Nasogastric tube (NGT) insertion and removal Nursing Procedure
<ul><li>Usually inserted to decompress the stomach , a nasogastric tube (NG) tube prevent vomiting after major surgery ....
The NG tube can also be used to assess and treat: <ul><li>Upper GI bleeding </li></ul><ul><li>Collect gastric contents for...
Equipments needed
Equipments needed <ul><li>Tube (usually #12, #14, #16 or #18 French for a normal adult. </li></ul>
Equipments needed <ul><li>Towel or linen-saver pad </li></ul>
Equipments needed <ul><li>Penlight </li></ul>
Equipments needed <ul><li>1” or 2” hypoallergenic tape or Opsite </li></ul>
Equipments needed <ul><li>Liquid skin barrier </li></ul>
Equipments needed <ul><li>Gloves </li></ul>
Equipments needed <ul><li>Water soluble lubricant </li></ul>
Equipments needed <ul><li>Cup or glass of water with straw (if appropriate) </li></ul>
Equipments needed <ul><li>Stethoscope </li></ul>
Equipments needed <ul><li>Tongue blade </li></ul>
Equipments needed <ul><li>Catheter-tip or bulb syringe or irrigation set </li></ul>
Equipments needed <ul><li>Safety pin </li></ul>
Equipments needed <ul><li>Ordered suction equipment </li></ul>
Equipments needed (optional) <ul><li>Metal clamp </li></ul>
Equipments needed (optional) <ul><li>Ice </li></ul>
Equipments needed (optional) <ul><li>Alcohol pad </li></ul>
Equipments needed (optional) <ul><li>Warm water </li></ul><ul><li>(in the picture is a hot water bag) </li></ul>
Equipments needed (optional) <ul><li>Large basin or plastic container </li></ul>
Equipments needed (optional) <ul><li>Rubber band </li></ul>
Preparation <ul><li>To ease insertion, increase a stiff tube’s flexibility by coiling it around your finger for a few sec...
Procedure <ul><li>Provide privacy, wash your hands, and put on gloves. </li></ul>
Inserting an NG tube <ul><li>Explain the procedure to the patient. </li></ul><ul><li>Tell her that she may experience som...
 
Inserting an NG tube <ul><li>Help the patient into high Fowler’s position unless contraindicated. </li></ul>
Inserting an NG tube <ul><li>Stand at the patient’s right side if you’re right-handed or at her left side if you’ left-han...
Inserting an NG tube <ul><li>Drape the towel or linen-saver pad over the patient’s chest. </li></ul>
Inserting an NG tube <ul><li>To determine how long the NG tube must be to reach the stomach , hold the end of the tube at ...
 
Inserting an NG tube <ul><li>Mark this distance on the tubing with tape. </li></ul>
Inserting an NG tube <ul><li>To determine which nostril will allow easier access , use a penlight and inspect for a deviat...
 
Inserting an NG tube <ul><li>Lubricate the first 3” (7.6 cm) of the tube with a water-soluble gel. </li></ul>
 
Inserting an NG tube <ul><li>Instruct the patient to hold her head straight and upright. </li></ul>
Inserting an NG tube <ul><li>Grasp the tube with the end pointing downward, curve it if necessary, and carefully insert it...
 
Inserting an NG tube <ul><li>Aim the tube downward and toward the ear closest to the chosen nostril. </li></ul><ul><li>Ad...
Inserting an NG tube <ul><li>When the tube reaches the nasopharynx, you’ll feel resistance. </li></ul>
 
Inserting an NG tube <ul><li>Instruct the patient to lower her head slightly to close the trachea and open the esophagus. ...
 
Inserting an NG tube <ul><li>Then rotate the tube 180 degrees toward the opposite nostril to redirect it so that the tube...
Inserting an NG tube <ul><li>Unless contraindicated, offer the patient a cup of water with a straw. </li></ul><ul><li>Dir...
 
