Mabini Colleges

College of Nursing and Midwifery

Daet, Camarines Norte

Objectives: AT THE END OF THE DISCUSSION THE STUDENTS WILL BE ABLE TO;

To define the Purposes of GI Intubation

Define terminologies
Identify the types of Nasogastric tubes.
Learn how to insert and remove a nasogastric tube and enteral feeding.
Discuss nursing management of the patient who has nasogastric or
nasoenteric tube.
Learn the procedure of Esophageal Balloon Tamponade and its uses
Purposes of GI Intubation
To Decompress the stomach and remove gas and fluid
To Lavage the stomach and remove ingested toxins
To Diagnose GI disorders
To Administer medications and feeding
To Treat an obstruction
To Compress a bleeding site
To Aspirate gastric contents for analysis
Terminologies
Anti-reflux valve- valve that prevents the return or backward flow of fluids
Decompression(intestinal)- removal of intestinal contents to prevent gas
and fluid from distending the coils of the intestine.
Duodenum- the first part of the small intestine, which connects with the
pylorus of the stomach and extends to jejunum.
Jejunum- second portion of the small intestine, extending from the
duodenum to the ileum.
Lavage- the therapeutic washing out of an organ or part.
Gavage- introduction of material into the stomach by a tube.
Peristalsis- wavelike movement that occurs involuntarily in alimentary
canal.
Alimentary canal- digestive canal.
Nasogastric tube-is a tube that is passed through the nose and down
through the nasopharynx and esophagus into the stomach
GI intubation-Is the insertion of a flexible tube into the stomach beyond the
pylorus into the duodenum or the jejunum. May be inserted through the
nose, mouth or the abdominal wall.

Nasogastric tubes
Tube typec

Length(CM)

Size(french)

Lumen

Levin

125

14-18

single

120

12-18

Double

Moss

90

12-16

Triple

Sengstaken-blakemore

90

12-16

Triple

(plastic or rubber)
Gastric sump or
Salem sump
(plastic)

(rubber)

Nasogastic Tube insertion

Equipments
Non sterile gloves
Nasogastric tube(salem sump)
Lubricating jelly
Penlight
Glass of water with a straw
Emesis basin
Tape and safety pin
Catheter tip syringe
Stethoscope
Linen protector
Procedure
To insert begin by washing your hands and elevate the bed by 45 to 90
degrees.
Inspect the clients nose which has better air flow,
o Ask about a history of any injuries or surgeries on the nose,
Coil the tube over your fingers
o Coiling helps soften the tube and facilitate the insertion to the
clients nares
USE THE TUBE TO MEASURE from the nose to the earlobe then to the
xiphoid process plus 6 inches. Mark with a tape.
Lubricate 3-4 inches of the tube

 With the client head sitting upright or extended carefully insert the tube
into the clients nostrils and aim it toward the clients ear and downwards
o Gently advance it into the clients nasopharynx.
When the tube reaches the nasopharynx resistance will be felt.
o Ask the client to open his mouth and check with a penlight if the tube
is coiled up in the mouth or not.
Once the tube is advance toward the back of the throat have the client
flexed the head forward then rotate the tube 180 degrees inward toward
the clients other nostril.
o This helps the tube pass the nasopharynx
o Minimizes the chance of the tube coiling in the mouth.
Ask the client to sip some water several times while advancing the tube
until the tape mark is reach.
o If the client gags, briefly stop the tubes advancement
o Swallowing helps to open the upper esophageal sphincter and allow
the tube to pass into the esophagus.
Aspirate 20-30 cc of air to the syringe , attach the syringe to the free end.
Place the stethoscope over the clients epigastric region , then inject the air
listening for the whooshing sound
o If heard it indicates that the tube has reached the stomach
Then aspirate some gastric contents
o Check for color and pH of the content with the pH tape.
o pH must be 5.5 or below.
Make a pair of pants shape tape, 2-3 inches.
Put it on the nose of the client. And wrap the pants shape tape on the tube
to stabilize it.
o It reduces tissue trauma and tube displacement.
Loop a piece of tape around the tube to attach it on the clients gown, you
may use safety pin to pin it.
o This is done so that if the tube is accidentally pulled, the tension is on
the pinned site rather than the nose.
Then you can now plug the tube to the suction machine

