NGT/OGT INSERTION Nasogastric Tube Step 4

USES OF NGT: ❖ With a penlight, Examine the nostrils. Quickly check both
➢ The client is comatose, semiconscious, or unable to consume nostrils for signs of deformity or obstruction.
sufficient nutrition ❖ You will need to insert the tube into whichever nostril appears
➢ Medications for patients who cannot swallow clearest.
➢ decompression of gastric contents before/after GI surgery ❖ If necessary, use a small flashlight or similar light to look into the
➢ Obtain gastric specimen for dx of peptic ulcer nostrils
➢ Irrigation/lavage – after ingestion of poisonous substances Step 5
➢ Presence of blood in the stomach ❖ Measure the tube. Measure the necessary tube length by
NURSING DIAGNOSIS drawing the NG tubing across the outside of the patient's body.
1. Imbalanced Nutrition: Less than Body Requirement ❖ Start at the bridge of the nose, then draw the tube across the face
2. Swallowing Impairment to the earlobe.
3. Risk for Aspiration ❖ From the earlobe, draw the tube down to the xiphisternum, which
4. Risk for Diarrhea lies halfway between the end of the sternum and the navel. This
2 MOST COMMONLY USED TYPES OF NGT point lies at the center front of the body, where the lower ribs
1. Levin`s tube meet.
2. Salem sump tube
EQUIPMENT NEEDED:
1. NGT: adult – (french14-18)
a. child/infant – (5-10)
2. water-soluble lubricant
3. Aseptic syringe
4. Glass of drinking water with a straw
5. Towel or tissue ❖ For an infant, this point will be roughly one finger-width beneath
6. Stethoscope the chest bone. For a child, measure two finger-widths.
7. Penlight ❖ The distance can vary more dramatically for teenagers and adults
8. Basin depending on height.
9. gloves ❖ Write down the proper measurement on the tube using a
PROCEDURE: permanent marker
1. Review the client`s medical hx Step 6
2. Assess consciousness ❖ Numb the patient's throat. Spray the back of the patient's throat
3. Prep the equipment with anesthetic throat spray. Wait a few seconds for the spray to
4. High-fowler`s position, cover the chest with a towel take effect.
Step 1. ❖ This procedure can be uncomfortable for many patients, and the
❖ Wash hands & Put on gloves. Wash your hands and put on a pair use of throat spray can minimize discomfort and reduce gagging.
of disposable medical gloves before advancing with the It is not strictly necessary, however.
procedure.
❖ Even though you'll have gloves on, you should still wash your
hands with warm water and antibacterial soap to further reduce
the risk of introducing germs into the nasogastric tube
Step 2
❖ Explain the procedure to the patient. Introduce yourself to the
Step 7
patient and explain the procedure. Make sure that you have the
❖ Lubricate the tube. Coat the first 2 to 4 inches (5 to 10 cm) of the
patient's consent before continuing.
NG tube with water-based lubricant.[2]
❖ Talking the patient through the procedure before you perform it
❖ Using a lubricant containing 2 percent Xylocaine or a similar
can allow you to gain his or her trust while also calming the
anesthetic can further reduce irritation and discomfort.
patient down.
Step 3
❖ Position the patient. For best results, the patient should be
positioned in an upright sitting position (high fowlers) with his or
her chin touching the chest. He or she should also face forward. [1]
❖ If the patient has a difficult time holding his or her head up, you
may need someone to assist you by holding the patient's head
forward. You can also use stiff pillows to hold the head steady.
❖ When placing an NG tube in a baby, you can lay the baby back
instead of holding him or her in an upright sitting position. The
baby's face should be up, and the chin should be slightly raised
INSERTION THE TUBE
STEP 1
Insert the tube into the chosen nostril. Insert the lubricated end
of the tube into the clearest nostril, aiming the end of the tube
straight back as you feed it in.
Ask px to slightly flex the neck – glottis closes
The patient must continue looking straight at you.
Direct the tube down and toward the ear on that side of the head.
Do not allow the tube to feed upward and into the brain.
Stop if you feel resistance. Pull the tube out and try the other
nostril. Never force the tube inward.
Direct the tube down and toward the ear on that side of the head.
Do not allow the tube to feed upward and into the brain.
Stop if you feel resistance. Pull the tube out and try the other
nostril. Never force the tube inward.
STEP 2
Check the back of the throat. If you have coated the patient's
throat with anesthetic throat spray, ask the patient to open his or
her mouth and watch for the other end of the tube.[3]
For patients who were not treated with throat spray, opening the
mouth might be too painful. Instead, you should simply ask the
patient to indicate when he or she feels the tube at the back of
the throat.
As soon as the tube hits the top of the throat, guide the patient's
head so that the chin touches the chest. This can help encourage
the tube into the esophagus, rather than into the trachea
✓ **. Have a basin in px’s lap and tissues handy, ask px to
swallow/sip water and gently advanced the tube
✓ **. Temporary gagging – subsides when a tube is
progressed
STEP 3
Instruct the patient to swallow. Give the patient a glass of water
with a straw. Ask him or her to take small sips and swallows as
you continue guiding the tube downward.
If the patient is unable to drink water for any reason, you should
still encourage him or her to dry swallow as you feed the tube
into the throat.
For infants, give the patient a pacifier to encourage him or her to
suck and swallow during the process
STEP 4
Stop once you reach the measured mark. Continue feeding the
tube into the patient's throat until the marked measurement
reaches the patient's nostril.
If you meet resistance further into the throat, slowly rotate the
tube as you advance it. This should help. If the tube still gives
considerable resistance, pull it out and try again. Never force it
in.
Stop immediately and remove the tube if you notice a change in
the patient's respiratory status. This can include choking,
coughing, or difficulty breathing. A change in respiratory status
suggests that the tube has been inserted into the trachea by
mistake.
You should also remove the tube if it comes out of the patient's
mouth.
CHECK THE PLACEMENT OF THE TUBE
R1
➢ Inject air into the tube. Use a clean, dry syringe to insert air into
the NG tube. Listen for the sound it makes using a stethoscope.[4]
➢ Draw back the plunger of the syringe to collect 3 ml of air, then
attach the syringe to the open end of the tube.
➢ Place a stethoscope over the patient's stomach, just below the
ribs and toward the left side of the body.
➢ Quickly depress the plunger to insert the air into the tube. You
should hear a gurgling or popping sound through the stethoscope
if the tube has been positioned correctly.
➢ Remove the tube if you suspect improper placement.
R2
➢ Aspirate from the tube. Use a syringe to draw stomach acid
through the tube, then test the contents with pH indicator paper.
➢ Attach an empty syringe to the adapter at the free end of the tube.
Lift the plunger to draw 2 ml of stomach contents into the tube.
➢ Wet the pH indicator paper with the collected sample and
compare the color on the strip to its corresponding color chart.
The pH should usually be between 1 and 5.5
➢ Remove the tube if the pH is too high or if you otherwise suspect
improper placement.
✓ ** Confirmatory tube placement is by Xray
R3
➢ Secure the tube. Secure the placement of the tube by taping it to
the patient's skin with 1-inch (2.5 cm) thick medical tape.
➢ Attach one piece of tape to the patient's nose, then wrap the ends
of that piece around the tube. Place a separate piece of tape
across the tube and over the patient's cheek, as well.
➢ The tube must not be able to move around as the patient moves
his or her head naturally.
IMPLEMENTATION
1. Assess the client`s consciousness level
2. Check the client`s chart – previous hx of nostril surgery, injury,
or unusual nostril bleeding
3. Use a penlight to assess nostrils for a deviated septum