This is a simplified presentation done by Patrick Nkemba, a student of clinical medicine at Rockview University. it is the product his desire to make the work easier to all the members of his presentation group. It should be noted that no copy right was obtained for the information compiled in this presentation. Therefore, its not for commercial use. the first receivers of this information are the members of the presentation group.

2. INSERTION OF NASAL GASTRIC TUBE
Indications
1. Provision of nutrition and hydration
2. Paralysis of pharynx or larynx
3. Operation of mouth and plate
4. Premature infants
5. Gastric Lavage
6. Analysis of stomach contents
7. Diagnosis of intestinal obstruction
8. Paralytic ileus
9. General Anaesthesia
Contraindication
1. Pulmonary placement
2. Intracranial placement
3. Increased cervical and cranial pressures with gagging/vomiting
4. Epistaxis
5. Invagination of stomach lumen into eyes of NGT

3. Relative Contraindications
1. Severe coagulopathy
2. Gastric bypass and lap band procedures
3. Esophageal varices/strictures
4. History of alkali ingestion

4. BEFORE PROCEURE
1. Wash hands and dry them
2. Kindly and respectfully greet the patience
3. Explain the procedure and encourage the client to ask questions
4. Get permission before you begin/ consent
ACTUAL PROCEDURE
1. Position the client (a) conscious , sit with head forward
(b) unconscious, put semi-prone position
2. If conscious, tell the client to blow their nose. If unconscious, clean the nostrils with dressed
orange sticks
3. End of the tip of the nose, earlobe down to xiphoid process until to the stomach
4. Mark the length on the tubing with the tape
5. Lubricate the tube by putting in water
6. Stop advancing when the tape mark on the tube reaches the nostril
7. Confirm
8. Once confirmed aspirate or give food
9. If the tube is to be withdrawn, remove gently through a peace of gauze, leave the pt
comfortable and thank the pt.

5. After procedure
1. Give appropriate IEC to client
2. Wash hands and dry them.
3. Report your findings to the ward manager

6. URETHRAL CATHETERIZATION
Urethral catheterization is a routine medical procedure that facilitates direct drainage of the urinary
bladder
Indications
Diagnostic indications include the following:
1. Collection of uncontaminated urine specimen
2. Monitoring of urine output
3. Imaging of the urinary tract
Therapeutic indications include the following :
1. Acute urinary retention (eg, benign prostatic hypertrophy, blood clots)
2. Chronic obstruction that causes hydronephrosis
3. Initiation of continuous bladder irrigation Intermittent decompression for neurogenic bladder
4. Hygienic care of bedridden patients

7. Contraindications
Urethral catheterization is contraindicated in the presence of traumatic injury to the lower urinary
tract (eg, urethral tear). This condition may be suspected in male patients with a pelvic or
type injury.
Signs that increase suspicion for injury are a high-riding or boggy prostate, perianal hematoma
blood at the meatus. When any of these findings are present in the setting of possible trauma, a
retrograde urethrogram should be performed to rule out a urethral tear prior to placing a
into the bladder.

8. Explanation and Consent
1.Confirm the patients identification
- Check full name, DOB, and hospital number
- Confirm against patients wristband
2. Explain the procedure
- Describe the procedure
- State the importance of the procedure
3. Get permission/ consent.
Check that the patient is happy to go ahead with the procedure. Ask the patient if they would
like a chaperone present. Preferably, the patient has washed their genitals beforehand or has
assistance to do so

9. Preparation
Chose the correct catheter size, based upon sex of the patient, length of time of insertion,
any allergies to latex
Catheter size (diameter measured in Ch) should be the smallest as possible to drain urine
Patients with urine debris or clots may require a larger diameter catheter
When in the treatment room, prepare your equipment on an appropriate equipment trolley.
Decontaminate your hands
Clean your trolley and plastic tray with appropriate aseptic agent (e.g. Chlor-clean), allowing
dry fully. Decontaminate your hands
Gather the equipment into the plastic tray on the trolley and move to the patients bedside
Equipment required catheter pack, catheter, drainage bag, instillagel, saline vial,
chlorhexidine wipe, sterile forceps, 2x pairs sterile gloves, apron, and inco pad
Catheter pack should contain J-tray, sterile swabs, cotton wool balls, plastic pot, and
drape

10. During Procedure
1. Once at the patient’s bedside
2. Re-confirm the patients identification
3. Expose the patient from the waist down
1. Put the sterile gloves on
2. Take the sterile drape and tear a hole in the centre, draping over the penis
A sling may be made from sterile gauze, placed around the patient penis, to aid mobility
the penis during the procedure
3. Using at least 5 cotton wool balls, clean the glans of the penis and penile shaft from tip to
base
Best practice is to use one hand to pick the cotton wool balls and hold the sling whilst
the other to clean the penis
4. Hold the penis erect and inject 11ml instillagel into the urethra and gently squeeze the tip to
prevent leakage

11. - Remove your gloves and decontaminate your hands
- Carefully open the catheter and syringe onto your sterile field
- Open another sterile gloves package
5. Decontaminate your hands
6. Put the sterile gloves on and open up the syringe
7. Place the J-tray between the patients legs
8. Carefully open the catheter from its sterile packaging, exposing only the catheter tip
Without touching the catheter directly, insert the catheter along the urethra into the bladder
If any resistance is felt, ask the patient to cough to ease insertion
9. Once the urine begins to flow, advance the catheter a further 5cm
Inject the contents of the syringe into the catheter to inflate the balloon in the catheter
- Monitor the patient for any signs of discomfort
- Gently withdraw the catheter to ensure the balloon is secure against the bladder neck
10. Attach the catheter to the drainage bag
Attach the drainage bag to the patients leg, patients bed, or catheter stand
11. Replace the foreskin
12. Discard all waste into the correction disposal bins and ensure the patient is comfortable
13. Remove your gloves and decontaminate your hands

12. Aftercare
Instruct the patient to:
1. Regularly wash with warm soapy water at least twice a day, washing in a direction away
from the urethra
2. Do not pull on the catheter
3. Inform the nursing staff if any pain or discomfort
4. Thank the patient and leave the patient’s bedside.
5. Ensure the correct catheterization documentation is filled out completely and placed in
patients notes.
Good luck
Patrick Nkemba