Nasogastric tube
(NGT)
insertion and removal
Nursing Procedure
• Usually inserted to decompress
the stomach, a nasogastric tube
(NG) tube prevent vomiting after
major surgery. An NG ...
The NG tube can also be used to
assess and treat:
Upper GI bleeding
Collect gastric contents for
analysis
Perform ...
Equipments needed
Equipments needed
• Tube (usually
#12, #14, #16
or #18 French
for a normal
adult.
Equipments needed
• Towel or linen-saver pad
Equipments needed
• Penlight
Equipments needed
• 1” or 2” hypoallergenic tape or
Opsite
Equipments needed
• Liquid skin barrier
Equipments needed
• Gloves
Equipments needed
• Water soluble lubricant
Equipments needed
• Cup or glass of water with straw
(if appropriate)
Equipments needed
• Stethoscope
Equipments needed
• Tongue blade
Equipments needed
• Catheter-tip or bulb syringe or
irrigation set
Equipments needed
• Safety pin
Equipments needed
• Ordered
suction
equipment
Equipments needed (optional)
• Metal clamp
Equipments needed (optional)
• Ice
Equipments needed (optional)
• Alcohol pad
Equipments needed (optional)
• Warm water
• (in the picture is a
hot water bag)
Equipments needed (optional)
• Large basin or plastic container
Equipments needed (optional)
• Rubber band
Preparation
• To ease insertion, increase a stiff
tube’s flexibility by coiling it
around your finger for a few
second...
Procedure
• Provide privacy, wash your
hands, and put on gloves.
Inserting an NG tube
• Explain the procedure to the
patient.
• Tell her that she may experience
some discomfort and th...
Inserting an NG tube
• Help the patient
into high
Fowler’s position
unless
contraindicated.
Inserting an NG tube
• 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
• Drape the
towel or linen-saver
pad over
the patient’s
chest.
Inserting an NG tube
• To determine how long the NG
tube must be to reach the stomach,
hold the end of the tube at the ...
Inserting an
NG tube
• Mark this
distance on the
tubing with
tape.
Inserting an NG tube
• To determine which nostril will
allow easier access, use a
penlight and inspect for a
deviated ...
Inserting an NG tube
• Lubricate the first 3” (7.6 cm) of
the tube with a water-soluble gel.
Inserting an NG tube
• Instruct the patient to hold her
head straight and upright.
Inserting an NG tube
• Grasp the tube with the end
pointing downward, curve it if
necessary, and carefully insert it
i...
Inserting an NG tube
• Aim the tube downward and
toward the ear closest to the
chosen nostril.
• Advance it slowly to ...
Inserting an NG tube
• When the tube reaches the
nasopharynx, you’ll feel
resistance.
Inserting an NG tube
• Instruct the patient to lower her
head slightly to close the trachea
and open the esophagus.
Inserting an NG tube
• Then rotate the tube 180 degrees
toward the opposite nostril to
redirect it so that the tube won...
Inserting an NG tube
• Unless contraindicated, offer the
patient a cup of water with a straw.
• Direct her to sip and s...
Ensuring proper tube placement
• Use a tongue blade and penlight
to examine the patient’s mouth
and throat for signs of...
Ensuring proper tube placement
• As you carefully advance the tube
and the patient swallows, watch
for respiratory dist...
Ensuring proper tube placement
• Stop advancing the tube when the
tape mark reaches the patient’s
nostril.
Ensuring proper tube placement
• Attach the catheter-tip or bulb
syringe to the tube and try to
aspirate stomach conten...
Ensuring proper tube placement
• If you don’t obtain stomach
contents, position the patient on
her left side to move th...
Ensuring proper tube placement
• If you still can’t aspirate stomach
contents, advance the tube 1” to
2” (2.5 - 5 cm). ...
Ensuring proper tube placement
• At the same time, auscultate for
air sounds with your stethoscope
placed over the epig...
Ensuring proper tube placement
• 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
• Secure the NG tube to the
patient’s nose with hypoallergenic
tape, (or other designate...
Ensuring proper tube placement
• Apply liquid skin barrier to make
the tape more adherent to the
skin.
Ensuring proper tube placement
• You’ll need about 4” (10 cm) of
1”tape.
• Split one end of the tape up the
center abo...
Ensuring proper tube placement
