NASOGASTRIC INTUBATION

• Indications: Drainage of gastric content or lavage (in case of poisoning or drug overdose),
aspiration of gastric content, prevention of vomiting and aspiration, evaluation of upper
gastrointestinal bleeding (ie, presence, volume), feeding, administering medications.

• Contraindications: Sever midface trauma (High risk of inserting the tube intracranially),
recent nasal surgery

• Complications: Trauma to the mucous membranes and airway tissues, Aspiration because
of vomiting during insertion of the NG tube

• Equipment: Nasogastric tube (14 – 18 Fr single lumen (one channel) or double lumen (
two-channneld), disposable drainage bag (reservoir bag) for gastric contents, syringe 60
ml, gloves, tape, stethoscope, water based lubricant, pH test strips, torch, tongue
depressor (blade)

• Positioning of patient: Seated in an upright position. If the patient is conscious explain

the procedure and gains his consent.
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NASOGASTRIC INTUBATION

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 NASOGASTRIC INTUBATION
Procedure:
• Wash the hands
• Gather equipment
• Put on the gloves
• If the patient is conscious explain the procedure
• Place the patient in an upright position
• Check each nostrils for patency (deformation,obstruciton), in case of orogastric intubation check for dental
prosthesis and foreign objects.
• Determine the length of the tube to be inserted and mark the point with a piece of tape.
• Nasogastric intubation – From the tip of the nose to the earlobe then to the xyphoid process.
• Orogastric intubation- From the corner of the lips to the earlobe and then to the xyphoid process.
• Lubricate the tip of the tube
• Inserting the tube:
• Nasogastric intubation- insert the tube into the nostril and advance it toward the posterior pharynx. If
you meet resistance while inserting the tube, rotate it or withdraw it and try another nostril, do not use
force.
• Orogastric intubation – Ask the patient to breath deeply through the nose and advance the tube.
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• If the patient is conscious encourage him to drink water and swallow.
 NASOGASTRIC INTUBATION
• Once past the nasopharynx ask patient to put
their head as forward as possible – chin to
chest (neck flexed). If, at any time, the patient
experiences respiratory distress, is unable to
speak, starts coughing or turns cyanotic, or if
the tube coils, stop advancing the tube and
withdraw it.
• Advance the tube without using force as the
patient swallows until the desired tube length
is inserted.
• Verify proper placement of the NG tube by
auscultating a rush of air over the stomach
using the 60 mL syringe and by aspirating
gastric content and checking the pH
• In case of proper placement secure the tube
with a tape
• Connect NG tube to disposable drainage bag
• Take of the gloves off
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• Wash your hands
 Gastric lavage
• Indications: removing toxic substances and food, alcohol and other
poisonous agents

• Contraindications: esophageal burn, gastric ulcer, esophageal/gastric

bleeding
• Complications
• (see nasogastric tube insertion)

• Equipment: Nasogastric tube, syringe 60 ml, gloves, tape, stethoscope,

water based lubricant, funnel or 1L reservoir

• Positioning of patient: Seated in an upright position. If the patient is

conscious explain the procedure and gains his consent. patient:
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 GastrIc lavage
Procedure:
• Wash the hands
• Gather equipment
• Don the gloves
• If the patient is conscious explain the procedure
• Place the patient in an upright position
• Insert the nasogastric tube
• Connect the reservoir to the nasogastric tube and hold it below the level of gaster
• Pour to 37°C warmed water into the reservoir , lift the reservoir slowly above the level of gaster, so that the
content moves to gaster
• Pull down the reservoir below the level of gaster and wait untill it refills with fluid moving from gaster
• Repeat the procedure untill effluent is clear
• Remove the nasogastric tube
• Take of the gloves
• Wash your hands
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GastrIc lavage

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 NasogastrIc tube removal
• Explain procedure to patient and assist in an upright seated position.
• Gather equipment.
• Perform hand hygiene.
• Don clean disposable gloves.
• Place towel or disposable pad across patient’s chest. Give tissues to patient.
• Prior to removal attach the syringe and inject 30 ml water and afterwards 30 ml air, to
clear the tube of fluid and to ensure that is it free of debris.
• Carefully remove adhesive tape from patient’s nose.
• Have the patient take a deep breath in and hold it. (Holding the breath closes the
glottis and reduces the risk of aspiration)
• With the patient holding her breath, pinch off the tube at the naris and withdraw it.
• Place tube in disposable plastic bag. Remove gloves
• Perform hand hygiene.
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 Urethral catheterization

Urethral catheterization is a routine medical procedure that facilitates direct

drainage of the urinary bladder.