Enteral Feeding
This May Be Nasogastric Tube Feeding Or Gastrostomy Feeding.
(A). Nasogastric Tube Feeding
This Is Also Called Gastric Gavage, NGT Feeding.
The Feeding Formula Should Be At Room Temperature. To Prevent GI
Cramping And Discomfort From Cold Formula.
The Client Should Be Placed In Semi- To High- Fowlers Position. To Prevent
Gastric Reflux And Aspiration.
Check Placement Of NGT Before Feeding.
o Check pH Of Gastric Aspirate(Should Be Acidic pH 1-3).
o Gastric Aspirate Appears Greenish Or Yellowish.
o Introduce 10ml. Of Air Into NGT And Auscultate At Epigastric Area
For Gurgling Sounds.
Aspirate All Stomach Content To Check For Residual Feeding. If Residual
Feedings Is 100mls. Or More Than Half Of The Last Feedings, Hold The
Feeding, Notify The Physician.
Reinstill The Aspirated Gastric Content. To Prevent Metabolic Alkalosis.
Use Infusion Pump If Gavage Bag Is Used To Allow Feeding To Flow Slowly.
Feedings Given Too Rapidly Cause Nausea, Vomiting, Flatulence, And
Abdominal Cramps. Gastric Residuals Are Checked Every 4 To 6 Hours, Then
Flushed With 30-60 Ml. Of Water.
After Each Feeding, Instill 30-60ml. Of Tap Water( If Syringe Is Used).
Have Client Remain In Semi- To High Fowlers Position Or In Slightly
Elevated Side-Lying Position 30-60 Minutes After Feeding. To Prevent
Gastric Reflux And Aspiration.
Note: Avoid Placing End Of The NGT In Water To Check For Placement. Water May
Be Aspirated If NGT Is In The Trachea.
Removing the tube
Before removing the tube, Intermittently clamp and unclamp it for trial
period of several hours to ensure that the patient does not experience
nausea, vomiting or distention.
Before the tube is removed, it is flushed with 20 ml of water and 20 ml of
air to clear the water from the tube. The gloves are worn to remove the
tube. The tube is withdrawn gently and slowly for 15-20 cm(6-8 inches)
until the tip reaches the esophagus; the remaining is withdrawn rapidly
from the nostril.

 If tube the tube does not come out easily do not use brute force, report it
to the attending physician.
After removal of the tube, provide oral hygiene.
Complications
The main complications of NGT insertion include aspiration and tissue trauma.
Placement of the catheter can induce gagging or vomiting, therefore suction
should always be ready to use in the case of this happening. More serious
complications include esophageal perforation, aspiration, pneumothorax, and,
rarely, intracranial placement.
Nursing Care of the Patient with a Nasogastric Tube
Patient teaching and preparation
Tube insertion
Confirming placement
Securing the tube
Monitoring the patient
Maintaining tube function
Oral and nasal care
Monitoring, preventing, and managing complications
Esophageal Balloon Tamponade
o The Procedure Is Done To Control Bleeding Of The Ruptured Esophageal
Varices In Clients With Liver Cirrhosis.
o The Catheter Used Is Sengstaken-Blakemore Tube. It Is A Triple- Lumen
Tube With 2 Baloons
o The Three Lumen Have The Following Functions: (A) For Inflation Of
Esophageal Balloon, (B) For Inflation Of Gastric Balloon, (C) The Middle
Lumen Is To Be Connected To Gastric Suction.
o The 2 Balloons Have The Following Functions: (A) The Esophageal Balloon
Compresses The Ruptured Esophageal Varices, To Stop The Bleeding, (B)
The Gastric Balloon Serves As Anchor To Prevent Upward Displacement Of
The Esophageal Balloon.
o Sponge Rubber Should Be Placed Near The Nares, To Serve As Traction. This
Prevents Downward Displacement Of The Sengstaken-Blakemore Tube.
o Encourage Client To Expectorate Or Suction His Mouth As Needed To
Prevent Aspiration. The Inflated Esophageal Balloon Makes The Client
Unable To Swallow. Provide Good Oral Care.

o Keep A Pair Of Scissors Readily Available, As An Emergency Equipment.

Airway Obstruction May Occur Due To Upward Displacement Of The
Esophageal Balloon When The Gastric Balloon Accidentally Punctured.
Emergency Nursing Action Is To Cut The Sengstaken-Blakemore Tube.
Airway Is Priority.

Reference
Youtube.Com/Nasogastric-Intubation-Demonstration-NGT
The MS Book VOLUME 1 Suddarth [chapeter 36] [page 1175]
Medical-Surgical Nursing: Concepts And Clinical Application(Second Edition)
Jose Quiambao-Udan

PREPARED BY:
MICHAEL ANGELO BACUO SEA. RM