Ensuring proper tube placement <ul><li>Use a tongue blade and penlight to examine the patient’s mouth and throat for sign...
Ensuring proper tube placement <ul><li>As you carefully advance the tube and the patient swallows, watch for respiratory d...
Ensuring proper tube placement <ul><li>Stop advancing the tube when the tape mark reaches the patient’s nostril. </li></ul>
Ensuring proper tube placement <ul><li>Attach the catheter-tip or bulb syringe to the tube and try to aspirate stomach con...
 
Ensuring proper tube placement <ul><li>If you don’t obtain stomach contents, position the patient on her left side to mov...
Ensuring proper tube placement <ul><li>If you still can’t aspirate stomach contents, advance the tube 1” to 2” (2.5 - 5 cm...
Ensuring proper tube placement <ul><li>At the same time, auscultate for air sounds with your stethoscope placed over the e...
 
Ensuring proper tube placement <ul><li>If these test don’t confirm proper tube placement, you’ll need X-ray verification. ...
 
Example of a CXR showing a misplaced NG tube
Ensuring proper tube placement <ul><li>Secure the NG tube to the patient’s nose with hypoallergenic tape, (or other design...
 
 
Ensuring proper tube placement <ul><li>Apply liquid skin barrier to make the tape more adherent to the skin. </li></ul>
Ensuring proper tube placement <ul><li>You’ll need about 4” (10 cm) of 1”tape. </li></ul><ul><li>Split one end of the tap...
Ensuring proper tube placement <ul><li>Stick the uncut tape end on the patient’s nose so that the split in the tape starts...
Ensuring proper tube placement <ul><li>Crisscross the tabbed ends around the tube. </li></ul><ul><li>Then apply another p...
Ensuring proper tube placement <ul><li>Alternatively, stabilize the tube with Opsite or a prepackaged product that secures...
Ensuring proper tube placement <ul><li>To reduce discomfort from the weight of the tube, tie a slipknot around the tube wi...
Ensuring proper tube placement <ul><li>Attach the tube to suction equipment, if ordered, and set the designated suction pr...
Ensuring proper tube placement <ul><li>Provide frequent nose and mouth care while the tube is in place. </li></ul><ul><li>...
*Confirming NG tube placement <ul><li>When confirming NG tube placement, never place the tube’s end in a container of wate...
*Confirming NG tube placement <ul><li>Besides, water without bubbles doesn’t confirm proper placement. </li></ul><ul><li>I...
Removing an NG tube <ul><li>Explain the procedure to the patient and that it may cause some discomfort. </li></ul>
 
Removing an NG tube <ul><li>Assess bowel function by auscultating for peristalsis or flatus. </li></ul>
 
Removing an NG tube <ul><li>Help the patient into semi-Fowler’s position. </li></ul><ul><li>Then drape a towel or linen-s...
 
Removing an NG tube <ul><li>Put on gloves. </li></ul><ul><li>Using a catheter-tip syringe, flush the tube with 10ml of no...
 
Removing an NG tube <ul><li>Untape the tube from the patient’s nose, and then unpin it from her gown. </li></ul>
<ul><li>Please wear gloves!!! </li></ul>
Removing an NG tube <ul><li>Clamp the tube by folding it in your hand. </li></ul>
Removing an NG tube <ul><li>Ask the patient to hold her breath to close the epiglottis. </li></ul><ul><li>Then withdraw t...
<ul><li>Please wear gloves!!! </li></ul>
Removing an NG tube <ul><li>Assist the patient with thorough mouth care, and clean the tape residue from her nose with adh...
Removing an NG tube <ul><li>Monitor the patient for signs of GI dysfunction. </li></ul>
 
Pointers <ul><li>If the patient has a nasal condition that prevents nasal insertion, pass the tube orally after removing...
Pointers <ul><li>First coil the end of the tube around your hand. </li></ul><ul><li>This helps curve and direct the tube ...
Pointers <ul><li>While advancing the tube. </li></ul><ul><li>Observe for signs that it is entered the trachea, such as cho...
 
