Nasogastric Tube

Gastrointestinal intubation is inserting of Polypropylene, Silicone or Latex (rubber) tube into the stomach , duodenum or intestinal

Nasogastric tubes come in various sizes (8, 10, 12, 14, 16 and 18 Fr).

Indications for GI Intubation

• To decompress the stomach and remove gas and fluid
• To lavage the stomach and remove ingested toxins
• To diagnose disorders of GI motility and other disorders
• To administer medications and feedings
• To treat an obstruction
• To compress a bleeding site
• To aspirate gastric contents for analysis

Intubating the patient with an NG tube

• Assessment:

• Who needs an NG:

  • Surgical patients (bowel obstruction, Ileus, …)
  • Ventilated patients
  • Neuromuscular impairment .
  • Patient with swallowing disorders (post CVA, …)

• Assess patency of nares.

• Assess patient medical history:

  • Nosebleeds
  • Nasal surgery
  • Deviated septum

• Anticoagulation therapy

• Assess patients’ gag reflex.

• Assess patient’s mental status.

• Assess bowel sounds.

Technique

equipment:

• 14 0r 16 Fr NG tube

• Lubricating jelly

• PH test strips

• Tongue blade

• Flashlight

• Emesis basin

• syringe

• 1 inch wide tape or commercial fixation device

• Suctioning available and ready

• Explain procedure to client

• Position the patient in a semi-sitting or high fowlers position. If comatose-semi fowlers.

• Examine feeding tube for flaws.

• Determine the length of tube to be inserted.

• Measure distance from the tip of the nose to the earlobe and to the xyphoid process of the sternum.

• Prepare NG tube for insertion.

  Fowler’s Position. Head rest is adjusted to desired height and bed is raised slightly under patient’s knees

Implementation

1. Wash Hands
2. Put on clean gloves
3. Lubricate the tube
4. Hand the client a glass of water
5. Gently insert tube through nostril to back of throat (posterior naso pharynx). Have patient flex head toward chest after tube has passed through naso pharynx

6. Emphasize the need to mouth breathe and swallow during the procedure.

7. Swallowing facilitates the passage of the tube through the oropharynx.

8. Advance tube each time client swallows until desired length has been reached.

9. Do not force tube.  If resistance is met or client starts to cough, choke or become cyanotic stop advancing the tube and pull back.

10. Check placement of the tube.

• X-ray confirmation
• Testing pH of aspirate

12. Secure the tube with tape or commercial device

Evaluation

• Observe client to determine response to procedure.

• ALERTS!!! Persistent gagging – prolonged intubation and stimulation of the gag reflex can result in vomiting and aspiration

• Coughing may indicate presence of tube in the airway.

• Note location of external site marking on the tube

• Documentation - Size of tube, which nostril and client’s response. - Record length of tube from the nostril to end of tube - Record aspirate pH and characteristics

Testing Placement (Confirmation)

• Use more than one method when in doubt because all methods of confirmation have some possibility of error
• Radiographic evaluation is the most definitive way

Methods: - Insufflation test: Insufflate air into NG tube and auscultate for rush of air over the stomach - Aspiration of stomach content - PH-tested of aspiration - If patient awake & cooprative, ask the patient to talk, if he/she can not speak, suspect respiratory placement - Chest X-ray.

Complications

• Clogged Tube- most common
• Oral mucosal breakdown
• Nasal irritation/ulceration
• Dumping Syndrome.
• Aspiration during feeding : ensure head of bed is elevated at least 30 degrees while feeds are being administered
• Dehydration- diarrhea is a common problem.
• Electrolyte imbalance: hyperkalemia and hypernatremia
• Gastric mucosa ulceration