NG tubes and Foley catheter Flashcards
what are the indications for NG intubation
Lavage, Irrigation or dilution of gastric contents
Gastric decompression for ileus or small bowel obstruction
Feeding
sampling of gastric contents
Absolute CI for NG intubations
suspected basilar skull fracture
obstructions of nasal passages secondary to either acute or old trauma
relative CI for NG intubation
maxillofacail fractures
hemophiliacs
Is nasogastric intubation a sterile technique?
no
what equip do you need for NG tube?
nasogastric tube (16-18Fr) Anesthestic spray/gel lubricant gel 50/60cc syringe Tape Stethoscope Suction apparatus Cup of water/straw water for irrigation emesis basin
what is the procedure for NG tube insertion
place awake pt in sitting position, if patient is unconscious be prepared to suction vomitus
examine nasal passage for obstruction and select patent side
spray posterior pharynx with anesthetic spray
estimate distance from nasal opening to stomach by placing tube near patient from tip of nose to tragus then from tragus to stomach and note nearest black like on tube
how do you confirm placement of NG tube?
place air filled syringe onto opening of NG tube, then place stethoscope on patients stomach and push air in briskly listening for gurgling noise to insure proper placement of tube
what should you never do when checking placement of an NG tube
Neve use H20 or any liquid to test tube position because you could end up in the lungs
what do you need to do once tube is established?
tabe securely but don’t tape tube directly to nasal alae because this can cause undo pressure and injury
alternate taping place tape on patients forehead then loop tube from nose and tape tube to tape on forehead
Secure tube to patients gown
What should you do if tube will not pass through nostril?
try other side
what should you do if patient gags or vomits while placing tube
remove tube reanesthetize and try again
what will happen in tube is in trachea?
coughing will usually result
what can happen if you put excessive force on the NG tube?
avoid excessive force on the tube during insertion because perforation of esophagus can occur
how would you manage a nose bleed from NG tube
although rare you can use ephedrine (afrin) nasal drops
When removing the tube what should you do?
disconnect suction and tape
gently pull tube from nose
provide tissues for patient to wipe nose and eyes
what are indication for a foley catheter?
accurate assessment of urinary output
bladder decompression:
obstruction d/t BPH
prior abdominal surgery
Diagnosis- to obtain uncontaminated specimen for culture and screen, presence of reflux
Tx: bladder injuries, tamponade for hemostasis, instillation of BCG for bladder cancer
CI for foley catheter?
suspected urethral disruption as with a pelvic fracture
difficulty encountered when trying to pass catheter
Is foley catheter sterile?
Yes
equipment for foley catheterization
foley kit includes:
sterile gloves, sterile drapes, sterile water soluble lubricant, sterile cotton or applicator sponges
sterile cleaning solution,syringe and sterile H2O for balloon
why do we have a sterile specimen container?
use it to send off for culture
which catheter is bigger 16 or 18
18, the bigger the number the larger the catheter
Foley catheter procedure preparation
open equipment kin in sterile fashion
don sterile gloves
Fill the syringe with desired amount of H2O to test balloon! If balloon does not work catheter wont stay in!!
open sterile cleansing solution and saturate swabs/applicators or place in sterile container
Expose and drape perineum
open sterile lubricant and place on sterile field or at end of catheter.
How to insert foley catheter procedure
grasp penile shaft with non-dominant hand and retract foreskin if present- this hand is now contaminated do not touch any sterile materials With dominant (sterile hand) pick up forceps containing cleansing cotton and cleanse the penile glans by stoking from meatus towards shaft to remove bacteria from urethral opening In females cleanse urethral meatus by stroking towards the vagina
what should you do if the catheter will not pass?
try steady gentle pressure which will usually fatigue the sphincter and catheter should then pass into bladder
when should you see visible urine in the tube or collecting system in females?
once catheter is advanced about 4 inches
when should you see visible urine in the tube or collecting system in males?
once catheter is advanced to about the sidearm of the catheter
what should you do if no urine is present in the catheter after being inserted?
the bladder may be empty so inject 50cc of sterile water into bladder through foley port or open end catheter.
Fluid drainage from bladder into collecting system confirms placement of catheter or bladder
what should you do once catheter is placed correctly?
place syringe with sterile water on the side arm and inflate the balloon. maintain pressure on plunger while removing to insure that water does not flow back into syringe
What should you do to ensure the balloon is inflated properly and the catheter is secured?
gently tug on catheter
what should you do if you feel resistance while attempting to inflate catheter?
deflate balloon and advance catheter further into bladder
what is the last thing you should do once urine is confirmed in the catheter and balloon has been properly inflated?
secure catheter by taping to medial thigh this limits any undue pressure to meatus
how should the catheter be removed?
if sterile culture is needed obtain prior to removing catheter
Place 5cc or correct size syringe on end of side arm of Foley cath and deflate balloon and gently remove catheter
What is the most common complication of a foley?
UTI
When should you consult urology?
when a foley resists insertion there may be false passage
what are some other complications with foley catheters?
leakage around catheter from bladder spasm
hematuria from traumatic catheterization
obstruction of urine flow from blood or debris
