NG tube for decompression Flashcards
What are the different types of nasogastric tubes?
Orogastric tubes:
Usually large bore tubes with wide openings.
More common in ER settings
Gastric tubes( the Focus of this week)
Levin
Sump
Enteric tubes
Feeding tubeswhat is a Levin tube?
Single Lumen14-18 Fr for decompressing
Used to withdraw specimens for diagnostic analysis, washing the stomach free of toxic substances, and irrigating the stomach to diagnose and treat upper gastrointestinal bleeding.
The Levin tube is connected to low intermittent suction (30 to 40 mm Hg) to avoid erosion or tearing of the stomach lining
What is a salem sump? aka the blue pigtail
Most Common
Double lumen,120 cm long,12-18 FR
Attached to Suction
Pigtail-Smaller Air Vent
THE BLUE AIR VENT limits the suction force to 25mm Hg
The smaller second lumen terminates in a blue vent, or “pigtail.” (This inner, smaller tube vents the larger suction-drainage tube to the atmosphere via an opening at the distal end of the tube)
What is the blue pigtail on the salem sump?
The blue vent is always open to the air, providing continuous atmospheric air irrigation
When irrigating the large lumen, inject 20 mL of air into the blue vent to re-establish a buffer of air between the gastric contents and the vent.
NEVER
Clamp off the air vent
connect it to suction
or use it for irrigation.
What is monitoring and maintenance for a decompression NG tube?
Maintaining a NG
NG for Decompression on suction
Measure and record drainage from the NG
Provide oral and nasal care (tape change, nasal mucosa, ice chips if ordered )
Measurement (It might be unattached or dislodged if patient has severe coughing fit or other choking experience. Check regularly especially before use )
In and outs are important for electrolyte balance.
Irrigation NS or Water (q 6-8H, Dr order or VIHA policy ). If difficult to irrigate , try repositioning the patient, injecting air - Think about repositioning patient)
Record amount, color and type of drainage
How do you irrigate the decompression NG tube?
Hand Hygiene Ensure Placement 30 cc of Saline or Water or Air Clamp NG tube/pinch tube feed Insert tip of syringe. Slowly and evenly inject saline. If resistance, Do not force irrigation. Check for kinks Move patient to left side. Aspirate to remove fluid/return gastric content If more or less fluid document on I/O Reconnect NG to suction or feed Mouth care is very important as the mucous membrane can become dry and sore so important to offer regular oral hygiene.
How do you remove the NG tube?
Trial periods before removal
Clamp the tube for several hours or remove from suction
Observe patient (abdominal concerns)
Dr’s Order to remove
Listen for Bowel Sounds
Talk about procedure
Hand Hygiene
Clean gloves/PPE
Disconnect from suction or drainage.
Position the patient in semi fowler’s position
Insert 20 ml of fluid
Deep breath and hold breath, pull out tube evenly and quickly.
Inspect tube/nares
Continue to assess patient. http://www.atitesting.com/ati_next_gen/skillsmodules/content/nasogastric-intubation/viewing/remove-naso-tube.html?id=undefined
https://www.youtube.com/watch?v=tsgNdU-nKak
What are some differences between NG feed and NG decompression
NG decompression: Does NOT need xray larger tube does not use a guide wire cannot be used for feeding One of the popular tubes (
What are some tips mentioned in class?
Salem: air vent, never clamp, irrigate or suction the air vent
- air vent doesn’t allow suction
- if air vent fails, it is like the levin tube
Blue part- air vent
Blue to blue- valve
Curve tip to help with placement
-use the heat of your hand
Rotate 180 when you feel it hit the back of the throat
Pigtail above the stomach
Decompression doesn’t need xray
Water soluble solution if breakdown in nose- no vaseline
Mucosal breakdown in stomach- brown content
Squeaking/whistling- irrigate the tube to try and get rid of the sound
Throat irritation- ice chips
What is the implementation for inserting a NG decompression tube (warning : LONG ASS ANSWER FROM BOOK)!!!!
1 Identify patient using two identifiers (i.e., name and birthday or name and account number) according to agency policy. Compare identifiers with information on patient’s identification bracelet.
2 Place patient in high-Fowler’s position. Place pillows behind head and shoulders. Raise bed to horizontal level comfortable for accessing patient.
3 Place bath towel over patient’s chest; give facial tissues to patient. Allow to blow nose if necessary. Place emesis basin within reach.
4 Pull curtain around bed or close room door.
5 Wash bridge of nose with soap and water or alcohol swab.
6 Stand on patient’s right side if right-handed, left side if left-
handed. Lower side rail.
7 Instruct patient to relax and breathe normally while occluding one naris. Then repeat this action for other naris. Select nostril with greater airflow.
8 Measure distance to insert tube:
a Traditional method: Measure distance from tip of nose, to earlobe, and to
xiphoid process (see illustration).
b Hanson method: First mark 50-cm (20-inch) point on tube and measure traditionally. Tube insertion should be to midway point between 50 cm (20 inches) and traditional mark.
