This should be commensurate with the reason for the NG tube. This allows the NG tube to pass more easily through the nasopharynx and into the stomach. Raise bed to a comfortable working height. This helps prevent biomechanical injury to the health care provider. Agree on a signal the patient can use if they wish you to pause during the procedure.
This procedure can be anxiety-provoking and uncomfortable for many patients. Providing a means for the patient to communicate discomfort and a desire to pause during the procedure helps alleviate anxiety. Nasal and oral secretions may be evident during the procedure. Provide patient with drinking water and a straw if the patient is not fluid restricted. Sipping water through a straw helps to initiate the swallowing reflex and facilitate passing of NG tube. You will use your dominant hand to insert the tube.
Measure distance of the tube from. This determines the appropriate length of NG tube to be inserted. Never use non-water-soluble lubricant e. Apply clean non-sterile gloves. Using gloves decreases the transfer of microorganisms. Colour-coded pH paper is usually used, as an initial and interim check, to confirm that acidic contents are present. Then an X-ray is taken to confirm placement prior to using NG tube for feeding. If the pH is more than 6, it may indicate the presence of respiratory fluids or small bowel content, and the tube should be removed.
An NG tube should be removed if it is no longer required. The process of removal is usually very quick.
Prior to removing an NG tube, verify physician orders. During the trial, the patient should not experience any nausea, vomiting, or abdominal distension. Skip to content Chapter Tubes and Attachments. You are inserting a nasogastric tube and the tube is not advancing. Explain your next steps, with rationale.
Your patient has a nasogastric tube and is requesting water because her throat feels dry. Describe your next actions. Previous: Next: Share This Book Share on Twitter. Disclaimer: Always review and follow your hospital policy regarding this specific skill. Safety considerations: Perform hand hygiene. Check room for additional precautions. Introduce yourself to patient. Confirm patient ID using two patient identifiers e. Explain process to patient; offer analgesia, bathroom, etc.
Listen and attend to patient cues. Apply principles of asepsis and safety. Asking them to swallow their saliva or a small amount of water may help to direct the tube into the oesophagus. Once in the oesophagus, it may be easy to push it down into the stomach.
The correct intragastric position is then verified see below. The tube is fixed to the nose and forehead using adhesive tapes. The stomach is decompressed by attaching a 60ml syringe and aspirating its contents. Blocked tubes can be flushed open with saline or air.
Other methods can be inaccurate and should not be used. The NG tube is aspirated and the contents are checked using pH paper, not litmus paper Earley, The NPSA b recommended that it is safe to feed patients infants, children and adults if the pH is 5. This advice does not apply to neonates preterm to 28 days.
Note that taking proton pump inhibitors or H 2 receptor antagonists may alter the pH. Similarly, intake of milk can neutralise the acid. This involves taking a chest X-ray including the upper half of the abdomen. The tip of the tube can be seen as a white radio-opaque line and should be below the diaphragm on the left side.
This test is mentioned here for historic interest only. Also known as the whoosh test, it has been shown to be an unreliable method of checking tube placement, and the NPSA ; a; b has said that it must no longer be used. There are several advantages associated with the use of NG tubes. They will decompress the stomach by releasing air and liquid contents. This is important for patients with ileus, intestinal and gastric outlet obstruction. These conditions can cause vomiting, and patients are at risk of aspirating their stomach contents, which can lead to potentially lethal pneumonitis.
Nasogastric tubes may also be useful for feeding patients who have dysphagia, for example after experiencing a stroke, and also for those being who have undergone a tracheostomy. Nasojejunal tubes are longer versions of NG tubes. They are inserted under endoscopic guidance to lie further in the jejunum and may be useful in feeding patients with pancreatitis. Nursing Times Jobs has thousands of current vacancies - start your job search today!
Dougherty, L. Chichester: Wiley Blackwell. If a patient has suffered head trauma and a base of skull fracture has not been ruled out, NG tube insertion should be avoided due to the potential risk of entering the cranial vault.
Estimate how far the NG tube will need to be inserted: measure from the bridge of the nose to the ear lobe and then down to 5cm below the xiphisternum. Continue to advance the NG tube down the oesophagus: ask the patient to take some sips of water and then swallow as this can facilitate the advancement of the NG tube.
Avoid giving patients a drink if their swallow is deemed unsafe, due to the risk of aspiration. Once you reach the desired nasogastric tube insertion length, fix the NG tube to the nose with a dressing. Once the NG tube is deemed safe for use, the radiopaque guidewire can be removed. Explain to the patient that the procedure is now complete and reassure them that the NG tube will become more comfortable over the next few hours. Dispose of used equipment, including PPE , into a clinical waste bin.
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