Nasogastric Tube Insertion

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Nasogastric Tube Insertion

• CHD 2
• Skills Lab

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Uses

• Client that cant or wont eat
• Clients that have increased energy needs
• Burns, Trauma, CA, Sepsis
• Clients requiring bowel rest
• Pancreatitis
• Upper GI bleed
• Gastric content for study
• Suspected bowel obstruction

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Nasoduodenal
NGT
Nasojejunal
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Benefits

• Prevents aspirations
• Administration of meds and nutrition safely
• Suction contents

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Concerns

• Aspiration
• Nasal erosion
• Esophagitis
• Gastric ulcer

Aspiration Precaution
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Equipment

• NGT (8-12 Fr)
• Levine single lumen
• Salem Sump dual lumen
• 60 ml syringe
• Tape
• Cup of water with straw
• Emesis basin

• Safety pin
• Rubber band
• Towel
• Gloves
• Suction equipment
• Pen light
• Tongue blade
• Stethoscope

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Procedure

• Check PMD order
• Understand patients need for NGT
• Assess patient nares
• Complete abdominal/ GI assessment/ ability to
  swallow
• Assess pt history
• Nares, Med history
• Assess for Gag reflux
• Assess mental status

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Procedure

• Intro. Self, Identify pt.
• Assess pt., Explain procedure
• Discuss ways to communicate during procedure
• Position pt.
• Don gloves
• Assess NGT

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Procedure

• Determine length
• Nares --- earlobe ---to xyphoid process
• Mark with ink
• Lubricate tube with water based lubrication
• 4 inches
• Hand water to pt
• Begin insertion aim back and down towards ear
• turn 180 degrees

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Procedure

• Have client flex head towards chest and sip water
• Advance tube with swallows
• Instruct pt. To breath through mouth and swallow
• DO NOT FORCE TUBE
• If Pt. Coughing, Choking, Cyanotic
• STOP PULL BACK
• Advance to measured mark

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Check placement

• Ask pt. To talk
• Check mouth with light and tongue blade
• Secure tube
• Check gastric contents/ Air auscultation
• Chest/Abdomen X-ray

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Documentation

• Tube size and type
• Time
• Route (nare)
• Residual
• Specimen
• Suction
• Feeding
• Patient response

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Risks of Displacement

• Due to
• Vomiting
• Suctioning
• Severe coughing
• Moving/transferring
• THEREFORE, You MUST check placement every single
  time of usage.

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Removal

• Check discharge order
• High fowlers
• Instruct to hold breath
• Gently and smoothly remove
• Good oral hygiene
• Document

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DAR

• D Pt. resting in semi fowlers position. No gag
  reflex present. PMD ordered NGT for nutrition and
  med. Administration.
• A Pt. teaching on NGT placement. NGT 10 F
  inserted to L nare. 20cc residual noted.
  placement validated via air bolus.
• R Pt. tolerated procedure well. Pt. able to
  speak clearly. Resp. even and unlabored.

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MEDICATION ADMINISTRATION
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Nasogastric Tube Insertion

• CHD 2
• Skills Lab

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PEG
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PEG administration

• Turn off continuous feeding
• Check for gastric contents
• Greater then 2X feeding HOLD meds and feeding
• Return gastric contents via gravity
• Flush via gravity 30cc luke warm water
• Dissolve and administer one medication at a time
• Flush with 15cc between meds.
• Final flush of approximately 30 cc
• Prevent introduction of air while administer
  fluid and meds.
• Turn on feeding
• Maintain HOB 45 degrees

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NGT Med. administration

• Turn off continuous feeding
• Check for placement via air bolus
• Check for gastric contents
• Greater then 2X feeding HOLD meds and feeding
• Return gastric contents via gravity
• Flush via gravity 30cc luke warm water
• Dissolve and administer one medication at a time
• Flush with 15cc between meds.
• Final flush of approximately 30 cc
• Prevent introduction of air while administer
  fluid and meds.
• Turn on feeding
• Maintain HOB 45 degrees

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Clamp suction tube while disconnecting it from NG
tube.
Prepare syringe with 30mL saline for irrigation.
Inject 10-20 cc of air into tube.
Gently instill irrigation
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Things to Remember

• Do NOT
• Mix medication with formula
• Crush enteric coated, extended release, capsules
• Use oily medications
• Use excessive force when administering anything
• Use cold water

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DO

• Use liquid form of medication
• Finely crush pills
• Check NGT placement every single time
• Keep HOB elevated
• Follow 5 RIGHTS

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If Patient Connected to Suction

• Turn suction OFF
• Follow previous steps.
• Keep Suction OFF for at least ONE HOUR!!

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Questions
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