Pointers <ul><li>If these signs occur, remove the tube immediately. </li></ul><ul><li>Allow the patient time to rest; then...
Pointers <ul><li>After tube placement, vomiting suggest tubal obstruction or incorrect position. </li></ul><ul><li>Assess ...
Complications of NG intubation <ul><li>Although nasogastric (NG) intubation is a common procedure, it does carry risk. </l...
Complications of NG intubation (Long-term concerns) <ul><li>Potential complications of prolonged intubation includes: </li...
Complications of NG intubation (Suction reactions) <ul><li>Additional complications include: </li></ul><ul><ul><li>Electro...
Complications of NG intubation (Suction reactions) <ul><li>Vigorous suction ,ay damage the gastric mucosa and cause signif...
Using an NG tube at home <ul><li>If your patient will have a nasogastric (NG) tube in place at home, find out who will ins...
Using an NG tube at home <ul><li>Make a list; check it twice </li></ul><ul><li>If the patient or a family member will perf...
Using an NG tube at home <ul><li>Use this checklist to prepare teaching topics: </li></ul><ul><ul><li>How and where to obt...
Using an NG tube at home <ul><ul><li>How to verify tube placement by aspirating stomach contents. </li></ul></ul><ul><ul><...
Using an NG tube at home <ul><ul><li>How to administer formula through the tube. </li></ul></ul><ul><ul><li>How to remove ...
Using an NG tube at home <ul><ul><li>How to use the NG tube for gastric decompression, if appropriate. </li></ul></ul><ul>...
“ Nurses Informations” http://nursesinformations.blogspot.com
<ul><li>All rights reserved 2008 </li></ul><ul><li>“ Nurses Informations” </li></ul>
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Nasogastric Tube (NGT) insertion and removal

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Transcripts - Nasogastric Tube (NGT) insertion and removal