• Indication: Acute and chronic urinary retention, bladder irrigation,

monitoring the fluid balance accurately( input and output),
different surgical interventions ( abdominal or pelvic surgery).
• Contraindications: Presented or suspected traumatic injury to the
lower urinary tract (eg, urethral tear), urethral stricture or
obstruction.
• Complications:Urinary tract infections, sepsis, injury of urethra,
hematuria, buildup of bladder stones.

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 Urethral catheterization
Equipment: Urinary catheters come in several
varieties. Catheters can be made of different
material : Latex, Teflon or silicone.

• Foley catheter – a flexible tube (commonly

made from latex) has two separated
channels, or lumens, running down its
length. One lumen is open at both ends,
and drains urine into a collection bag. The
other lumen has a valve on the outside end
and connects to a balloon at the tip. The
balloon is inflated with sterile water when
it lies inside the bladder to stop it from
slipping out. Mainly 10 – 28 Fr size
catheters are used.

• Sterile gloves, forceps, antiseptic solution,

water soluble lubricant, sterile cotton balls,
tape and collection bag.

• Patient positioning: Place the patient supine, in

the frogleg position, with knees flexed.
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Urethral catheterIzatIon

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Urethral catheterIzatIon

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Urethral catheterIzatIon

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 Urethral catheterIzatIon
Urethral catheterization is a sterile procedure, because of high risk of urinary tract
infection.
• Perform hand hygiene.
• Place the patient supine, in the frogleg position, with knees flexed.
• Place under pad beneath patient, plastic or “shiny” side down
• Open the catheter tray and place it between the patient’s legs; use the sterile package as an extended
sterile field.
• Don sterile gloves provided
• Open the iodine-povidone preparatory solution and pour it onto the sterile cotton balls.
• Pre-test the Foley catheter balloon integrity by inflating it with prefilled syringe containing sterile
saline
• Lubricate the tip of the catheter
• Connect the catheter to the urine drainage bag
• Position fenestrated drape on patient appropriately

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 Male patient
• Use the nondominant hand to hold the penis
and retract the foreskin (if present). This
hand is the nonsterile hand and holds the
penis throughout the procedure.
• Use the sterile hand and sterile forceps to
prep the urethra and glans in circular
motions with at least 3 different cotton balls
starting at the urethral meatus and working
outward.
• While holding the penis at approximately
90° and stretching it upward to straighten
out the penile urethra, slowly and gently
introduce the catheter into the urethra with
sterile-dominant hand. Catheter is hold 5-6
cm down the bladder opening. Proceed with
catheterization until urine is visible in the
drainage tube
Female patient
• Use the nondominant hand to separate the
labia with the thumb and index finger. This
hand is now nonsterile and is used to expose
the vulva throughout the procedure.
• With the sterile hand and a sterile forceps,
apply antiseptic solution to the urethra and
the surrounding vulva in circular motions,
using at least 3 different cotton balls. Use
each cotton ball for a single downward
stroke only.
• With the thumb, middle and index fingers
of the non-dominant hand separating the
labia majora and labia minora, slowly and
gently introduce the catheter into the
urethra with sterile-dominant hand.
Catheter is hold 5-6 cm down the bladder
opening. Proceed with catheterization until
urine is visible in the drainage tube.
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Urethral catheterIzatIon

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 Urethral catheterIzatIon
and inflate catheter through the cuff inflation port balloon using entire
sterile saline provided in the prefilled syringe.
• After visualization of urine return, insert catheter two more centimeters
• Once inflated, gently pull catheter until the resistance is met (inflated
balloon is snug against the bladder neck). If the patient is uncircumcised,
make sure to reduce the foreskin, as failure to do so can cause
paraphimosis.
• Secure the catheter to the patient's thigh with a tape.
• Position the urinary bag on bed rail at the foot of the bed, below the
level of urinary bladder, to avoid the reflux of urine.
• Take of the gloves
• Perform hand hygiene.

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Dear students!

After finishing second course program, you will have Objective

Structured Clinical Exam (OSCE), where each of you will have same
amount of time to demonstrate your theoretical knowledge and clinical
skills.

It’s important to remember that: Examiners will evaluate both - your

theoretical knowledge and clinical skills.

Demonstrate your knowledge , by talking about every theoretical aspect

of manipulation that you will be doing.

Good luck!