Nutritional Care and Support

Question 1

Describe the pathway of the Nasogastric (NG tube)

Answer 1

nose –> nasopharynx –> esophagus –> stomach

Question 2

What are some of the purposes of a NG tube?

Answer 2

• Decompress the stomach by removing fluids or gas to promote abdominal comfort
• To allow surgical anastomoses to heal w/o distention
• To decrease risk for aspiration
• To administer meds to pts who are unable to swallow
• To provide nutrition by acting as a temporary feeding tube
• To irrigate the stomach and remove toxic substances i.e. poisoning

Question 3

What is the pt’s position during NG tube insertion?

Answer 3

High-Fowler’s

Question 4

How do you determine the NG tubing length that will be used for the pt?

Answer 4

• Measure the length of the tube from the pt’s nose tip to the earlobe to the xiphoid process (NEX). Remember to place a tape to mark this length.
• NEX: Nose, earlobe, and xiphoid process

Question 5

Whenever there is any change in the pt’s respiratory status during NG tube insertion, what do you do?

Answer 5

Immediately stop the procedure and withdraw the tube

Question 5

When would you instruct pt to swallow or take small sips of water during NG tube insertion? Unless contraindicated

Answer 5

When the tube is near the back of the throat aka when the pt starts to gag and cough

Question 6

How should you maneuver the NG tube if you are met with resistance going down the throat?

Answer 6

Slowly rotate and guide the tube downward and toward the closer ear; have the pt’s head flexed toward the chest while passing the tube

Question 7

Why does the pt get a chest X-ray (CXR) after NG tube insertion?

Answer 7

To confirm placement of tube (Gold Standard)

Question 8

How can you engage the pt during NG tube insertion?

Answer 8

Prior to performing the procedure, inform the pt the purpose and different ways that they help to make the procedure go smoothly.

Question 9

It is important to determine which nostril is more patent prior to NG tube insertion. TRUE or FALSE.

Answer 9

TRUE. B/c the NG tube is inserted through the nose and into the stomach:

Question 9

If NG tube is going to be connected to a suction apparatus, what are the 3 main components of the suction apparatus?

Answer 9

• Canister
• Connector tube
• NG tube adaptor

Question 10

How do you prevent outflow from the stomach during NG tube insertion?

Answer 10

Occlude one end of the NG tube before inserting, using the plug end of the vent valve OR snugly insert the tip of a piston style irrigation syringe into the open end of the NG tube

Question 10

How can you determine if the NG tube is correctly placed in the stomach?

Answer 10

• Chest x-ray (Gold standard)
• Aspirate w/ syringe and measure for acidic pH (1-4)
• Using syringe to blow air through the tube and auscultate for sounds in abdomen

Question 11

Lubricate 3-4 inches of the tip of the NG tube with a small amount of _____-soluble lubricant

Answer 11

water. Avoid using petroleum-based lubricant due to risk for aspiration.

Question 11

What happens if after gentle rotation and angling the NG tubing, you are still met with more than slight resistance?

Answer 11

• Never force the tube forward b/c it can cause serious damage of the nasal mucosa
• Instead, remove the the tube and re-lubricate the end of the tube and attempt insertion in the opposite naris

Question 12

How should the pt position their neck for at the beginning of NG tube insertion?

Answer 12

Have the pt hyperextend their neck

Question 13

After the pt flexes their head forward, when should you advance the NG tube?

Answer 13

Each time they swallow– help cue the pt to swallow.

Question 14

When the pt begins to gag, then the NG tube is currently located in the _____. What do you do?

Answer 14

nasopharynx. Stop advancing the tube and instead withdraw about 1/8 inch to stop the gagging and instruct the pt to flex their head forward towards their chest and drink a sip of water and swallow.

Question 15

If the pt continues to gag and cough, what may have happened to the tube? What do you do?

Answer 15

It may have curled up in the back of the throat. Stop the procedure immediately if the pt exhibits symptoms of respiratory distress or cyanosis.

Question 16

When collecting the aspirate from the pt’s stomach after NG tube insertion, it is important to note the _____ and check the _____.

Answer 16

color; pH

Question 16

Once the NG tube is placed inside of the pt, what do you do next?

Answer 16

Tape the tubing to the pt’s nose– making sure to avoid positioning the tube where it is against the naris

Question 17

While waiting for the NG tube placement to be verified by a chest X-ray (CXR), can you instill anything into the tubing? Including a normal saline, water, meds, and formula?

Answer 17

No. Nothing should be instilled in the NG tube because the NG tube could be placed in the lungs and aspiration can result.