the procedure
• Obtain the specimens as directed by the physician or local SOP
• Label each specimen with the amount and the time collected in addition to
the patient identification
• Note and report the presence of the following:
• Undigested food
• Blood
• Fecal odor
• Assess the patient's tolerance to the procedure
• By monitoring blood pressure and pulse

28. After the procedure
• Monitor the patient's vital signs in accordance with the ward's SOP
• Observe for signs of throat irritation secondary to tube placement
• Observe for signs of bleeding from the throat or stomach
• Resume diet and medication IAW the physician's orders or ward SOP

29. Complications
• Improper positioning of gastric tube (to trachea instead of the esophagus)
• Overactive gag reflex,
• May result in a transient rise in blood pressure due to anxiety .
• Bleeding
• Dysrhythmias
• Esophageal perforation
• Layrngospasm
• Decreased mean pO2 (a measure of blood oxygen levels)
• Nausea, vomiting, and abdominal distention or pain

31. Definition:
• Administration of food via a tube which is placed through the skin and the
stomach wall and goes directly into the stomach
• Gastrostomy is an operation performed to create an opening in to the
stomach the purpose of administering food and medications.
• For insertion of the gastrostomy tube requires either upper abdominal
midline incision or a left upper quadrant transverse incision.

32. Why the Procedure is Performed?
• Gastrostomy feeding tubes are put in for different reasons.
• They may be needed for a short time or permanently.
• This procedure may be used for:
• Babies with birth defects of the mouth, esophagus, or stomach (for
example, esophageal atresia or tracheal esophageal fistula)
• People who cannot swallow correctly
• People who cannot take enough food by mouth to stay healthy
• People who often breathe in food when eating

33. Equipments
• Gastrostomy tube
• 50 ml syringe
• Funnel
• Clamper
• Measuring jag
• Sterile gauze
• Adhesive tape
• Chart

34. Procedure
1. Explain the procedure to the patient
2. Wash hand
3. Assemble the necessary equipment
4. Position the patient in his/ her comfortable position (mostly sitting position)
5. Pour the fluid (food) into the measuring jag as prescribed
6. Connect the syringe with the tube
7. Hold syringe at angle so that air doesn’t enter stomach and continue
pouring the fluid into the syringe or funnel

35. 8. Hold syringe perpendicular so feeding can enter by gravity
9. After feeding rinse with water and remove the syringe
10. Cover the tip of the tube with sterile gauze using a plastic band and attach
to the dressing
11. Apply light dressing over the stoma and tube
12. Comfort patient; keep the head of the bed elevated for at least 30minutes
after procedure to aid digestion
13. Clean return used equipments
14. Wash hands and document procedure in the client’s medical record

36. complications
• Tube dysfunction
• Infection
• Wound infection
• Necrotizing fasciitis
• Bleeding
• Peristomal leakage
• Ulceration
• Gastric outlet obstruction
• Inadvertent gastrostomy tube removal
• Leakage of gastric contents or tube feeds into the peritoneal cavity

37. Thank you