NG wk 12

Question 1

cues start by ignoring most of med surg.

when is NG tube secured to skin?
what are gen methods of securement?

Answer 1

after confirmation placement and Clamping end of tube or connect tube to drainage bag or suction machine after properly inserted

• Use liquid skin barrier where NG tube will be secured then cover that area w hypoallergenic tape or Op-site, place tube over tape and secure w second piece of tape
• Can use feeding tube attachment device instead (adheres to nose and uses adjustable clip to hold in place.

Question 2

where is tube secured to pt? only here? considerations for this?

how do you secure tube?

Answer 2

o Tape tube to nose avoiding P on nares
 Cut strip of tape 10cm and split down middle halfway
 Apply tincture to nose let dry then put tape on nose w split end free
 Wrap split ends of tape around tube in opposite directions or use fixation device
o Fasten to gown by looping rubber band to gown in slip knot

Question 3

consideration for securing to gown when using pigtail pump

Answer 3

o When using salem pump tube, keep pigtail above level of stomach

Question 4

when is NG tube indicated for decompresion?

When should it stay in until?

Answer 4

• after major sx or w some GI conditions normal peristalsis is temporarily altered. Eating or drinking mayabdm distension. Inserting NG tube decompresses stomach to keep it empty until normal peristalsis returns

Question 5

which type of eqpt is preferred for decompression? whats special about this eqpt?
which sx pt is this useful for?

Answer 5

• Salem sump tube is preferred for stomach decompression.
Has two lumens: one for removal og gastric contents and one to give air vent which prevents gastric mucosa getting suctioned into eyelets at distal tip of tube.
• Sump tube can protect gastric suture lines as it maint force of suctions at

Question 6

what is the blue pigtail and which eqpt is this found on? what must NOT be done to this?

consideration with securement?
what do you do to this after irrigation?

Answer 6

A blue pigtail is the air vent that connects w second lumen
never clamp off the air vent, connect to suction or use for irrigation

• To prevent reflux of gastric contents through lumen (blue pigtail) the vent lumen is kept above pts waist. Theres also one way antireflux valve in blue pigtail to prevent reflux of contents out the vent lumen
• After irrigation of the suction lumen the valve is removed and 20ml air is injected to re-establish a buffer of air between the gastric contents and the valve

Question 7

which is shorter levin tube or gastric sump?

how is levin less complex than gastric sump?

Answer 7

gastric sump is shorter 120 instead of 125cm

• Single lumen 14-18 french and 125cm long. Has markings that are guides for insertion

Question 8

when hooking NG tube up to suction what is nec

gen pattern, rate of suction

Answer 8

order for suction rate-is gen low intermittent (to avoid erosion from constant adherence) suction 30-40mmhg

Question 9

can NG tube be used ideally for feeding?

Answer 9

• NG tube is pliable. NG tube cn be used for enteral feeding but a softer small-bore feeding tube is preferred for feeding puroses

Question 10

assessment of pt for NG tube. before insertion

Answer 10

• Inspect nasal and oral cavity
• Ask pt if has hx of nasal sx or congestion and allergies and note if septum is deviated
o (the tube should be inserted into uninvolved nasal passage. Sx may contraindicate insertion)
• Auscultate x4 for BS. Palpate abdm for distension, pain, rigidity.
o If diminished ausc for 1full minute in each quadrant. Document baseline from your assessments
• Assess LOC and ability to follow instructions
o If pt is confused etc get assistance from another staff member
• Det if pt had previous NG tube, their exp with it, and which nares was used
• Verify order for type of NG tube and whether tube is to be attached to suction or drainage bag
• Develop hand signal with pt for if theyre unable to tolerate procedure

Question 11

youve just inserted NG tube. what is first visible thing you could look for to see if done wrong?
audible?

gen overview of how to test right if in right spot (usually 2 are used in combo and which is always nec)?

Answer 11

o Inspect posteror pharynx for coiling (can coil behind pharynx)
o Get pt to talk (if they cant the tuve has passed through vocal cords)

• pH of aspirate
• visual inspection of aspirate
• comparing to measurements taken initially
• xray (always nec before using)
• auscultatory method of air isnt good method

id also say look for resp complications, listen etc but doesnt confirm exactly

Question 12

after insertion what is measured

when else is this measured

Answer 12

• after insertion meas the exposed portion of tube and document.

then in future compare meas to initial meas

• Before giving fluids or meds the nurse meas tube length and compares to baseline. Also does this q shift

Question 13

how does gastric aspirate look?
intestinal aspirate?
pleural fluid?
tracheobronchial sec?