  • 1. Nasogastric tube (NGT) insertion and removal Nursing Procedure
  • 2. <ul><li>Usually inserted to decompress the stomach , a nasogastric tube (NG) tube prevent vomiting after major surgery . An NG typically is in place for 48-72 hours after surgery, by which time peristalsis usually resumes. </li></ul>
  • 3. The NG tube can also be used to assess and treat: <ul><li>Upper GI bleeding </li></ul><ul><li>Collect gastric contents for analysis </li></ul><ul><li>Perform gastric lavage </li></ul><ul><li>Aspirate gastric secretions </li></ul><ul><li>Administer medications and nutrients </li></ul>
  • 4. Equipments needed
  • 5. Equipments needed <ul><li>Tube (usually #12, #14, #16 or #18 French for a normal adult. </li></ul>
  • 6. Equipments needed <ul><li>Towel or linen-saver pad </li></ul>
  • 7. Equipments needed <ul><li>Penlight </li></ul>
  • 8. Equipments needed <ul><li>1” or 2” hypoallergenic tape or Opsite </li></ul>
  • 9. Equipments needed <ul><li>Liquid skin barrier </li></ul>
  • 10. Equipments needed <ul><li>Gloves </li></ul>
  • 11. Equipments needed <ul><li>Water soluble lubricant </li></ul>
  • 12. Equipments needed <ul><li>Cup or glass of water with straw (if appropriate) </li></ul>
  • 13. Equipments needed <ul><li>Stethoscope </li></ul>
  • 14. Equipments needed <ul><li>Tongue blade </li></ul>
  • 15. Equipments needed <ul><li>Catheter-tip or bulb syringe or irrigation set </li></ul>
  • 16. Equipments needed <ul><li>Safety pin </li></ul>
  • 17. Equipments needed <ul><li>Ordered suction equipment </li></ul>
  • 18. Equipments needed (optional) <ul><li>Metal clamp </li></ul>
  • 19. Equipments needed (optional) <ul><li>Ice </li></ul>
  • 20. Equipments needed (optional) <ul><li>Alcohol pad </li></ul>
  • 21. Equipments needed (optional) <ul><li>Warm water </li></ul><ul><li>(in the picture is a hot water bag) </li></ul>
  • 22. Equipments needed (optional) <ul><li>Large basin or plastic container </li></ul>
  • 23. Equipments needed (optional) <ul><li>Rubber band </li></ul>
  • 24. Preparation <ul><li>To ease insertion, increase a stiff tube’s flexibility by coiling it around your finger for a few seconds or by dipping it into warm water. </li></ul><ul><li>Stiffen a limp rubber tube by briefly chilling it in ice. </li></ul>
  • 25. Procedure <ul><li>Provide privacy, wash your hands, and put on gloves. </li></ul>
  • 26. Inserting an NG tube <ul><li>Explain the procedure to the patient. </li></ul><ul><li>Tell her that she may experience some discomfort and that swallowing will ease the tube’s advancement. </li></ul>
  • 28. Inserting an NG tube <ul><li>Help the patient into high Fowler’s position unless contraindicated. </li></ul>
  • 29. Inserting an NG tube <ul><li>Stand at the patient’s right side if you’re right-handed or at her left side if you’ left-handed to ease insertion . </li></ul>
  • 30. Inserting an NG tube <ul><li>Drape the towel or linen-saver pad over the patient’s chest. </li></ul>
  • 31. Inserting an NG tube <ul><li>To determine how long the NG tube must be to reach the stomach , hold the end of the tube at the tip of the patient’s nose. </li></ul><ul><li>Extend the tube to the patient’s earlobe and then down to the xiphoid process. </li></ul>
  • 33. Inserting an NG tube <ul><li>Mark this distance on the tubing with tape. </li></ul>
  • 34. Inserting an NG tube <ul><li>To determine which nostril will allow easier access , use a penlight and inspect for a deviated septum or other abnormalities. </li></ul>
  • 36. Inserting an NG tube <ul><li>Lubricate the first 3” (7.6 cm) of the tube with a water-soluble gel. </li></ul>
  • 38. Inserting an NG tube <ul><li>Instruct the patient to hold her head straight and upright. </li></ul>
  • 39. Inserting an NG tube <ul><li>Grasp the tube with the end pointing downward, curve it if necessary, and carefully insert it into the more patient nostril. </li></ul>
  • 41. Inserting an NG tube <ul><li>Aim the tube downward and toward the ear closest to the chosen nostril. </li></ul><ul><li>Advance it slowly to avoid pressure on the turbinates and resultant pain and bleeding. </li></ul>
  • 42. Inserting an NG tube <ul><li>When the tube reaches the nasopharynx, you’ll feel resistance. </li></ul>
  • 44. Inserting an NG tube <ul><li>Instruct the patient to lower her head slightly to close the trachea and open the esophagus. </li></ul>
  • 46. Inserting an NG tube <ul><li>Then rotate the tube 180 degrees toward the opposite nostril to redirect it so that the tube wont enter the patient’s mouth. </li></ul>
