Download The Basics about Nasogastric Tubes

The Basics about Nasogastric Tubes
Definition
Nasogastric intubation refers to the process of placing a soft plastic
nasogastric (NG) tube through a patient's nostril, past the pharynx and
down the esophagus into a patient's stomach
Purpose
Nasogastric tubes are inserted to deliver substances directly into the stomach,
remove substances from the stomach or as a means of testing stomach function
or contents.
The most common purpose for inserting a nasogastric tube is to deliver tube
feedings to a patient when they are unable to eat. Patients who may need a NG
tube for feedings include: premature babies, patients in a coma, patients who
have had neck or facial surgery or patients on mechanical ventilation. Other
substances that are delivered through a NG tube may include ice water to stop
bleeding in the stomach or medications to neutralize swallowed poisons. Also
known as “having your stomach pumped”
Another purpose for inserting a nasogastric tube is to remove substances from
the stomach. A NG tube is used to empty the stomach when accidental poisoning
or drug overdose has occurred. A NG tube is used to remove air that
accumulates in the stomach during cardiopulmonary resuscitation (CPR). It is
used to remove stomach contents after major trauma or surgery to prevent
aspiration of the stomach contents. Placing a NG helps prevent nausea and
vomiting by removing stomach contents and preventing distention of the
stomach when a patient has a bleeding ulcer, bowel obstruction or other
gastrointestinal diseases.
A NG tube may be inserted to take samples of stomach contents for laboratory
studies and to test for pressure or motor activity of the gastrointestinal tract
The use of a nasogastric tube for feedings can effectively prevent malnutrition in
the patient who is unable to eat. A nasogastric tube is also an effective
temporary measure for decompression and removal of stomach contents and
free air in a variety of gastrointestinal illnesses, major trauma, or surgery.
A physicians order is always required prior to insertion.
This is done under clean technique: not sterile
It is best to have an assistant when placing an NGT
Precautions
Do not use force when inserting a NG tube. If resistance occurs, rotate and
retract the tube slightly and try again. Forcing the tube can cause traumatic
injury to the tissue of the nose, throat or esophagus.
Always check the tube positioning before giving feedings. If the tube is out of
place the patient may aspirate the feeding solution into the lungs.
Keep the patient in an upright or semi-upright sitting position when delivering a
tube feeding to enhance peristalsis and avoid regurgitation of the feeding.
Check patients who are receiving continuous feedings via a pump or gravity
hourly or according to the medical settings policy, to assure that the tube is in
position, the formula is flowing at the correct rate and the patient is comfortable
with no signs of distention or distress.
Cap or clamp off the NG tube when not in use to prevent backflow of stomach
contents or accumulation of air in the stomach.
If a patient has severe sinus conditions, nasal obstruction or has had facial
surgery, it may be necessary to place a oral-gastric tube to avoid further nasal
trauma. Check for history of deviated septum
If the amount of gastric aspirate is large prior to a bolus or intermittent feeding,
notify the physician and follow the protocol of the medical setting for re-instilling
the gastric aspirate. The feeding size may need to be decreased if the patient is
not digesting it.
NG tube placement is meant to be a short-term solution for feeding problems.
Patients that require long term tube feeding should have surgical placement of a
gastrostomy tube or gastrostomy button. Long-term NG tube usage can cause
nasal erosion, sinusitis, esophogitis, gastric ulceration, esophageal-tracheal
fistula formation, oral infections and respiratory infections.
Always check the mouth for curling of the tube in the top of the oropharynx.
Patients will typically gag during placement however: if they cough
uncontrollably, become cyanotic or appear to be gasping for air, the tube has
been placed into the trachea and must be immediately removed
Complications
The complications of nasogastric intubation may include:
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aspiration of the stomach contents leading to asphyxia, abscess formation
or aspiration pneumonia;
• trauma injury including perforation of the nasal, pharyngeal, esophageal
or gastric tissue
pulmonary hemorrhage, empyema, pneumothorax, pleural effusion or
pneumonitis from a malpositioned tube
nosebleeds
secondary infection in the sinus, throat, esophagus or stomach
development of a tracheal-esophageal fistula
erosion and/or necrosis of nasal, pharyngeal, esophageal or gastric tissue
The complications of nasogastric tube feedings may include:
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obstruction of the tube
perforation of the tube
tube migration out of correct position
regurgitation and aspiration of the feeding
diarrhea
nausea and vomiting
abdominal distention, cramping and discomfort from too much feeding or
a rate of feeding that is too rapid
any of the complications listed above in the complications of nasogastric
intubation
The rest of this all think lesson will demonstrate the technique. It is important to
understand the purpose of insertion. This will determine if you are going to use
continuous suction or low intermittent suction (LIS)