Ng/OG

Question 1

Indications

Answer 1

• Diagnose certain conditions through analysis of stomach contents
  
  • Ex. Coffee ground emesis, GI bleed
• To empty or decompress the stomach /intestines of gas/contents
  
  • Ex. BVM before extubation or if they have not waited four hours prior to extubation or trach change
• Administer enteral feedings or medications

Question 2

OG/NG for VAP Prevention

Answer 2

An OG tube instead of an NG tube may be placed in patients who are intubated for >24 hours to allow for VAP prevention

OG is selected over NG because the accumulation of secretions in the pharynx of reflux gastric contents from the stomach into the pharynx

Question 3

Small bore flexible feeding tube

Answer 3

Polyurethane, PVC, or silicone

Short term 3-4 weeks

Feeding and med delivery

Question 4

Small bore PVC Tube

Answer 4

Firmer material

Used in pediatric and infants

Short term use <7 days

Question 5

Large Bore/Decompression Tube

Answer 5

Rigid large diameter tube

Salem-sump tube

Short term use to empty gastric contents <7 days

Question 6

Nasal-Intestinal Tube

Answer 6

Tip will sit in the small intestine

Short term feeding 3-4 weeks

Question 7

Esophageal Tube

Answer 7

“Blakemore” tube

Balloon tipped, sits in the esophagus

Controls bleeding of esophageal varices

Question 8

Gastric Lavage tube

Answer 8

Large bore tube

Used short term to remove poisonous or overdosed substances

Question 9

G-Tube

Answer 9

PEG (Percutaneous endoscopic gastronomy

Surgically placed through the abdominal wall into the stomach

Used for long term feeding (>1 month)

Most common long term feeding tube

Different types: long tube, button tube, etc.

Question 10

Jejunal Tube (J-tube)

Answer 10

Used for long term feeding >1 month

Inserted percutaneously, laparoscopically, or surgically via laparotomy directly into the small intestines (usually endoscopically)

Question 11

Equipment

Answer 11

• PPE
• NG/OG Tube
  
  • NG:5-18 Fr
  • OG: 24-42 Fr
• Catheter tip irrigated with 60 mL syringe
• Water soluble lubricant
• Adhesive tape
• Suction equipment
• Stethoscope
• Felt Pen
• Glass of water with straw/soother
• Flashlight
• Non-sterile gloves

Question 12

OG Tube Measurement

Answer 12

Measure the distal tip of the tube from the end of the mouth to the ear lobe, to ½ way between the end of sternum and naval

Question 13

NG Tube Measurement

Answer 13

Measure the distal tip of the tube from the tip of the nose to the ear lobe, to ½ way between the end of sternum and naval

Question 14

Special Considerations with NG and OG Tubes

Answer 14

Fluid body precautions

Clean procedure

Do not force the tube into the position-Resistance may be felt as the tip of the tube reaches the nasopharynx

NG tubes may cause nasal bleeding

Reflux gagging-Pull back on the tube and have the patient flex their chin to their chest

Have the patient drink and swallow

Question 15

Inserting the NG and OG Tube

Answer 15

• Instruct the patient to swallow and advance the tube past the pharynx into the esophagus and then into the stomach
• NG Tube
  
  • Gently insert the tube into the appropriate nostril, aiming towards the back of the head
  • Have the tip parallel to the nasal septum and superior to the hard palate
• OG Tube
  
  • Pass the tube through the lips and over the tongue
  • Aim down and back towards the pharynx with the patients head flexed forwards

Question 16

What to do if resistance is met when inserting the NG and OG tube

Answer 16

If resistance is met the rotate the tube slowly downwards and advanced without excessive force

Question 17

Withdrawl the NG and OG tube immediately if

Answer 17

Changes occur in the patient’s respiratory status

Tube coils in the mouth

Patient starts to cough, desaturate, or becomes cyanotic

Question 18

What to do after you have inserted the NG and OG tube

Answer 18

Check for placement

Secure the tube and connect to suction

Tidy up, wash hands, and chart

Question 19

What should you chart in regards to NG and OG tube insertion

Question 20

Placement Confirmation

Answer 20

Correct placement can be checked via

• X-ray
• Attach syringe to free end of the tube and determining if you can aspirate gastric contents also insert air (5-20 cc) into the tube and auscultate the stomach to see if you can hear bubbling
• Have the patient talk-Failure to speak is an indication of tracheal intubation and you should remove the tube

If there is any doubt regarding proper placement hold off any instillation through the tube

Question 21

When are OG Tubes Preferred

Answer 21

• Patient will have ETT in place for more than 24 hours
  
  • This is to allow for VAP prevention
  • OG is selected over NG because the accumulation of secretions in the pharynx of reflux gastric contents from the stomach into the pharynx
• Infants are <6 months
  
  • Due to the fact that they are nose breathers

Question 22

Securing the NG Tube

Answer 22

• Anchor the tube to the nose using hypoallergenic tape
• Place the tape around the tube near to the chest and pin it to the clothing
• This will tend to get in the way of bag mask ventilation or BiPAP
  
  • Usually there is a silicone piece that can surround the tube and create a better seal

Question 23

Complication of NG Tubes

Answer 23

Complication tend to be rare and minor but can include

Epistaxis (nosebleed)

Esophageal perforation

Chocking (tracheal placement)

Nasal necrosis when improperly secured

Fluid and electrolyte imbalance from suctioning