  • 47. Inserting an NG tube <ul><li>Unless contraindicated, offer the patient a cup of water with a straw. </li></ul><ul><li>Direct her to sip and swallow as you slowly advance the tube. </li></ul><ul><li>This helps the tube pass to the esophagus. (If you aren’t using water, ask the patient to swallow.) </li></ul>
  • 49. Ensuring proper tube placement <ul><li>Use a tongue blade and penlight to examine the patient’s mouth and throat for signs of a coiled section of tubing. </li></ul>
  • 50. Ensuring proper tube placement <ul><li>As you carefully advance the tube and the patient swallows, watch for respiratory distress signs, which may mean the tube is in bronchus and must be removed immediately. </li></ul>
  • 51. Ensuring proper tube placement <ul><li>Stop advancing the tube when the tape mark reaches the patient’s nostril. </li></ul>
  • 52. Ensuring proper tube placement <ul><li>Attach the catheter-tip or bulb syringe to the tube and try to aspirate stomach contents. </li></ul>
  • 54. Ensuring proper tube placement <ul><li>If you don’t obtain stomach contents, position the patient on her left side to move the contents into the stomach’s greater curvature, and aspirate again. </li></ul>
  • 55. Ensuring proper tube placement <ul><li>If you still can’t aspirate stomach contents, advance the tube 1” to 2” (2.5 - 5 cm). </li></ul><ul><li>Then inject 10cc air into the tube. </li></ul>
  • 56. Ensuring proper tube placement <ul><li>At the same time, auscultate for air sounds with your stethoscope placed over the epigastric region. </li></ul><ul><li>You should hear a whooshing sound if the tube is patent and properly positioned in the stomach. </li></ul>
  • 58. Ensuring proper tube placement <ul><li>If these test don’t confirm proper tube placement, you’ll need X-ray verification. </li></ul>
  • 60. Example of a CXR showing a misplaced NG tube
  • 61. Ensuring proper tube placement <ul><li>Secure the NG tube to the patient’s nose with hypoallergenic tape, (or other designated tube holder). </li></ul><ul><li>If the patient’s skin is oily, wipe the bridge of her nose with an alcohol pad and allow to dry. </li></ul>
  • 64. Ensuring proper tube placement <ul><li>Apply liquid skin barrier to make the tape more adherent to the skin. </li></ul>
  • 65. Ensuring proper tube placement <ul><li>You’ll need about 4” (10 cm) of 1”tape. </li></ul><ul><li>Split one end of the tape up the center about 1 ½” (3.8 cm). </li></ul><ul><li>Make tabs on the split ends (by folding sticky sides together). </li></ul>
  • 66. Ensuring proper tube placement <ul><li>Stick the uncut tape end on the patient’s nose so that the split in the tape starts about ½” (1.3 cm) to 1 ½” from the tip of her nose. </li></ul>
  • 67. Ensuring proper tube placement <ul><li>Crisscross the tabbed ends around the tube. </li></ul><ul><li>Then apply another piece of tape over the bridge of the nose to secure the tube. </li></ul>
  • 68. Ensuring proper tube placement <ul><li>Alternatively, stabilize the tube with Opsite or a prepackaged product that secures and cushions it at the nose. </li></ul>
  • 69. Ensuring proper tube placement <ul><li>To reduce discomfort from the weight of the tube, tie a slipknot around the tube with a rubber band, and then secure the rubber band to the patient’s gown with a safety pin, or wrap another piece of tape around the end of the tube and leave a tab. </li></ul><ul><li>Then fasten the tape tab to the patient’s gown. </li></ul>
  • 70. Ensuring proper tube placement <ul><li>Attach the tube to suction equipment, if ordered, and set the designated suction pressure. </li></ul>
  • 71. Ensuring proper tube placement <ul><li>Provide frequent nose and mouth care while the tube is in place. </li></ul><ul><li>An NG tube may be inserted or removed at home. </li></ul>
  • 72. *Confirming NG tube placement <ul><li>When confirming NG tube placement, never place the tube’s end in a container of water. </li></ul><ul><li>If the tube is malpositioned in the trachea, the patient may aspirate water. </li></ul>
  • 73. *Confirming NG tube placement <ul><li>Besides, water without bubbles doesn’t confirm proper placement. </li></ul><ul><li>Instead, the tube may be coiled in the trachea or the esophagus. </li></ul>
  • 74. Removing an NG tube <ul><li>Explain the procedure to the patient and that it may cause some discomfort. </li></ul>
  • 76. Removing an NG tube <ul><li>Assess bowel function by auscultating for peristalsis or flatus. </li></ul>
  • 78. Removing an NG tube <ul><li>Help the patient into semi-Fowler’s position. </li></ul><ul><li>Then drape a towel or linen-saver pad across her chest to protect her from spills. </li></ul>
  • 80. Removing an NG tube <ul><li>Put on gloves. </li></ul><ul><li>Using a catheter-tip syringe, flush the tube with 10ml of normal saline solution to ensure that the tube doesn’t contain stomach contents that could irritate tissues during tube removal. </li></ul>
