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NASO-GASTRIC FEEDING TUBE INSERTION

NASO-GASTRIC FEEDING TUBE INSERTION. Prepared by: Imran Iqbal Clinical Instructor. DEFINITION.

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NASO-GASTRIC FEEDING TUBE INSERTION

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  1. NASO-GASTRIC FEEDING TUBE INSERTION Prepared by: Imran Iqbal Clinical Instructor

  2. DEFINITION • Nasogastric intubation is a process involving the insertion of a plastic tube (nasogastric tube or NG tube) through the nose, past the throat, and down into the stomach.

  3. PURPOSES • Nasogastric tube is used for: • Feeding • Administering drugs • Administering oral agents such as activated charcoal. • To treat life threatening eating disorders • Nasogastric aspiration

  4. PURPOSES • Gastric Lavage • Pre Operatively (Anaesthesia) • Obtaining gastric samples for analysis • Continuous drainage of stomach contents

  5. PURPOSES • Administration of radiographic contrast to the GI tract • Evaluation of upper gastrointestinal (GI) bleeding (i.e, presence, volume)

  6. DIFFERENT SIZES • New born • INFANT SIZES • PAEDIATRIC SIZES • ADULT SIZES

  7. SIZES FOR NEW BORN 4 Fr 5Fr 6 Fr

  8. INFANT AND CHILDREN UP TO 5 YEARS 7 Fr (Orange) 8Fr(Blue) 10 Fr (White)

  9. CHILDREN ABOVE 5 YEARS 12 Fr (White) 14 Fr (Green)

  10. NGT SIZES FOR ADULTS 16 Fr (Orange) 18 Fr (Red) 20 Fr(Yellow)

  11. NGT DRESSING :

  12. CONTRAINDICATIONS

  13. EQUIPMENTS NG Tube – Appropriate size Disposable gloves Lubricant and gauze – to lubricate NG tube tip Disposable bowl – in the event of vomiting Paper towels – to allow patient to wipe around their mouth if needed Catheter tip syringe (Feeding Tube)

  14. EQUIPMENTS pH testing strips – to assess pH of aspirate Tape / dressing to secure NG tube Glass of water for the patient (if swallow is deemed safe) Local anaesthetic spray – if available Stethoscope Torch Megal’s forceps

  15. HAND WASHING

  16. DON GLOVES

  17. PROCEDURE 1. Position the patient sitting upright with their neck straight

  18. SIZE MEASUREMENT

  19. SIZE MEASUREMENT

  20. MARK THE SIZE

  21. LUBRICATE THE DISTAL END Lubricate the tip of the NG tube

  22. PROCEDURE Insert the NG tube in through a nostril – warn the patient prior

  23. PROCEDURES Gently advance the NG tube through the nasopharynx

  24. Ask the patient to take some sips of their water and swallow This can help facilitate the advancement of the NG tube However avoid giving patients a drink if their swallow is deemed unsafe

  25. PROCEDURE This is often the most uncomfortable part for the patient, so don’t go too slowly If resistance is met, rotating the NG tube to 180 degrees can help. however DO NOT force the NG tube If the patient is becoming distressed or gagging, Pause to allow the patient to relax It’s useful to look inside the patient’s mouth intermittently to ensure the NG isn’t coiling in there

  26. PROCEDURE

  27. CONFIRMATION

  28. pH CHECKING Aspiration of NG tube 1. Attempt to aspirate gastric contents: If aspiration is successful, test the pH (if pH is <4 this suggests correct placement) If aspiration is unsuccessful or the pH is >4 the patient will require a chest x-ray (CXR) Some hospitals require a CXR regardless of pH, so check your local guidelines

  29. SECURE NGT

  30. FLUSH THE TUBE WITH WATER

  31. SOON AFTER THE INSERTION After the tube is inserted, remove the tube right Away if: coughing Gagging Sneezing Vomiting Wheezing Changing colour

  32. Cannot catch a breath change in respiratory rate change in oxygen needs Decrease in pulse oximeter readings Increased restlessness Unexplained irritability, discomfort, or abdominal pain Cannot talk or change in the quality of cry or you see the tube coming out of the mouth

  33. DISPOSE OF USED EQUIPMENTS

  34. PATIENT’S EDUCATION To complete the procedure 1. Explain to the patient that the procedure is over 2. Reassure that the NG tube will become more comfortable over the next few hours 3. Offer patient paper towels to clean their face and nose

  35. DOCUMENTATION • Document clearly the procedure of NG tube placement: • Your full name and medical grade • Procedural details and any complications • CXR details if used – e.g. NG tube visible sitting below the left hemidiaphragm • Outcome – e.g. “SAFE to commence feeding” • Your signature, and registration number

  36. COMMUNICATION TEAM MEMBER Inform nursing staff that the NG tube is inserted and safely positioned

  37. TUBE REPLACEMENT • The use of a nasogastric tube is suitable for enteral feeding for up to six weeks. • Silicone feeding tubes are unaffected by gastric acid and can therefore remain in the stomach for a longer period • (6 weeks) • PVC tubes, which can only be used for up to two weeks.

  38. NG TUBE FEEDING

  39. POSITION THE PATIENT

  40. ASPIRATE BEFORE FEEDING

  41. ASPIRATE BEFORE FEEDING

  42. PUSH BACK IF ASPIRATE IS LESS THAN 30 ML

  43. REMOVE PLUNGER AND GIVE PRESCRIBED DIET

  44. NEVER PUSH–ALWAYS USE GRAVITY

  45. CLOSE THE SYRINGE AND NGT TO AVOID FLOW BACK

  46. KEEP HEAD SIDE ELEVATED UP TO 60 DEGREE FOR AT LEAST 30 MINS

  47. DOCUMENTATION 1-Amount of aspiration 2-Type and amount of diet given 3-Any complaint during feeding 4-Your Signature and ID number

  48. GASTRIC LAVAGE DEFINITION: Removal of potentially toxic contents from a patient’s stomach. INDICATIONS: Strongly consider nasogastric lavage in a patient who has taken an overdose of drugs that are particularly toxic. Suspected extreme doses associated with high morbidity/mortality and do not have easily available and effective antidotes.

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