Nf2 module 7

Nasogastric Tubes

Enteral nutrition

 Enteral nutrition is the delivery of nutrients directly to the intestine

o Enteric = involving the intestine
o Stoma or NG tubes
 Total Parenteral Nutrition is the delivery of nutrients to the bloodstream
o Parenteral = occurring outside the intestine
o IV only
Page 1148

Enteral nutrition: Indications

 Cancer
o Head, neck, GI cancers
 Critical illness or trauma
o Respiratory failure
 Neurological and muscular disorders
o Stroke
 Gastrointestinal disorders

Dementia patients be in enteral feeding, but with precautions due to their confusion
Types of feeding tubes

LO#2 Identify and differentiate

between the following alternative
measures to feeding. GT, TPN, NG

Types of feeding tubes

Less than 4 weeks
 Nasogastric (NG Tube):
o passes through nose into stomach
 Orogastric (OG tube):
o passes through mouth into stomach
Long term
 Gastrostomy Tube (G-Tube or PEG Tube):
o passes through the skin into the stomach
 Nasoduodenal/jejunal (ND/NJ Tube):
o passes through the nose into the small intestine
 Jejunostomy Tube (J-Tube):
o passes through the skin into the jejunum, the
o upper part of small intestine
Types of feeding tubes: G-tubes
 Percutaneous Endoscopic Gastrostomy (PEG or G)
 Percutaneous Endoscopic Jejunostomy (PEJ or PEG-J)
• Long-term feeding option
• Endoscope lab
• Puncture through skin and subcutaneous tissue into stomach or jejunum
• Aseptic technique for care at site

Types of feeding tubes: G-tubes

Low-profile balloon G-tubes
 Balloon sits in stomach to prevent displacement
 Extension port, ("Button") requires extension tubing for use
 Anti-reflex valve to prevent leakage of gastric contents in case cap comes off
 Nursing can replace an established gastrostomy tube

Kangaroo (brand name) G-Tube, non-low-

profile G-Tube, has a "disk" Mic-Key (brand name) G-Tube, low-profile
G-Tube, has a "button"/extension port

Indications for NG tubes

 Decompression – removal of gas and fluids (stomach contents) to relieve distention /
nausea and vomiting
o Decompression – ordered until bowel activity returns (~ 3-5 days)
 Obstruction – relieve and treat
 Diagnosis – disorders and obtain specimens
 Post Operative Healing
 Compression – treatment of bleeding through a balloon
 Lavage – remove toxic substances and irrigate (washing out)
 Feeding – provide enteral feeding and medications

LO#2 Explain the purposes for NG suction following GI surgery

LO#3 Identify other reasons for insertion of a NG tube

Sizes of NG tubes
 Small Bore – flexible feeding tube
o 8 – 12 Fr
 Large Bore – decompression
o 12 – 18 Fr
 Gastric Lavage tube
o 34 – 40 Fr

Types of NG tubes
Salem sump
 Double lumen
 Air vent (intermittent and continuous
suction)
o Allows air to enter patient’s
stomach
o Prevents excess
suction/damage to stomach
wall
 Anti–reflux value (put on end of air vent)
 Do not clamp air vent
 Keep the air vent above patient’s waist level to
prevent drainage from flowing into the air vent
o Will cause the NG to be sucked against the
stomach wall
 If stomach contents back up in the air vent, irrigate the
air vent with approximately 20 mL air.

LO#4 Discuss the nursing assessments required for insertion,

monitoring and discontinuing a NG tube
LO#7 Demonstrate the skills of….. Maintaining NG
suctioning

Types of NG tubes
Levine tube
 Not vented – CANNOT be used for
continuous suction
 Feeding / irrigation / lavage /
decompression
Types of NG tubes
Blakemore tube
 Physician insertion
 High risk procedure
 Usual OR insertion except in ++ emergent
cases
 Used to stop or slow bleeding

Types of NG tubes
Silastic tube
 Small bore
 Used for enteral feeding
 May be weighted and have a stylet
 Can be used for 3-4 weeks
 X- ray required to confirm placement
 Cannot check for gastric secretions

Inserting an NG Tube
*Physician’s order required to insert or remove NG tube
DO NOT insert NG tube if the patient has:
 Recent trauma / surgery to nose, mouth, esophagus, stomach, duodenum
 Esophageal Varices
 Basal skull fracture or maxillofacial injury (can insert orogastric tube)

