Nasogastric Tube – Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialisms with differing levels of prescriber authority.
Many nurses provide care within the ordering scope of physicians, and this traditional role has shaped the public image of nurses as care providers. However, nurses are permitted by most jurisdictions to practice independently in a variety of settings depending on training level. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.
Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient’s family, and other team members, that focus on treating illness to improve quality of life. Nurses may help coordinate the patient care performed by other members of an interdisciplinary healthcare team such as therapists, medical practitioners, and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.
Nasogastric Tube
Definition of Nasogastric Tube:
Nasogastric tube is a tube that is passed through the nose and down through the nasopharynx and esophagus into the stomach.
A nasogastric tube is a tube that is inserted into the stomach through the nose. This flexible tube can contain one or two inner ducts and is connected to an external device.
Types of Nasogastric Tube:
1. Wide bore tubes (usually PVC):
- These tubes are for short term use only.
- They should be changed every seven days.
- In general, the range of sizes for paediatric use is 6 Fr to 10 Fr
2. Fine bore tubes (polyurethane):
- These tubes are intended for long term use
- They should be changed every 30 days.
Definition of Nasogastric (NG) Intubation:
Nasogastric intubation is a medical process involving the insertion of a plastic tube (nasogastric tube or NG tube) through the nose, past the throat, and down into the stomach.
or
Passing a tube through the nose to the stomach is called nasogastric intubation.
Purposes of Nasogastric Intubation:
1. To remove fluid and gas from gastrointestinal (decompression) tract.
2. Prevent or relieve nausea and vomiting after surgery.
3. To treat patients with mechanical obstruction and bleeding of the upper gastrointestinal tract.
4. To obtain a specimen of gastric contents for laboratory studies.
5. Administer medications and feeding directly into gastrointestinal tract.
Indication of Nasogastric Intubation:
A. Diagnostic indications for NG intubation include the following:
- Evaluation of upper gastrointestinal (GI) bleeding (ie, presence, volume)
- Aspiration of gastric fluid content
- Identification of the esophagus and stomach on a chest radiograph
- Administration of radiographic contrast to the GI tract
B. Therapeutic indications for NG intubation include the following:
- Gastric decompression, including maintenance of a decompressed state noitou after endotracheal intubation, often via the oropharynx
- Relief of symptoms and bowel rest in the setting of small-bowel obstruction noreny
- Aspiration of gastric content from recent ingestion of toxic material
- Administration of medication
- Feeding
- Bowel irrigation
Contraindication of Nasogastric Intubation:
A. Absolute contraindications for NG intubation include the following:
- Severe midface trauma
- Recent nasal surgery
B. Relative contraindications for NG intubation include the following:
- Coagulation abnormality
- Esophageal varices (usually, a Sengstaken-Blakemore tube is introduced, but an NG tube can be used for lower-grade varices) or stricture
- Recent banding of esophageal varices
- Alkaline ingestion (the tube may be kept if the injury is not severe)
Procedure of Nasogastric Intubation:
A. Equipment’s for nasogastric intubation:
The following equipment is needed (also see image below):
- Nasogastric tube
✓ Adult-16-18 Fr
✓ Pediatric – In pediatric patients, the correct tube size varies with the e patient’s age. 2000 To find the correct size, add 16 to the patient’s age in years and then divide by 2 (eg, [8 y + 16]/212Fr)
- Viscous lidocaine 2%
- Oral analgesic spray (Benzocaine spray or other)
- Syringe, 10 mL
- Glass of water with a straw
- Water-based lubricant
- Toomey syringe, 60 mL
- Tape
- Emesis basin or plastic bag
- Wall suction, set to low intermittent suction
- Suction tubing and container
B. Positioning
- Position the patient seated upright.
C. Procedure:
1. Check the physician’s order, progress notes and nursing care plan,
2. Identify the patient.
3. Explain the procedure to the patient.
4. Pre-determine a signal by which the patient can communicate if he/she require the nurse to halt the procedure, e.g. raise his/her hand.
5. Collect and prepare the equipment.
6. Ensure the patient’s privacy.
7. Help the patient into a comfortable position. Sitting upright either in a bed or on a chair. Support the patient head with pillows.
8. Observe the patient throughout this procedure.
9. Remove the patient’s dentures, if present place in labelled container.
10. Wash and dry hands.
11. Check the patient’s nostrils. Request patient to sniff each nostril in turn or clean the nostrils if necessary.
12. Ask the patient of any nasal defect or tenderness in order to avoid attempting to pass the tube through a defective nasal passage.
13. Establish the distance that the tube is to be passed by measuring the distance on on the tube from the patient’s ear lobe to the bridge of the nose to the bottom of the Xiphistemum.
14. Using clean technique assemble the equipment.
15. Lubricate about 15-20 cm of the tube with water soluble jelly, which has been placed on a gauze swab.
16. Ask the patient to relax as much as possible while the tube is passed.
17. Insert the tube and slide it gently but firmly inwards and backwards along the floor of the nose to the nasopharynx. If an obstruction is felt withdraw the tube and try again or use another nostril.
18. Encourage the patient to swallow and breath through his mouth when the tube reaches the pharynx keeping the chin down and head forward to assist the passage of the tube.
19. Advance the tube until the length previously measured has been inserted and the mark has reached the external nares. If the patient shows any signs of distress, e.g. gasping or cyanosis, remove the tube immediately.
20. Ascertain whether the tube is in the stomach by:
- Aspirating the contents of the stomach with a syringe. The aspirate should turn blue litmus paper red.
- Place the stethoscope over the epigastrium and inject 2-3 ml of air to the tube.
21. Secure the tube to the patient’s nose with tape. Secure the free-end of the tube in the suitable position avoiding visual obstruction.con obrne dttron at answ
22. Aspirate the stomach contents as per the order of the doctor (if required dispatch specimen to laboratory).
23. Ensure that the patient is left feeling as comfortable as possible.
24. Clean and dispose of the equipment.
25. Wash hands.
26. Initiate and maintain intake and output chart.
27. Document the nursing procedure appropriately, monitor after effects and report any abnormal findings immediately.
Confirmation of NG Tube Inserted Properly:
- Aspiration will bring out gastric contents.
- A few cc. of air is injected into the tube and at the same time auscultation done over epigastrium if the tube is in the stomach, a gurgling sound will be heard.
- In case of Ryle’s tube, a plan X-ray will locate the metallic bead at the tip.
Complications Nasogastric Intubation:
1. Patient discomfort
- Generous lubrication, the use of topical anesthetic, and a gentle technique may reduce the patient’s level of discomfort.
- Throat irritation may be reduced with administration of anesthetic lozenges (eg, benzocaine lozenges [Cepacol]) prior to the procedure.
2. Epistaxis may be prevented by generously lubricating the tube tip and using a gentle technique.
3. Respiratory tree intubation
4. Esophageal perforation
Procedure of Removing Nasogastric Tube:
- Remove the adhesive taper on the nose.
- Clamp the tube to prevent any leakage of fluid.
- Ask the patients to take a deep breath and to hold the breath while we steadily and quickly removed the tube. Holding the breathe closes the glottis and prevents the possibility of aspiration. Dispose the tube.
- Provide gauze to the patients to blow the nose and a glass of water to clear the throat. Offer to cleanse the mouth and/or nose. Leave the patient in a comfortable position.
- Record the removal of the tube.
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