Ng/OG Flashcards
Indications
- 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
OG/NG for VAP Prevention
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
Small bore flexible feeding tube
Polyurethane, PVC, or silicone
Short term 3-4 weeks
Feeding and med delivery
Small bore PVC Tube
Firmer material
Used in pediatric and infants
Short term use <7 days
Large Bore/Decompression Tube
Rigid large diameter tube
Salem-sump tube
Short term use to empty gastric contents <7 days
Nasal-Intestinal Tube
Tip will sit in the small intestine
Short term feeding 3-4 weeks
Esophageal Tube
“Blakemore” tube
Balloon tipped, sits in the esophagus
Controls bleeding of esophageal varices
Gastric Lavage tube
Large bore tube
Used short term to remove poisonous or overdosed substances
G-Tube
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.
Jejunal Tube (J-tube)
Used for long term feeding >1 month
Inserted percutaneously, laparoscopically, or surgically via laparotomy directly into the small intestines (usually endoscopically)
Equipment
- 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
OG Tube Measurement
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
NG Tube Measurement
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
Special Considerations with NG and OG Tubes
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
Inserting the NG and OG Tube
- 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
What to do if resistance is met when inserting the NG and OG tube
If resistance is met the rotate the tube slowly downwards and advanced without excessive force
Withdrawl the NG and OG tube immediately if
Changes occur in the patient’s respiratory status
Tube coils in the mouth
Patient starts to cough, desaturate, or becomes cyanotic
What to do after you have inserted the NG and OG tube
Check for placement
Secure the tube and connect to suction
Tidy up, wash hands, and chart
What should you chart in regards to NG and OG tube insertion
Placement Confirmation
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
When are OG Tubes Preferred
- 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
Securing the NG Tube
- 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
Complication of NG Tubes
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