Inserting an NG Tube
Nursing Assessments
What assessments would you do before inserting a NG?
 Level of Consciousness
 Gastrointestinal Assessment
o Bowel sounds
o Abdominal distention
o Nausea and vomiting
o Level of pain / discomfort
o nutrition
 Respiratory Assessment
o Increased respiratory rate, diminished air entry
o Increased temperature
 Suction level and frequency
 Placement of tube
LO#4
Inserting an NG Tube
Supplies
 Appropriately sized NG
 Connecting tube / connector
 Functioning wall suction and container
 Nonsterile gloves
 60 mL Syringe (catheter tip)
 Stethoscope
 Securement device or tape
 Water soluble lubricant
 Ph test strips

LO# 5 Demonstrate the skill of…. Inserting a NG tube along with safe methods to check
placement

Inserting an NG Tube
 Explain procedure to patient – reason for NG and need to swallow during insertion
 Always ask for consent
 Children’s parents or guardians are the one ones you gain consent from
 Recommended position:
o Adults = high fowler’s
o Infants = supine and propped at 30 degrees
 Determine which nostril to insert NG
o Avoid nostril with history of trauma
o Assess patency – determine air flow

Inserting an NG tube
Estimate the length of tubing
Adult/child – measure from the tip of nose to ear lobe and then to
the xyphoid process
o Indicate this point on tube with a sharpie or
piece of tape
o

Inserting an NG tube
Confirming NG tube placement
 Correct tube length exiting from body – check mark on tubing and documentation at
time of insertion
o When should you check?
 Assess gastric contents
o Observe color of aspirated contents
 Grassy green, clear, brown
o Test pH of aspirate
  pH of stomach 1-5
 pH of intestine 5-7
 pH of lung > 7
 Co2 levels at distal end
 Gold Standard = Xray after placement
o Needed for high-risk patients or if extended into the small intestine prior to
instilling anything into a NG
o Do not inject air or dye - why?

Potter et al., 2019, pp. 1150- 1151

Managing suction
*Need a physician's order for suction
 Intermittent LOW suction
o 40 – 80 mmHg is used (single lumen NG tube)
 Continuous HIGHER suction
o 60-120 mmHg is used (double lumen tube)

Nursing interventions
 Ensure patency of nostrils – cleanse and lubricate
 Ensure the tube is well secured and remains in place
 Provide frequent oral care (minimum q2h)
 Reconnect tube to suction after walks, toileting, etc.
 Monitor and assess drainage (type, amount, colour/consistency)
 Assess for return of peristalsis
 Change the suction canister when ¾ full – appropriate disposal
 Clamp tube 60 minutes after medications administered through tube
 Document intake and output per shift or as ordered

Patient teaching
 What to expect/report
o NPO
o Procedures/equipment
o Drainage/suction
o Positioning
o Intake and output
 Keep vent above stomach
 Frequent mouth care/ice chips or candy?
 Signs & symptoms of electrolyte imbalance/distension/nausea & vomiting
 Include them where you can!

Remove canister when it’s ¾ full

Troubleshooting
If the tube is not draining:
 No suction – check tubing and suction unit
 NG tube blocked – irrigate with 20-30 mL NS or sterile water (not done routinely)
 Air vent (blue tube on Salem sump tube) can block – ensure it remains clear of
secretions
 Reposition patient – turn to the lateral (side-lying) position
 Never irrigate or change the position of an NG tube inserted during gastric surgery
without a physician’s order

Removal of an NG tube
What assessments do you need to do prior to removing a NG?
Removal:
 Physician order is required
 NG may be clamped for several hours prior to assess patient tolerance (depending on
reason for insertion)
 Place disposable pad across patient’s chest
 Remove tube – steadily during patient’s exhalation
Post-removal:
 Provide/assist with mouth care
 Dispose of equipment appropriately (biohazard)
 Complete DARP charting
 Monitor for abdominal distention, nausea and vomiting, bowel sounds
 Smooth motion

NG tubes: Documentation
 Size and type of tube inserted/removed
 Coca
 Confirmation of placement
 Patient’s tolerance of procedure
 Assess drainage
 GI assessment
o turn suction off when auscultating for bowel sounds

LO#8 Report and document pertinent information regarding NG tubes

Inserted a #16 NG tube. How did you confirm. Patient asked several times to stop so she could
breath
Applied 20 cm suction
Immediately got large amount of mucousy greenish drainage
Reassess in one hour and abdomen much softer and patient states she feels not so full