Module 8 - Nasogastric tubes

Question 1

indications for nasogastric tube insertion and suction

Answer 1

Gastric decompression, bowel obstruction, to obtain specimens (insert to aspirate gastric contents), lavage (wash or irrigate stomach), short term enteral feeds

Question 2

What is the only NG tube we can use for intermittent and continuous suction?

Answer 2

Salem Sump

because of air vent

Question 3

2 main points for using an salem sump NG tube…

What do you do if stomach contents back up in the air vent?

Answer 3

• Do Not clamp air vent (blue pigtail)
• Keep the air vent above patient’s waist level
• If stomach contents back up in the air vent, irrigate the air vent with approximately 20 mL air. Secure the air vent ABOVE level of stomach

Question 4

what can the Levine tube be used for?

Answer 4

Feeding / irrigation / lavage / decompression

Question 5

silastic tube is a small bore used for…

Answer 5

enteral feeding

Question 6

If indication is for gastric decompression, what type of NG tube will you use?

Answer 6

Salem Sump

Question 7

steps for inserting an NG tube

Answer 7

•Explain procedure to patient – reason for NGT and need to swallow during insertion (ensure able to swallow)
• Recommended position for adults is high fowler’s and infants supine and propped at 30 degrees
•Determine which nostril to insert NG
o void nostril with history of trauma
o Assess patency – determine air flow
- estimate length of tubing

Question 8

How do you know how far to insert tube

Answer 8

measure from the tip of nose to ear lobe and then to a point midway between the xyphoid process & umbilicus
•Indicate this point on tube with a sharpie or piece of tape

Question 9

How can you check / confirm the placement of NG tube ?

Answer 9

• Check oral cavity to ensure tube not coiled in mouth/throat
• Correct tube length exiting from body – check mark on tubing and documentation at time of insertion
• Auscultating air instilled into the tube
- Assessing the pH of aspirated gastric contents.

Question 10

If the physician orders Intermittent LOW suction, how much mmHg is used? single or double lumen?

Answer 10

40 – 80 mmHg is used (single lumen NG tube)

Question 11

If the physician orders Continuous HIGHER suction, how much mmHg is used? single or double lumen?

Answer 11

60-120 mmHg is used (double lumen tube)

Question 12

Levin tube vs salem sump tube - describe

Answer 12

Levin Tube - has a larger lumen and is shorter
Salem Sump Tube - has a double lumen which allows a small amt of air to be drawn in during suctioning, thus decreasing the chance of the stomach wall from adhering to and obstructing the suction tube
o use with an anti-reflux valve

Question 13

What nursing assessments are done for a patient requiring gastric decompression?

Answer 13

LOC, I/O, Nares.
GI Assessment - bowel sounds, last BM, abdominal distention, N/V, level of px/discomfort
•Suction level and frequency – what is order, how frequent?
•Placement of tube – with x-ray

Question 14

What nursing assessments are done for a patient requiring a feeding?

Answer 14

LOC, I/O, Nares.
Respiratory assessment - respiration rate, temperature, 02 sat, what are lung sounds like - any crackles?
•Suction level and frequency – what is order, how frequent?
•Placement of tube – with x-ray

Question 15

What are General Nursing Interventions for NG tubes

Answer 15

• Ensure patency of nostrils – cleanse and lubricate
• Ensure tube is well secured & remains in place
• Provide frequent mouth care (minimum q2h)
• Re connect tube to suction after walks etc.
• Monitor amount and character of drainage
• Assess for return of peristalsis
• Change suction canister when ¾ full – appropriate disposal
• Clamp tube for 60 mins after “oral” meds given
• Document output q shift

Question 16

when should the suction canister be changed

Answer 16

3/4 full

Question 17

What do you do after “oral” meds are given?

Answer 17

Clamp tube for 60 mins

Question 18

Why is important to replace a patient’s NG losses?

Answer 18

– if pt is receiving NG tube for decompression, could be a lot of gastric losses. Losing gastric fluid puts pt at risk for electrolyte imbalance, especially potassium

Question 19

What assessments do you need to do prior to removing an NGT for a pt with gastric decompression?

Answer 19

Has peristalsis returned, presence of gas, bowel sounds present? no longer nauseous? distention gone? No discomfort?

Question 20

Removal general guidelines of NG tube

Answer 20

• may be clamped for several hours prior to assess patient tolerance (depending on reason for insertion)
• Physician’s order is required
• Flush tube with air (clears any drainage in tube)
• Place disposable pad across patient’s chest
• Remove tube – steadily during patient’s exhalation – Steady pull

Question 21

What does the nurse do post removal? (4)

Answer 21

• Provide/assist with mouth care
• Dispose of equipment appropriately
• Document –date, time, patient reaction
• Monitor for abdominal distention, nausea and vomiting

Question 22

What do you do if the tube does not drain

Answer 22

No suction - check tubing and suction unit. Check air vent, may need to reposition patient
• NG tube blocked - irrigate with 20-30ml of normal saline or sterile water (Not to be done routinely)
• Air vent - blue tube on salem sump tube, can block, ensure it remains clear of secretions
• Reposition your patient to the lateral position
o Never irrigate or change the position of an NG tube inserted during gastric surgery without a physician’s order.