Module 8: Nasogastric Tubes Flashcards
1
Q
Explain the purposes for nasogastric suction following gastrointestinal (GI) surgery
A
- physician order for suction is necessary
- intermittent low suction: 40-80 mmhg is used (single lumen NG tube)
- continuous higher suction: 60-120 mmHg is used (double lumen tube)
2
Q
Explain the purposes for nasogastric suction following gastrointestinal (GI) surgery
A
- physician order for suction is necessary
- after surgery to reduce abdominal distention, speed return of bowel function, reduce the change of wound dehiscence and hernia
- intermittent LOW suction: 40-8- mmHg is used (single lumen NG tube)
- continuous HIGHER suction: 60 - 120 mmHg is used ( double lumen tube)
3
Q
Identify other reasons for insertion of a nasogastric tube
A
- Decompression: removal of gas and fluids (stomach contents) to relieve distention/nausea and vomiting
- decompression - ordered until bowel activity returns (3-5) days
- Obstruction: relieve and treat
- Diagnosis: disorders and obtain specimens
- Post Operative Healing
- Compression: treatment of bleeding through a balloon
- Lavage: remove toxic substances and irrigate (washing out)
- Feeding: provide enteral feeding and medications
Small bore - flexible feeding tube (silastic)
- 8-12 Fr
Large bore - decompression tube (salem sump tube)
- 12-18 Fr
Gastric Lavage Tube
- 34-40 Fr
4
Q
Salem Sump
A
- Double lumen
- air vent (intermittent and continuous suction)
- allows air to enter patients stomach
- prevents excess suction/damage to stomach wall
- anti-reflux value (put on end of air vent)
5
Q
Tips for Salem Sump NG Tube Care
A
- Do not clamp air vent
- keep the air vent above the patent’s waist level… is fills below then drainage will flow into the air vent which will cause the NG to be sucked against the stomach wall
- if stomach contents back up in the air vent, irrigate the air vent with approximately 20 ml air. Secure the air vent above the level of stomach
6
Q
Levine Tube
A
- not vented - CANNOt be used for continuous suction
- feeding/irrigation/lavage/decompression
7
Q
Blakemore Tube
A
- physician insertion
- high risk procedure
- usual or insertion except in ++ emergent cases
- used to stop or slow bleeding
8
Q
Silastic tube
A
- small bore
- used for enteral feeding
- may be weighted and have a stylet
- can be used for 3-4 weeks
- x-ray required to confirm placement
- cannot check for gastric secretions
9
Q
Discuss the nursing assessments required for insertion, monitoring and discontinuing a nasogastric tube
A
- physician’s order required to insert or remove NG tube
- do not insert NG tube if patient has:
- recent trauma/surgery to nose, mouth, esophagus, stomach, duodenum
- esophageal varices
- basal skill fracture or maxillofacial injury (can insert oral gastric tube)
- level of consciousness
- gastrointestinal assessment
- bowel sounds, abdominal distention, nausea and vomiting, level of pain/discomfort
- respiratory assessment
- increased respiratory rate, diminished air entry
- increased temperature
- suction level and frequency
- placement of tube
10
Q
Describe how and why the nurse must account for gastric loss from nasogastric suctioning.
A
- must monitor patient’s NG output every shift and PRN
- physician may order IV fluids to replace NG output
- IV replacement fluid usually contains potassium because of potassium loss
- Ng replacement fluid is based on NG output and lab values (potassium) and maintenance IV (if ordered)
11
Q
Replacement of NG losses
A
- physicians order:
- replace NG losses with 1:1 with 0.9% NaCl at 100 ml/hr
- you are only the day shift and your patients’ NG output (losses) overnight was 500ml brownish fluid (as reported by the night nurse and documented in the I/O record in SCM)
- you need to replace the NG losses from the night shift over your day shift
In order to do this you:
Total NG loss (output) = ml/hr
time in hours
500 ml (NG LOSS) = 62.5 ml/hr = 63ml/hr 8 hours
how many ml/hr of IV fluid will this patient receive in total? 1.5 L
12
Q
Prior to inserting a nasogastric tube you should
A
- explain procedure to patient - reason for NG and need to swallow during insertion
- recommended position for adults is high fowler’s and infants supine and propped at 30 degrees
- determine which nostril to insert NG
- assess patency - determine air flow
13
Q
Estimate the Length of Tubing
A
- adult/child - measure from the tip of the nose to ear lobe and then to a point midway between the xyphoid process and umbilicus
- indicate this point on tube with a sharpie or piece of tape
14
Q
How Can you Check/Confirm the Placement of NG tube?
A
- 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 - not reliable
- Checking NG tube Placement
- aspirate gastric contents:
- observe colour of aspirated contents
- grassy green, clear, brown
- test pH of aspirate
- pH of stomach 1-5
- pH of intestine 5-7
- pH of lungs > 6
- DI confirmation - chest x-ray - needed for high risk patients or if extended into the small intestine prior to installing anything into a NG
- observe colour of aspirated contents
- aspirate gastric contents:
15
Q
General Nursing Interventions in regards to nasogastric tube insertion
A
- ensure patency of nostrils- cleanse and lubricate
- ensure tube is well secured & remains in place
- provide frequent mouthcare (minimum q2h)
- reconnect tube to suction after walks etc
- monitor amount and character of drainage
- assess for return of peristalsis
- changed suction canister when 3/4 full - appropriate disposal
- clamp tube 60 minutes after “oral” meds given
- document output q shift or as ordered
