NG tubes and Foley catheter

Question 1

what are the indications for NG intubation

Answer 1

Lavage, Irrigation or dilution of gastric contents
Gastric decompression for ileus or small bowel obstruction
Feeding
sampling of gastric contents

Question 2

Absolute CI for NG intubations

Answer 2

suspected basilar skull fracture

obstructions of nasal passages secondary to either acute or old trauma

Question 3

relative CI for NG intubation

Answer 3

maxillofacail fractures

hemophiliacs

Question 4

Is nasogastric intubation a sterile technique?

Answer 4

no

Question 5

what equip do you need for NG tube?

Answer 5

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

Question 6

what is the procedure for NG tube insertion

Answer 6

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

Question 7

how do you confirm placement of NG tube?

Answer 7

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

Question 8

what should you never do when checking placement of an NG tube

Answer 8

Neve use H20 or any liquid to test tube position because you could end up in the lungs

Question 9

what do you need to do once tube is established?

Answer 9

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

Question 10

What should you do if tube will not pass through nostril?

Answer 10

try other side

Question 11

what should you do if patient gags or vomits while placing tube

Answer 11

remove tube reanesthetize and try again

Question 12

what will happen in tube is in trachea?

Answer 12

coughing will usually result

Question 13

what can happen if you put excessive force on the NG tube?

Answer 13

avoid excessive force on the tube during insertion because perforation of esophagus can occur

Question 14

how would you manage a nose bleed from NG tube

Answer 14

although rare you can use ephedrine (afrin) nasal drops

Question 15

When removing the tube what should you do?

Answer 15

disconnect suction and tape
gently pull tube from nose
provide tissues for patient to wipe nose and eyes

Question 16

what are indication for a foley catheter?

Answer 16

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

Question 17

CI for foley catheter?

Answer 17

suspected urethral disruption as with a pelvic fracture

difficulty encountered when trying to pass catheter

Question 18

Is foley catheter sterile?

Answer 18

Yes

Question 19

equipment for foley catheterization

Answer 19

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

Question 20

why do we have a sterile specimen container?

Answer 20

use it to send off for culture

Question 21

which catheter is bigger 16 or 18

Answer 21

18, the bigger the number the larger the catheter

Question 22

Foley catheter procedure preparation

Answer 22

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.

Question 23

How to insert foley catheter procedure

Answer 23

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

Question 24

what should you do if the catheter will not pass?

Answer 24

try steady gentle pressure which will usually fatigue the sphincter and catheter should then pass into bladder

Question 25

when should you see visible urine in the tube or collecting system in females?

Answer 25

once catheter is advanced about 4 inches

Question 26

when should you see visible urine in the tube or collecting system in males?

Answer 26

once catheter is advanced to about the sidearm of the catheter

Question 27

what should you do if no urine is present in the catheter after being inserted?

Answer 27

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

Question 28

what should you do once catheter is placed correctly?

Answer 28

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

Question 29

What should you do to ensure the balloon is inflated properly and the catheter is secured?

Answer 29

gently tug on catheter

Question 30

what should you do if you feel resistance while attempting to inflate catheter?

Answer 30

deflate balloon and advance catheter further into bladder

Question 31

what is the last thing you should do once urine is confirmed in the catheter and balloon has been properly inflated?

Answer 31

secure catheter by taping to medial thigh this limits any undue pressure to meatus

Question 32

how should the catheter be removed?

Answer 32

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

Question 33

What is the most common complication of a foley?

Answer 33

UTI

Question 34

When should you consult urology?

Answer 34

when a foley resists insertion there may be false passage

Question 35

what are some other complications with foley catheters?

Answer 35

leakage around catheter from bladder spasm
hematuria from traumatic catheterization
obstruction of urine flow from blood or debris