Nasogastric tube insertion Flashcards
Describe nasogastric tube insertion.
- Exclude base of skull fracture and examine for septal deviation
- Ask patient to blow their nose
- Measure the length needed and note this
- Lubricate the tip
- Advance the tube, ask patient to swallow water to help advance it into oesophagus
- Secure tube with soft tape Tube is secured using soft tape
- Gastric contents withdrawn and pH tested to confirm the location
- X Ray may be required to check the placement
What are the benefits and disadvantages of NG tubes?
++
- Most commonly used and easy to insert
- Allow use of hypertonic feeds, high feeding rates, bolus feeding into stomach reservoir
–
- Easily displaced by coughing etc
- Depens on adequate gastric emptying
What are the complications of NG tube feeding?
- Nasopharyngeal discomfort and nasal erosions, abscesses, sinusitis later.
- Pharyngeal/oesophageal perforation, intracranial or bronchial insertion
- Oesophagitis, oesophagal ulceration and stricture
- Tubes should be replaced each month
What are the indications for NG tube insertion?
- Relief of symptoms/bowel rest in obstruction
- Aspiration of gastric contentc from ingestion of toxic material
- Administration of medication
- Feeding
- Bowel irrigation
- Decompression of the stomach
- Treatment of eating disorder/malnourishment
Contraindications:
- midface trauma- cribiform plate injuries
- recent nasal surgery
- coagulation abnormality
- oesophageal varices/recent banding
- alkaline ingestion
How do you estimate length of NG tube needed?
From the bridge of the patient’s nose, to the ear lobe and down to the xiphisternum
What type of NG tube is used in bowel obstruction?
Ryles tube - this is a wider bore tube for gastric aspiration or bowel decompression
What are the contraindications for NG tube insertion?
Which type of NG tube is used for feeding and medications?
Fine bore (usually less than 9FR) - more durable and comfortable than most other NGT, are less likely to interfere with eating and drinking, and carry less risk of causing rhinitis, pharyngitis or oesophageal erosion
How often does an NG tube need to be changed?
Every 4-6 weeks
What equipment is needed when inserting an NG tube?
- Nasogastric tube: 16-18 French
- Cup of water with straw
- Tape
- pH indicator
- Gloves
- Emesis basin
- Benzocaine spray (optional)
- Water-based lubricant (optional)
- Suction (have on hand in case of vomiting, particularly in patient with reduced consciousness level)
How do you check position of the tube?
pH testing of aspirate = if pH _<_5 or less this reasonably indicates the NG is in the stomach and safe to be used. Try after 30mins if this is not successful
In the event an NG aspirate cannot be obtained or the pH result is above 5 then the NG position must be confirmed via an X-ray
How do you confirm NG tube placement on XR?