9 With small piece of tape placed around tube, mark length that will be inserted.
10 Perform hand hygiene and apply clean gloves. Curve 10 to 15 cm (4 to 6 inches) of end of tube tightly around index finger and release.
11 Lubricate 7.5 to 10 cm (3 to 4 inches) of end of tube with water-soluble lubricant.
12 Alert patient when procedure will begin.
13 Initially instruct patient to extend neck back against pillow;
insert tube gently and slowly through naris with curved end
pointing downward.
14 Continue to pass tube along floor of nasal passage, aiming
down toward patient’s ear. If resistance occurs, apply gentle downward pressure to advance tube (do not force past resistance).
15 If there is continued resistance, try to rotate tube and see if it advances. If still resistant, withdraw it, allow patient to rest, lubricate it again, and insert into other naris.
16 Continue insertion of tube until just past nasopharynx by gently rotating it toward opposite naris.
a Once past nasopharynx, stop tube advancement, allow
patient to relax, and provide tissues.
b Explain to patient that next step requires him or her to swallow. Give patient glass of water unless contraindicated.
17 With tube just above oropharynx, instruct patient to flex head forward, take a small sip of water, and swallow. Advance tube 2.5 to 5 cm (1 to 2 inches) with each swallow of water. If patient is not allowed fluids, instruct to dry swallow or suck air
through straw. Advance tube with each swallow.
18 If patient begins to cough, gag, or choke, withdraw tube slightly and stop advancement. Instruct patient to breathe easily and take sips of water.
19 If patient continues to cough during insertion, pull tube back slightly.
20 If patient continues to gag and cough or complains that tube feels as though it is coiling behind throat, check back of oropharynx using flashlight and tongue blade. Withdraw tube until tip is back in oropharynx if coiled. Reinsert with patient swallowing.
21 After patient relaxes, continue to advance tube with swallowing until you reach tape or mark on tube that signifies that tube is in the desired distance. Temporarily anchor tube to patient’s cheek with piece of tape until tube placement is verified.
22 Verify tube placement. Check agency policy for preferred methods for checking tube placement.
a Ask patient to talk.
b Inspect posterior pharynx for presence of coiled tube.
c Place towel under end of NG tube and attach Asepto or catheter-tipped syringe to end of tube. Aspirate gently back on syringe to obtain gastric contents, observing color (see illustration).
d Use gastric (Gastroccult) pH paper to measure aspirate for pH with color-coded pH paper. Be sure that paper range of pH is at least from 1.0 to 11.0 or greater (see illustration).
e Obtain x-ray film examination of chest and abdomen as ordered.
f If tube is not in stomach, advance another 2.5 to 5 cm (1 to 2 inches) and repeat Steps 22a-d to check tube position and verify with radiography.
23 Anchor tube.
a Clamp end of tube or connect tube to drainage bag or
suction machine after properly inserted.
b Tape tube to nose; avoid putting pressure on nares.
(1) Cut strip of tape about 10 cm (5 inches) and split
down the middle halfway.
(2) Apply small amount of tincture of benzoin to lower
end of nose and allow drying before taping tube to nose (optional). Apply prepared tape to nose, leaving split end free. Be sure that top end of tape over nose is secure.
(3) Carefully wrap two split ends of tape around tube in opposite directions (see illustrations).
(4) Alternative: Apply tube fixation device using shaped adhesive patch (see illustration).
c Fasten end of NG tube to patient’s gown by looping rubber band around tube in slipknot. Pin rubber band to gown.
d When using Salem sump tube, keep pigtail above level of
stomach.
24 Unless health care provider orders otherwise, elevate head of
bed 30 degrees.
25 Explain to patient that sensation of tube in back of throat
decreases somewhat with time.
26 Once placement is confirmed:
a Make either a red mark or use tape on tube to indicate
where tube exits nose.
b Alternative: Measure length of tube from nares to connector.
c Document length of tube in patient’s record.
27 Attach NG tube to suction as ordered.
28 NG tube irrigation:
a Perform hand hygiene and apply clean gloves.
b Check for tube placement in stomach (see Step 22). Temporarily clamp tube or reconnect to connecting tube
and remove syringe.
c Draw up 30 mL of normal saline into Asepto or catheter-tip
syringe.
d Clamp NG tube. Disconnect from connecting tubing and
lay end of connection tubing on towel.
e Insert tip of irrigating syringe into end of NG tube. Remove
clamp. Hold syringe with tip pointed at floor and inject saline slowly and evenly. Do not force solution.
f If resistance occurs, check for kinks in tubing. Turn patient onto left side. Repeated resistance should be reported to health care provider.
g After instilling saline, immediately aspirate or pull back slowly on syringe to withdraw fluid. If amount aspirated is greater than amount instilled, record difference as output. If amount aspirated is less than amount instilled, record difference as intake. h Use an Asepto syringe to place 10 mL of air into blue pigtail. i Reconnect NG tube to drainage or suction. (Repeat irrigation if solution does not return.)
