what is nasogastric tube
inserted through one nostril, down nasopharynx, down esophagus into stomach
large bore tube
salem sump tubing for gastric decompression and medications
small bore tube
nasoenteric tube for feeding and medications
how do you determine length of tube for insertion
tip in nostril, measure to ear, ear down to xiphoid process
how can we determine correct tube placement
aspirate to gather gastric fluid
pH of liquid
1-5.5
what is likely if the fluid is greater than 6 pH
tracheal-bronchial tree
ongoing care and management
- pH check
- external measurement check
- inspection of nostrils (discharge, irritation, adhesive tape on)
- resp assessment
- abdominal assessment
- mouth care
- connection to suction
nasoenteric tubes for enteric feeds
- duodenum placement to reduce aspiration risk
how do you verify placement for nasoenteric tubes?
XRAY
for nasoenteric, what position should the patient be in
30-45 degrees
complications of enteric feeds
- tube displacement
- tube occlusion
- abdo cramping, nausea, vomiting
- diarrhea
- pulmonary aspiration
flushing meds through tube
- 30 cc before meds
- mix each med with 15-30 cc
- flush in between with 15-30 cc (10 cc for fluid restriction)
tips for flushing meds through tube
- use warm water to mix for difficult to dilute meds
- use liquid meds
- crush finely!!
- flush well in between and after
feeding solution types
- open
- closed
open feeding system
pour solution into bag and prime tubing
closed feeding system
comes prepared so you can spike bag with tubing
gastrojejunum tubes
- long term use
- surgically inserted
- no risk for aspiration due to placement (jejunum)
what equipment needed for nasogastric tube insertion
- NG tube (12-14fr)
- water soluble lubricant
- adhesive tape
- statlock stabilization device
- glass of water + straw
- 50mL syringe
- pH test strip
- suction set up
- marker
how do you determine which nostril
- close either one, determine which has the best airflow and least amount of skin breakdown
where do you aim when insertin
towards the ear
pt gags?
- stop
- allow rest, take few breaths & sips of water
- advance with each swallow
documentation for NG tube
- date & time insertion
- location of tube insertion (L/R nostril)
- type of tube
- size of tube
- means by which correct placement has been determined (pH reading, CXR)
- type of suction
- colour, amount, and other characteristics of gastric contents
- pt tolerance