  • 82. Removing an NG tube <ul><li>Untape the tube from the patient’s nose, and then unpin it from her gown. </li></ul>
  • 83. <ul><li>Please wear gloves!!! </li></ul>
  • 84. Removing an NG tube <ul><li>Clamp the tube by folding it in your hand. </li></ul>
  • 85. Removing an NG tube <ul><li>Ask the patient to hold her breath to close the epiglottis. </li></ul><ul><li>Then withdraw the tube gently and steadily. (when the distal end of the tube reaches the nasopharynx, you can pull it quickly.) </li></ul>
  • 86. <ul><li>Please wear gloves!!! </li></ul>
  • 87. Removing an NG tube <ul><li>Assist the patient with thorough mouth care, and clean the tape residue from her nose with adhesive remover. </li></ul>
  • 88. Removing an NG tube <ul><li>Monitor the patient for signs of GI dysfunction. </li></ul>
  • 90. Pointers <ul><li>If the patient has a nasal condition that prevents nasal insertion, pass the tube orally after removing any dentures, if necessary. </li></ul>
  • 91. Pointers <ul><li>First coil the end of the tube around your hand. </li></ul><ul><li>This helps curve and direct the tube downward at the phaynx. </li></ul>
  • 92. Pointers <ul><li>While advancing the tube. </li></ul><ul><li>Observe for signs that it is entered the trachea, such as choking or breathing difficulties in a conscious patient and cyanosis in an unconscious patient or a patient without a cough reflex. </li></ul>
  • 94. Pointers <ul><li>If these signs occur, remove the tube immediately. </li></ul><ul><li>Allow the patient time to rest; then try to reinsert the tube. </li></ul>
  • 95. Pointers <ul><li>After tube placement, vomiting suggest tubal obstruction or incorrect position. </li></ul><ul><li>Assess immediately to determine the cause. </li></ul>
  • 96. Complications of NG intubation <ul><li>Although nasogastric (NG) intubation is a common procedure, it does carry risk. </li></ul>
  • 97. Complications of NG intubation (Long-term concerns) <ul><li>Potential complications of prolonged intubation includes: </li></ul><ul><ul><li>Esophagitis </li></ul></ul><ul><ul><li>Esophagotracheal fistula </li></ul></ul><ul><ul><li>Gastric ulceration </li></ul></ul><ul><ul><li>Pulmonary and oral infection </li></ul></ul><ul><ul><li>Sinusitis </li></ul></ul><ul><ul><li>Skin erosion at the nostril </li></ul></ul>
  • 98. Complications of NG intubation (Suction reactions) <ul><li>Additional complications include: </li></ul><ul><ul><li>Electrolyte imbalances </li></ul></ul><ul><ul><li>Dehydration </li></ul></ul>
  • 99. Complications of NG intubation (Suction reactions) <ul><li>Vigorous suction ,ay damage the gastric mucosa and cause significant bleeding, possibly interfering with endoscopic assessment and diagnosis. </li></ul>
  • 100. Using an NG tube at home <ul><li>If your patient will have a nasogastric (NG) tube in place at home, find out who will insert the tube. </li></ul><ul><li>If he will have a home care nurse, tell him to expect her. </li></ul>
  • 101. Using an NG tube at home <ul><li>Make a list; check it twice </li></ul><ul><li>If the patient or a family member will perform the procedure, you’ll need to provide additional instruction and supervision. </li></ul>
  • 102. Using an NG tube at home <ul><li>Use this checklist to prepare teaching topics: </li></ul><ul><ul><li>How and where to obtain equipment needed for home intubation. </li></ul></ul><ul><ul><li>How to insert the tube. </li></ul></ul>
  • 103. Using an NG tube at home <ul><ul><li>How to verify tube placement by aspirating stomach contents. </li></ul></ul><ul><ul><li>How to correct tube misplacement. </li></ul></ul><ul><ul><li>How to prepare formula for tube feeding. </li></ul></ul><ul><ul><li>How to store formula, if appropriate. </li></ul></ul>
  • 104. Using an NG tube at home <ul><ul><li>How to administer formula through the tube. </li></ul></ul><ul><ul><li>How to remove and dispose of an NG tube. </li></ul></ul><ul><ul><li>How to clean and store a reusable NG tube. </li></ul></ul>
  • 105. Using an NG tube at home <ul><ul><li>How to use the NG tube for gastric decompression, if appropriate. </li></ul></ul><ul><ul><li>How to set up and operate suctioning equipment. </li></ul></ul><ul><ul><li>How to troubleshoot suctioning equipment. </li></ul></ul><ul><ul><li>How to perform mouth care and other hygenic procedures. </li></ul></ul>
  • 106. “ Nurses Informations” http://nursesinformations.blogspot.com
  • 107. <ul><li>All rights reserved 2008 </li></ul><ul><li>“ Nurses Informations” </li></ul>

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