• Stick the uncut tape end on the
patient’s nose so that the split in
the tape starts ab...
Ensuring proper tube placement
• Crisscross the tabbed ends around
the tube.
• Then apply another piece of tape
over t...
Ensuring proper tube placement
• Alternatively, stabilize the tube
with Opsite or a prepackaged
product that secures an...
Ensuring proper tube placement
• To reduce discomfort from the weight
of the tube, tie a slipknot around the
tube with ...
Ensuring proper tube placement
• Attach the tube to suction
equipment, if ordered, and set the
designated suction press...
Ensuring proper tube placement
• Provide frequent nose and mouth
care while the tube is in place.
• An NG tube may be i...
*Confirming NG tube placement
• When confirming NG tube
placement, never place the tube’s
end in a container of water. ...
*Confirming NG tube placement
• Besides, water without bubbles
doesn’t confirm proper placement.
• Instead, the tube ma...
Removing an NG tube
• Explain the procedure to the
patient and that it may cause
some discomfort.
Removing an NG tube
• Assess bowel function by
auscultating for peristalsis or
flatus.
Removing an NG tube
• Help the patient into semi-
Fowler’s position.
• Then drape a towel or linen-saver
pad across he...
Removing an NG tube
• Put on gloves.
• Using a catheter-tip syringe, flush
the tube with 10ml of normal
saline solutio...
Removing an NG tube
• Untape the tube from the patient’s
nose, and then unpin it from her
gown.
• Please wear gloves!!!
Removing an NG tube
• Clamp the tube by folding it in
your hand.
Removing an NG tube
• Ask the patient to hold her breath to close
the epiglottis.
• Then withdraw the tube gently and
...
• Please wear gloves!!!
Removing an NG tube
• Assist the patient with thorough
mouth care, and clean the tape
residue from her nose with
adhes...
Removing an NG tube
• Monitor the patient for signs of GI
dysfunction.
Pointers
• If the patient has a nasal
condition that prevents nasal
insertion, pass the tube orally
after removing any...
Pointers
• First coil the end of the tube
around your hand.
• This helps curve and direct the
tube downward at the pha...
Pointers
• While advancing the tube.
• Observe for signs that it is
entered the trachea, such as
choking or breathing ...
Pointers
• If these signs occur, remove the
tube immediately.
• Allow the patient time to rest; then
try to reinsert t...
Pointers
• After tube placement, vomiting
suggest tubal obstruction or incorrect
position.
• Assess immediately to det...
Complications of NG intubation
• Although nasogastric (NG)
intubation is a common
procedure, it does carry risk.
Complications of NG intubation
(Long-term concerns)
• Potential complications of prolonged
intubation includes:
 Esop...
Complications of NG intubation
(Suction reactions)
• Additional complications include:
Electrolyte imbalances
Dehydr...
Complications of NG intubation
(Suction reactions)
• Vigorous suction ,ay damage the
gastric mucosa and cause
signific...
Using an NG tube at home
• If your patient will have a
nasogastric (NG) tube in place at
home, find out who will insert...
Using an NG tube at home
• Make a list; check it twice
• If the patient or a family member
will perform the procedure, ...
Using an NG tube at home
• Use this checklist to prepare
teaching topics:
How and where to obtain
equipment needed fo...
Using an NG tube at home
How to verify tube placement by
aspirating stomach contents.
How to correct tube misplacemen...
Using an NG tube at home
How to administer formula through
the tube.
How to remove and dispose of an
NG tube.
How ...
Using an NG tube at home
How to use the NG tube for gastric
decompression, if appropriate.
How to set up and operate ...
“Nurses Informations”
http://nursesinformations.blogspot.com
All rights reserved 2008
“Nurses Informations”
Nasogastric tube-ngt-1215082454278959-8
Nasogastric tube-ngt-1215082454278959-8
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Nasogastric tube-ngt-1215082454278959-8

ngt
Published on: Mar 3, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - Nasogastric tube-ngt-1215082454278959-8

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

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