Answer 13

• Gastric aspirate is most freq cloudy and green, tan or off white, or bloody or brown. P and P says Gastric contents are gen grassy green, clear, odourless.
• Intestinal aspirate is mostly clear and yellow to bile coloured. P and P says Postpyloric =golden yellow, yellow brown, greenish brown w
• Pleural fluid is mostly pale yellow and serous
• Tracheobronchial secretions are usually tan or off white mucus

Question 14

procedure for obtaining gastric aspirate

Answer 14

o W towel under end attach Asepto or catheter tipped syringe to end of tube and aspirate gently and observe the colour.

Question 15

pH of gastric vs postpyloric aspirate (pH tests are best to det between g and pp)
resp aspirate

how do you meas pH? what kind of paper is nec?

Answer 15

gastric is 6
resp >7

dip or let droplets fall onto the paper. paper must range from 1-11.0

Question 16

what is the only definitive way to confirm placement

Answer 16

xray

the tube can also be put in by specially trained person along w fluoroscopy

Question 17

what is better determinant of placement pH, measuring length, or visual inspection?
what else can this best thing be used to monitor

Answer 17

• pH is more accurate than mea length or visual inspection and can also be used to monitor advancement into sm intestine

Question 18

when is pH method not useful

Answer 18

• pH method is less helpful with continuous feed as tube feeds have pH of 6.6 and neutralize the GI pH

Question 19

how is postpyloric placement confirmed?
hard or easier?
what drug helps move it past stomach

what pos should pt be for these

Answer 19

• postpyloric placement into duodenum is harder to check.
Sometimes use fibreoptics but v $$.
Sometimes magnets.
Use IV metoclopramide to enc peristalsis. Insufflating 100-500ml of air into feeding tube once confirmed in stomach may be useful method of ensuring eventual postpyloric placement

• all bedside methods require placement on R side

Question 20

when can aspiration be challenging

what should be done?

how can you restore patency?

Answer 20

• using aspiration can be issue d/t diameter and properties of tubes. If hard to aspirate inject 30ml of air using lg syringe 30-60ml and then pull plunger back. If nec repeat air injection, change to 10ml syringe and aspirate. Then have pt change positions and aspirate again. If still not working notify.
• Pancreatic Es and water is better to restore patency of tube than cola and cranberry juice. Before using anything to declog tube the placement must be confirmed

Question 21

why is tube displaced?

most comonly displaced because

Answer 21

• Displacement of tube may be caused by tension on tube, cough, trchea or nasotracheal suctioning, or a/w intubation

usually from tugging

Question 22

what should be recorded during gen care of pt with NG tube (not r/t insertion/removal)

how often is color, amount, type drainage recorded?

Answer 22

• Keep accurate record of all intake, feedings, and irrigation
• Record colour, amount, type of all drainage q8hrs

Question 23

you have double lumen NG tube how can you make sure the wrong tube isnt accessed

Answer 23

labelled according to intended use: aspiration, feeding, or balloon inflation

Question 24

complications of tube for decompression (not exhaustive list)

Answer 24

• Susceptible to FVD, pulm complic, tube related irritations

Question 25

s/s of FVD (pretty obvious stuff might want to ski)

what labs are monitored for FVD

Answer 25

• s/s of FVD=dry skin and mucous memb, dec urinary output, lethargy, inc HR (keep careful I/O such as meas NG drainage, fluid given by NG, water by mouth, vomit, water admin w tube feeding, IV fluid)

o labs: BUN and creatinine monitored

Question 26

why do pulm complic occur?

Answer 26

• pulm complic occur because coughing and clearing of pharynx are impaired; gas buildup may irritate phrenic nerve; tubes may get dislodged, retracting the distal end above esophageaol sphincter (making pts at risk of aspiration).

Question 27

s/s of pulm cmplic

Answer 27

• s/s of complic= coughing during admin of foods or meds
o diff clearing the a/w
o tachypnea
o fever

Question 28

which pt population would you never want to move their NG tube and why

if irrigating and there is resistance how should you positon pt and why

Answer 28

• Never reposition an NG tube of gastric sx pt as repositioning could rupture the suture line

If resistance, check for kinks in tubin, turn pt onto L side (the tip of tubing may lie against stomach lining and repos may dislodge from there).

Question 29

how many mls to irrigate with

what do put into blue pigtail and why (after irrigation)

Answer 29

30ml NS

Use asepto syringe to place 10ml of air into blue pigtail (ensures patency of air vent)

Question 30

how to perform NG tube irrigation?

why is this done?

