NG Tubes

Question 1

What types of GI intubation can be done?

Answer 1

• Orogastric
• Nasogastric
• Gastrostomy
• Jejunostomy

Question 2

What is the purpose of nasogasric/enteric tubes?

Answer 2

• Decompression (ex. intestinal blockage)
• Nutrition
• Lavage (washing out of body cavity)
• Diagnostic

Question 3

What do we need to consider before giving an NG tube?

Answer 3

• Purpose
• Patient (age, dementia, etc.)
• Type of tube required
• Size of the tube
• Policy (UFV & agency)

Question 4

What are the different types of tubes?

Answer 4

• Levine
• Salem sump
• Feeding tubes

Question 5

What are the different sizes of NG tubes?

Answer 5

• Related to purpose
• Nutrition: less than 12, small bore or longer
• Decompression: 12 to 16 Fr., large bore and shorter
• Lavage: up to 18 Fr.

Question 6

According to UFV policy, when do we NOT insert NG tubes?

Answer 6

• Unconscious
• No gag or swallow reflex
• Neck or facial trauma or surgery
• Basal skull fracture
• Esophageal varices or obstruction
• Recent upper GI surgery
• Thermal or chemical injury to upper GI or Respiratory tract

Question 7

What equipment is required for NG tubing?

Answer 7

• Tube (14 to 16 Fr.)
• Gloves
• Water soluble lubricant
• pH test strips
• Tongue depressors
• Flashlight
• Catheter tipped syringe
• Tape or tube fixator
• Tissue
• Water with straw
• Stethoscope
• Save-a-day tray
• Incontinence pad

Question 8

What are steps 1-5 of NG tube insertion?

Answer 8

1) Check the physician’s order
2) Assess & prepare patient (ensure privacy)
3) Prepare for procedure (positiion selt, gather equipment, hand hygiene)
4) Examine nose
5) Measure and mark (nose, ear, xiphoid process)

Question 9

What are steps 6-10 of NG tube insertion?

Answer 9

6) Lubricate the tube
7) Alert the client about the commencement of the procedure
8) Instruct client to extend neck back against pillow
9) Insert the tube slowly through the naris, with curved end pointing downward
10) Once past the nasopharynx, instruct client to flex his head forward and swallow water

Question 10

What are steps 11-15 of NG tube insertion?

Answer 10

11) Advance 2 to 5 cm with each swallow
12) Continue to advance the tube until desired length has been inserted
13) Secure the tube slightly to nose, while checking for placement; anchor tube when placement is confirmed
14) HOB should remain elevated at 30 degrees
15) Remove gloves and wash hands

Question 11

How and when do we check for placement of the tube?

Answer 11

• Ask client o talk
• Inspect posterior nares for evidence of coiled tube
• Check aspirate for pH volume (wait one hour post insertion)
• Check for changes in residual volumes
• Check q4h, with documentation, and verify tube length q8h

Question 12

What do we record and report?

Answer 12

• Time and type of NG tube inserted
• Client’s tolerance of procedure
• Confirmation of placement
• Character of gastric contents and pH value
• Whether tube is clamped or connected to drainage device
• Amount and character of NG drainage every shift

Question 13

What are the two different types of suction?

Answer 13

• Wall suction (hospital rooms)

- Gomco

Question 14

How do we establish gastric suctioning?

Answer 14

1) Gather equipment and check (no leaks)
2) Connect to NG tube
3) Turn on suction (as ordered by physician)
4) Observe function
5) Monitor patient: GI system, respiratory system, F & E balance
6) Monitor suction system regularly
7) Check tube placement
8) Avoid reflux through blue pigtail
9) Empty, measure, observe & document

Question 15

What is the purpose of irrigation of NG tube? (i.e. cleansing with water)

Answer 15

Maintain patency of tube to ensure continued sunctioning

Question 16

What are the S&S of occlusion (suctioning not functioning)?

Answer 16

• Decreased drainage
• N&V
• Gastric distention

Question 17

What is the procedure for irrigation?

Answer 17

• Clean procedure
• Instill 30-50 ml saline gently and aspirate
• Keep equipment at bedside and change Q24 hours
• Document

Question 18

What are the steps for removing a NG tube?

Answer 18

1) Assess, prepare and position patient
2) Gather equipment
3) Hand hygiene and gloves
4) Disconnect suction
5) Remove anchoring tape
6) Clear NG tube and remove (to prevent aspiration)
7) Provide mouth care, nose care and give sips of water
8) Measure drainage
9) Dispose off equipment
10) Document procedure

Question 19

What are some comfort and care techniques we can use while caring for a patient with a NG tube?

Answer 19

• Mouth care (breathing mostly through mouth)
• Nasal care (nare care)
• Care of the throat
• Ambulate patient (see if losenges are allowed to combat dry mouth)