Indications for NG tube
- Lavage, irrigation or dilution of gastric contents (e.g. overdose)
- Gastric decompression for small bowel obstruction
- Feeding
- Sampling of gastric contents
Absolute contraindications for NG intubation
- Suspected basilar skull fracture
- Obstruction of nasal passages (from acute or old trauma)
Relative contraindications for NG intubation
- Maxillofacial fractures
- Hemophiliacs
Is NG intubation sterile or not and why?
NOT sterile - going through nose and mouth (bacteria present)
What position should a patient be in for NG intubation?
Sitting
How are nasal passages examined prior to NG tube insertion?
Examine for obstructions, select most patent side
How to estimate distance from nasal opening to stomach for NG tube insertion
Place tube near patient from tip of nose to tragus then from tragus to stomach (note nearest black line on tube)
When should patient be given water to facilitate NG tube insertion?
When patient feels tube in posterior pharynx
How to test NG tube position after placement?
Fill 50-60 cc syringe with air, listen over stomach with stethoscope for gurgling noise
Why shouldn’t H2O be used to test NG tube position?
If the NG tube is in the lungs, you will cause aspiration/PNA!
NG tube should NOT be taped where?
Do NOT tape tube directly to nasal alae (may create undo pressure and possible injury)
Where should the distal end of the NG tube be secured?
To patient’s gown with safety pin (to reduce risk of tube catching something and being dislodged)
Indications for Foley catheter
- Monitor urinary output
- Bladder decompression (e.g. BPH obstruction, prior to abd surgery)
- Specimen for culture
- Tx of bladder injuries, tamponade, instillation of BCG for bladder cancer
Foley contraindications
- Suspected urethral disruption (pelvic fx esp from crush injury)
- Difficulty encountered when trying to pass catheter
Is Foley catheterization a sterile procedure?
YES to avoid causing a UTI
Size of Foley catheter
16 Fr for females
16-18 Fr for males
Standard type of Foley catheter
2 way
What is a 3 way Foley used for?
Irrigation (clots, s/p TURP, etc)
When should urine be visible in Foley placed in a female?
Once Foley is advanced about 4 inches (10 cm)
Where should a Foley be secured after placement?
Tape to medial thigh (limit any undue pressure to meatus)
Complications of Foley catheterization
- False passage
- UTI (MC complication)
- Obstruction of urine flow
- Leakage around catheter
- Hematuria
What is important to tell a patient before placing an NG tube?
- Importance of swallowing
- Pt will feel tube in their throat
Equipment for an NG tube placement
- NG tube (16-18 Fr)
- Anesthetic spray/gel
- Lubricant gel
- 50-60 cc syringe
- Tape
- Stethoscope
- Suction apparatus
- Cup of H2O/straw
- H2O for irrigation
- Emesis basin
What should you be prepared for if patient is unconscious for NG tube placement?
Be prepared to suction vomitus