Answer 30

o Hand hygiene and gloves
o Check placement. Tmproarily clamp tube or reconnect to connecting tube an remove syringe (to prevent accidentally going into lung)
o Draw up 30ml of Ns into asepto or catheter tip syringe
o Clamp NG tube. d/c from connecting tubing and lay end of connection tubing on towel
o Insert tip of irrigation syringe into end of NG tube. Remove clamp. Hold syringe w tip ointed at floor (to prevent intro f air into vent ubing whichgastric distension) and inject saline slow and even. Don’t force
o If resistance, check for kinks in tubin, turn pt onto L side (the tip of tubing may lie against stomach lining and repos may dislodge from there). Report repeated resistance to HCP
o After instilling saline, aspirate. If amount aspirated is > than amount instilled record as output, if less then its input
o Use asepto syringe to place 10ml of air into blue pigtail (ensures patency of air vent)
o Reconnect NG tube to drainage or suction

Question 31

what is worse for pt insertion or removal

what to assess before removal of NG tube. what eqpt is nec to be in what state for this

what to do to NG tube before removal

Answer 31

insertion is worse

assess BS before removing. Turn off suction while doing so

insert 20ml of air to flush it, preventing aspiration and getting stuff everywhere

o Clamp (prevents tube contents entering oropharynx) aand getting everywhere

Question 32

what should pt do as you remove NG tube

Answer 32

o Tell pt to take and hold breath (temp a/w obstr occurs during removal. Prevents aspiration)

Question 33

after removing tube what do you inspect and measure

Answer 33

o Inspct tube

o Meas drainage and note char of content.

Question 34

procedure NG removal

Answer 34

o Order
o BS
o Explain and reassure removal is easier than insertion
o Hygiene, gloves
o Turn off suction and disconnect NG tube from drainage bag/suction. W irrigating syringe insert 20ml of air into lumen of NG tube. Remove tape or fixation device from bridge of nose and unpin tube from gown
o Stand on pts R side if R handed
o Hand pt tissue (some like to blow after); place towel down
o Tell pt to take and hold breath (temp a/w obstr occurs during removal. Prevents aspiration)
o Clamp (prevents tube contents entering oropharynx) or unkink tubing securely and pull tube out steadily and smoothly into towel (its ugly) held in other hand while pt holds breath
o Inspct tube
o Meas drainage and note char of content. Dispose
o Clean nares, mouth care
o Position pt comfortably and exp procedure for drinking fluids if not contra. Instruct pt to notify if N occurs
 Sometimes pts aren’t allowed anything PO for 24hrs

Question 35

point from evaluation (i think it applies to general assessments youre doing after insertion, irrigation etc

what subjective question are you asking

Answer 35

• Observe amount and char of contents draining from NG tube. (shows if decompressing stomach)
• Ask pt if nauseated
• BS. Turn off suction while doing so
• Palpate abdm periodically and note pain, distension, rigidity (to det if decompression is occurring and return of peristalsis
• Inspect nares, nose
• Observe pos of tubing
• Ask pt if sore throat or irritation in pharyx

Question 36

probly not imp but what are you documenting for NG tube

Answer 36

• Length, size, type of gastric tube inserted and which naris inserted into
• Pt tolerane, confirmation of tube placement, char of gastric content, pH, result of radiography, whether tube is clamped or connected to drainage bag or suction and amount of suction applied
• Record rmoval of intact tube, pt tolerance, final amount and char of drainage

Question 37

Pts abdm is distended and painful. interventions?

Answer 37

• ass patency of tube (might not be in stomach)
• irrigate
• verify that suction is on as ordered
• notify HCP is distension unrelieived

Question 38

Pt complains of sore throat from dry, irritated mucous memb. interventions?

Answer 38

• do oral hygiene more freq

- ask HCP whether pt can suck on ice chips, lozenges, local anesthetic

Question 39

Pt dev irritation or erosion of skin around naris. interventions?

Answer 39

provide freq skin care

• tape tube on naris to avoid P
• consider switch to other naris

from med surg • Use moistened cotton tipped swabs to clean nose, followed by cleansing w water sol lube.
• Change nasal tape q2-3 days and inspect nose for skin irritation
• If nasal and pharyngeal mucosa are excessively dry can use steam,

Question 40

Pt dev s/s of pulm aspiration: fever, SOB, pulm congestion. inteventions?

Answer 40

• resp assessment
• notify
• CXR