Nasogastric tube placement

Indications Aspiration of gastric contents for therapeutic or diagnostic purposes Delivery of medication Assessment of upper gastrointestinal hemorrhage

Contraindications Patients who have suffered recent fractures of the base of the skull Patients who have had recent esophageal trauma or strictures

Complications Misplacement: cranial cavity after severe faciomaxillary trama or basal skull fractures Inadvertent insertion of nasogastric tubes into the trachea and distal airways is reported to range from 0.3% to 15% of insertions http://www.resourcenurse.com/RN/refcenter/naso_tube

Complications Trauma: epistaxis, pharyngeal or esophageal perforation, mediastinitis, gastric perforation Displacement Esophageal inflammation, strictures Aspiration. This may lead to bronchial infections and aspiration pneumonia.

Supplies Nasogastric feeding tube of appropriate size. Water soluble lubricant Tape Glass of water with a straw Stethoscope Emesis basin Towel Catheter tip syring Gloves Clamp, when appropriate Equipment for instilling liquids when appropriate

Procedure Explain procedure and purpose to patient and/or caregiver. You many have the patient should remove dental appliances before the nasogastric tube is inserted Answer the patient or family members’ questions about the procedure Wash hands. Gather supplies on a clean, dry surface. Apply gloves and other protective equipment.

Procedure Select the most patent nostril by having the patient alternately close each nostril and breathe Place the patient in a high or semi-fowlers position. Cover chest with a towel. Have an emesis basin available in case insertion stimulates vomiting.

Procedure Determine the appropriate length of tube to be inserted by measuring the distance from the tip of the nose to the lower edge of the ear lobe and the distance from the ear to the bottom of the xiphoid process ('NEX" - nose, ear, xiphoid). Mark the distance with a piece of tape.

Procedure Lubricate the tip of the tube with a water-soluble jelly if the tip is not pre-lubricated, about 6 - 8 inches. Hyperextend the head and neck slightly. Insert the tube into the nostril holding the nose to anchor the tube, aiming the tube downward into the posterior nasopharynx. Ask the patient to breath through his mouth

Procedure If not contraindicated, may flex the head and neck slightly as the tube reaches the oropharynx to facilitate esophageal passage. Allow patient to take sips of water through a straw and continue to pass tube firmly but gently until the tape mark reaches the nostril. Tube should advance approximately 3 - 5 inches each time patient swallows.

Procedure Do not force the tube if obstruction appears. Rotating the tube may assist in advancing. If persistent obstruction continues, stop intubation attempt.

Check placement of tube in stomach Aspirate for gastric contents with syringe. Place the stethoscope over the epigastric area. Inject 10 cc of air through the tubing. A "whooshing" or rumbling sound should be heard.

Other means of testing placement http://www.med.monash.edu.au/healthservices/cce/evidence/pdf/c/375.pdf

Secure tube Cut a piece of tape about 3 inches long. Cut tape lengthwise, three quarters of the way down the middle. Place the uncut end of the tape along the bridge of the patient’s nose. Wrap remainder of the tape around the tube. Place an extra piece of tape across patient’s nose, over first piece of tape.

Securing tube Place tape tab on the tube where attachment of tube to clothing will avoid tension on tube. Pin the tab to garment

Document procedure Date and time of tube placement Description of tube and size The patient's response to the procedure The amount and characteristics of gastric contents Instructions given to patient/caregiver

Removing the NG Tube Explain the procedure to the patient Remove tube from suction Clamp tube Untape tube from nose Utilizing a smooth quick movement, remove tube. Assure patient’s nostril is cleaned. Dispose of equipment. After the tube is removed, no special care is needed. The patient's throat may feel irritated from the presence of the tube.