Skills Flashcards
What are the main reasons for using an NG tube?
-Maintenance of nutrition and hydration
-To allow medication administration
-To allow drainage of gastric contents
What are patients indicate caution to NGT insertion?
-Oesophageal cancer
-Low GCS
-Basal skull fracture
-Oesophageal varices
-Severe GORD
-Oesophageal stricture
-Oesophageal fistula
How do you measure the appropriate length of the NGT?
NEX measurement
-Tip of Nose
-Earlobe
-Xiphisternum
NB must be at least 55cm in adults
What is the process of NGT insertion?
- Gain consent
- Prepare equipment
- Lubricate tube tip (not gel as may alter pH)
- Insert into nostril and advance along floor of nasopharynx
- Ask patient to swallow as tube moves into NP
- Advance tube to NEX mark
- Remove guide wire
- Confirm placement with aspirate using 50ml oral syringe and pH paper (pH should be between 1-5)
- Flush once position is confirmed
- Secure with tape
What steps can be done if an aspirate cannot be obtained?
- Lay patient on left side (may reposition end of tube towards any content)
- Give mouth care / drink and wait 15-30mins
- Advance / withdraw tube by 5cm
- Inject 10ml air in an attempt to uncoil the tube
What requirements are there for radiological confirmation of correct NGT position?
- Must follow path of oesophagus
- Must bisect the carina
- Must cross the diaphragm at the midline
- Must be visible 5cm below diaphragm
How is a NPA sized up?
-Measured against diameter of the patient’s little finger
How is an OPA sized up?
-From ear lobe to corner of the mouth
or
-From angle of mandible to front incisor
How is an endotracheal tube measured up?
-From distal tip to mouth (normally 21cm in females, 23cm in males)
What are some signs of airway obstruction?
-Inspiratory stridor (obstruction at laryngeal level or above
-Expiratory wheeze (obstruction of lower airways)
-Gurgling (fluid in upper airway)
-Snoring (pharynx is partially occluded by tongue or palate
-Crowing / stridor (laryngeal spasm / obstruction)
What can you check to ensure correct placement of an airway?
-End-tidal CO2 waveform should be visible
-Misting should be visible at the mouthpiece
-Observe equal chest expansion and auscultate
What are the different oxygen delivery systems and their flow rate?
-Nasal cannula (1-6L)
-Simple face mask (5-10L)
-Venturi mask (2, 4, 8 and 10L)
-NRBM (15L)
-Bag valve mask
What are the pros of using an I-gel over an LMA?
I-gel pros:
-Less leakage over the cuff as it does not require inflation
-Bite block incorporated
-Faster and easier to insert than LMA
I-gel and LMA pros:
-Easier and more efficient than bag valve
-Lower risk of gastric inflation and regurgitation
When is tracheal intubation used?
-Perceived to be the optimal method for maintaining a clear and secure airway
-Maintains a patent airway which is protected from aspiration of gastric contents / blood
-Allows suction of secretions
-Dependent on skills of HCP for correct placement
When is tracheal intubation too risky?
In patients with:
-Epiglottitis
-Pharyngeal pathology
-Head injury (coughing / straining may cause a further increase in intracranial pressure)
-Cervical spine injury
