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Clinical Procedures > Nasogastric Tube > Flashcards

Nasogastric Tube Flashcards

1
Q

What is the most common type of NG tube used?

A

Levin Tube

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2
Q

What are the indications for NG tube insertion?

A
  1. Administration of oral nutrition and meds in pts who are unable to tolerate po
  2. Removing air, blood, ingested substances and gastric contents
  3. Sampling gastric contents for diagnostic or therapeutic purposes
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3
Q

What are the contraindications for NG tube insertion?

A
  1. Facial/basilar skull fractures
  2. Esophgeal stricture/atresia
  3. History of caustic ingestions/esophageal burns
  4. Comatose patients with unprotected airways
  5. Penetrating cervical wounds
  6. Recent oropharyngeal or nasal surgery
  7. Hx of gastrectomy or bariatric surgery
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4
Q

Why is an NG tube used for intestinal obstruction?

A

Intestinal obstruction: relieve abd distention and vomiting

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5
Q

Why is an NG tube used for diverticulitis?

A

To rest the bowel and relieve obstructive symptoms if present, relieve abd distention and vomiting if present

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6
Q

Why is an NG tube used for GI bleeds?

A

Can be diagnostic

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7
Q

Why is an NG tube used for vomiting?

A

Prevent aspiration and SBO

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8
Q

What are the other uses for NG tube?

A
  1. Nutritional support
  2. Gastric lavage/aspiration
  3. Stomach/abd surgery: decompresses stomach to lessen chance of aspiration
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9
Q

What are the potential complications of NG tube?

A
  1. Epistaxis
  2. Erroneously assuming the tube the tube is in the stomach, irrigate NG tube can cause aspiration pneumonia
  3. Placement of NG tube in trachea or lung, forcefully
  4. Esophageal/gastric erosion w/ hemorrhage if NGT in place for long time
  5. Sinusitis (long term placement)
  6. Intracranial traumaif passed in a pt with head/neck trauma
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10
Q

What equipment is needed for NG Tube insertion?

A
  1. PPE
  2. NG tube (14-16 Fr for adults, 3-8 Fr children)
    A. adult range is 10-18 Fr
  3. 2% lidocaine jelly
  4. Vasoconstrictive nasal spray
  5. cup of water with straw
  6. Emesis basin
  7. Towel to cover pt’s clothing
  8. 60 ml catheter tip syringe
  9. Stethoscope
  10. Tape
  11. Suction tubing
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11
Q

What is the physiology of swallowing?

A

Swallowing

  1. Vocal cords of larynx are together, epiglottis swings backward, covering the larynx, thus preventing food/liquid/NGT from entering trachea
  2. During swallowing, the entire larynx is pulled upward and forward by muscles attached to hyoid; this causes opening of the esophagus to stretch; simultaneously, the upper portion of the esophagus relaxes and contents move more easily into upper esophagus
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12
Q

How long is the esophagus?

A

20 cm

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13
Q

How wide is the esophagus?

A

3 cm

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14
Q

What is the procedure for placing an NG tube?

A
  1. Obtain verbal consent from the pt
  2. Wear PPE
  3. Position pt standing upright or semi-sitting position (45 degree angle or greater) with slight anterior flexion of cervical spine, place towel over pt’s clothing
  4. Assess patency of both nares
  5. Apply topical vasoconstrictive substance (phenylephrine) only if pt does not have hypertension and/or CAD\
  6. Apply topical anesthetic to nares
  7. To determine length of insertion, place tip at patient’s nose, then loop over ear lobe and down to xiphoid; mark this spot with tape
  8. Lubricate distal end of NG tube
  9. Talk patient through it and try to help pt relax and feel comfortable
  10. Insert tip of tube parallel to floor of nose, at 60-90 degree angle to plane of face
  11. Once inserted into nare, instruct patient to swallow (sip water thru straw) to facilitate advancement of NGT down esophagus
  12. Keep advancing tube smoothly but quickly
  13. Once in esophagus, tube is easily advanced to stomach; advance tube to first mark
  14. Patient should be able to speak; if not or coughing occurs, remove tube right away and try again
  15. Secure tube to patient’s nose with adhesive tape
  16. Aspirate gastric contents to confirm if no return seen. Also may auscultate LUQ while pushing 20-30 ml of air into tube to hear “rush of air”
  17. ALWAYS confirm placement with CXR
  18. Attach tube to wall suction (
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15
Q

What are the special considerations for pts with impaired mentation or comatose?

A
  1. protect airway first
  2. NGT in ice bath first to stiffen tube helps to prevent curling or kinking of tube
  3. may need to pass tube into oropharynx and then pass tube into esophagus using Magill forceps
  4. may need to deflate cuff on ETT in order to pass NGT
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16
Q

What is the follow up care for an NG tube?

A
  1. Order and Check CXR for correct tube placement in stomach
  2. Make sure NGT is functioning properly or nurse will call you
  3. Write order for NGT to low wall suction
  4. Write order for Cepacol spray prn sore throat
  5. Inspect nares and nasopharynx periodically to ensure that there is not any pressure ulcers or tissue necrosis occurring from irritation or pressure from NGT
  6. Remove NGT as soon as it is no longer needed or indicated and document in the chart
17
Q

What is the best way to avoid complications for an NG tube placement?

A
  1. Obtain a cxr to insure correct placement

2. Place end of tube in a bowl of water. If the lungs, bubbles will appear

18
Q

What is the mc cause of a SBO?

A

Adhesions from abdominal surgery

Clinical Procedures (15 decks)

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