Chapter 5: Nasogastric Tube Placement Flashcards
What are the indications for nasogastric tubes?
- Treatment for ileum or bowel obstruction- gastrointestinal decompression
- Administration of medications or oral contrast
- Enteral nutrition
- Stomach lavage
What does nasogastric depression improve?
- Patient discomfort
- Prevents recurrent vomiting
- Serves as a means to monitor progression
What are contraindications for nasogastric tube placement?
- Esophageal stricture because of risk of perforation.
- Basilar skull fracture due to intracranial misplacement.
- Esophageal varices may trigger bleeding
- A bleeding diathesis
What are nasogastric tubes made of?
Polyvinyl chloride (PVC), polyurethane or silicone
When are nasogastric tubes made of PVC used?
They are stiff and more irritating long term and are used for gastrointestinal decompression.
What is the most commonly placed size nasogastric tube in adults?
16 Fr
Describe the larger lumen of the Salem sump tube.
It’s connected to intermittent wall suction for aspiration of gastric contents or it can be used for irrigation, delivery of medications or enteral feeding.
Describe the smaller lumen of the Salem sump tube.
The smaller lumen vents to atmosphere, thus preventing the distal holes from adhering to and damaging the stomach mucosa
How are nasoenteric tubes different from nasogastric tubes?
- More flexible
- Have smaller diameters (3.5 to 12 Fr)
- Vary in length
- May be weighted or non-weighted
Can a feeding tube be used for gastric decompression?
No!
Explain the placement for decompression.
The patient is alert. A soft 14-16 Fr Salem sump nasogastric tube is good for decompression. The tube should be straightened and lubricated.
What is the patients positioning for a nasogastric tube?
Patient should be seated with the head tilted toward the chest. The tube is introduced into one of the nares and advanced horizontally.
What are the steps for placing a nasogastric tube?
- Lubricate the NG tube and offer the patient a cup or a glass of water
- Gently advance the tube but stop before it reaches the nasopharynx
- Direct the patient to sip and swallow as the tube is advances which helps pass the tube into the esophagus
- Aspirate using the suction tip syringe and examine the aspirate.
- Secure the NG tube to the patients nose with tape.
When aspirating the typical gastric contents should look like?
Grassy green color, clear and colorless with mucous spreads, or brown.
What should the aspirate pH be?
Less than or equal to 5.
Where are tubes for gastric decompression placed?
Gastric fundus and connected to low intermittent suction.
Where are tubes intended for feeding placed?
Into the Antrum, duodenum (postpyloric) or jejunum
Do you place a nasogastric tube in an incubated patient blindly?
No, risk of placing into the lung
How do you confirm placement of nasogastric tube?
- Radiographic
- Clinical confirmation- once placed the main lumen is aspirated. Flushing 20-30 cc of warm water and immediately suctioned back I tot the syringe.
- Tube fixation
How do you manage nasogastric and nasoenteric tubes?
Irrigating the tube with water every 4-8 hours
What are some gastrointestinal complications?
- Malposition, coiling or knotting of tubes
- Impairs normal function of lower esophageal sphincter and are more susceptible to esophagitis, bleeding and pulmonary aspiration
- Pressure necrosis due to suctioning of gastric mucosa
What are some pulmonary complications?
Increased in nasogastric tubes.
Intubation of the lung and inadvertent administration of medications can lead to pneumonia
Why does nasal alar ulceration or necrosis occur?
Improperly securing the tube or placement of too large a tube in an unconscious patient
