Nasogastric Tube
Gastric lavage solution
- 300 mL of room-temp or warm (100.4) fluid - 0.9% NS or water (if more) - use 60 mL syringe
Gastric lavage - how
- aspirate - give activated charcoal
Removing a nasogastric tube
- auscultate bowel sounds - turn off suction - inject 10 mL of NS or 30-50 mL of air - semi-fowlers position - remove anchoring on nose and gown - take deep breath and then hold breath to close off epiglottis - clamp tube - wrap end over end when pulling out - inspect tube
Gastric decompression indications
- bowel obstruction - paralytic ileus - surgery on stomach or intestine
Care and maintenance of nasogastric tube steps
- check gastric drainage - monitor gastrointestinal function - verify placement with marking and pH - irrigation - check tape - inspect skin - clean around area at least every 8 hours - water-based lubricant on nose - mouth care (brush)
Nasogastric intubation purposes
- decompress the stomach - remove gass and fluid - lavage the stomach to remove ingested toxins other than poison - determine problems with gastrointestinal motility and other disorders - treat and obstruction - compress a bleeding site when endoscopy is not immediately available - aspirate contents for analysis - administer radiographic contrast media to the gastrointestinal tract - administer feedings and medications
Single-lumen tube uses
- decompressing - withdrawing specimens for diagnostic analysis - washing the stomach free of toxic substances other than poison - irrigating toe stomach to diagnose and treat upper gastrointestinal bleeding during emergencies when endoscopy is not immediately available - administering feedings and/or medications
Double-lumen (two-channeled) gastric sump tubes are used for
- decompression (most common) - irrigating (12 French)
Large-bore tubes are used for
- gastric lavage - aspiration - decompression (12 to 14 French)
Stomach contents color
- grassy, green/brown - colorless with mucous shreds
Inserting a Nasogastric tube steps
- high fowlers position (aspiration and swallowing) - bed at level of hips - lubricate the first 4 inches of the tube - assess nasal passage - test gag reflex - measure tube and mark length - drink sip of water while inserting tube - aim back and down towards ear - ask to partially flex head (closes off epiglottis) - can rotate tubing - advance each time they swallow until at predetermined length - look in back of throat - auscultate for breath sounds - withdrawal gastric aspirate - anchor tube to nose - mark tube directly below nose - secure tube to gown - test for pH, color, and appearance - lower head to bed to no less than 30 degrees
Gastric lavage uses
- medication toxicity - hyper/hypothermia (malignant) - preparation for an endoscopic exam - treatment following ingestion of a toxic substance other than poison - treat gastric hemorrhage (emergent)
Enteral tube types
- orogastic - nasogastric - nasointestinal
Complications of nasal intubation
- pulmonary aspiration - mucous injury and ulceration - chronic irritation causing rhinitis, sinusitis, pharyngitis, otitis media - fluid and electrolyte imbalance - acid-base imbalance (metabolic alkalosis)
Higher risk of complications with nasogastric tube placement
- recent head trauma - recent brain surgery deviated - esophageal varices or strictures - recent banding or cautery of esophageal varices - coagulation abnormalities - alkaline ingestion - nasal polyps
Orogastric tubes (Ewald) are used for
- removing contents (ER/ICU) - lavage and evacuation of contents
Contrindications to nasogastric tube placement
- severe midface trauma - recent nasal surgery - esophageal perforation
Gastric Decompression steps
- verify placement - suction on wall - connect tubing
Most common complications of gastrointestinal decontamination
- vomiting - subsequent aspiration
Stomach contents pH
1-5.5 (acidic)
Semi-Fowler's Position
15-45 degrees
With gastric double-lumen sump tubes inject
30 mL irrigation solution
High Fowler's Position
60-90 degrees
A nurse is teaching a group of unit nurses about clients who have a need for gastric decompression. The nurse should identify that which of the following clients needs nasogastric tube intubation for gastric decompression?
A 40-year old client who has a postoperative bowel obstruction - a client who has a postoperative bowel obstruction should have a nasogastric tube inserted for decompression to remove gastric secretions - relieve distention, nausea, and pain
A nurse is checking the client's nasogastric tube for placement. Which of the following procedures should the nurse implement?
Aspirate stomach contents and check the pH - 4 or less
Most common nasogastric tube
Double-lumen (two-channeled) gastric sump tubes
A nurse is caring for a client who has a nasogastric tube connected to suction. Which of the following findings indicates that the tube has become occluded?
Increased abdominal distention - n/v
A nurse is performing a nasogastric intubation on a client and has reached the tube's predetermined length. Which of the following actions should the nurse take first?
Inspect the oropharynx with a penlight and a tongue blade - check for kinks and to ensure the tube is not coiled in the airway - if so pull back and reinsert
A nurse is caring for a client who has a newly inserted nasogastric tube. Which of the following actions should the nurse use to verify the initial placement of the tube?
Obtain an x-ray - for initial placement
A nurse is caring for a client who is recovering from gastric surgery, is NPO, and has a nasogastric tube connected to suction. Which of the following actions should the nurse take to prevent dry mucous membranes?
Provide frequent mouth care - brush, oral swabs
A nurse is informed during shift report that a client has a nasogastric tube connected to continuous suction. The nurse should identify that this client must have which of the following types of tubes?
Salem sump tube - used for continuous suction to decompress the stomach - tube has two lumens; one to remove content the other as air vent (allow to float freely)
Irrigate double lumen NG tube
air vent with 20 mL of air
Duodenum or jejunum placement add
another 20-30 cm
Gastric double-lumen sump tubes provide
continuous atmospheric air irrigation
Double-lumen (two-channeled) gastric sump tubes can be used with
continuous suction
Gastric compression is used to
control gastric or esophageal bleeding
How often to irrigate NG tube
every 4 hours (usually)
After initial placement and before first use
get x-ray
Gastric lavage define
irrigation of the stomach
To prevent reflux with gastric double-lumen sump tubes
keep tube above patients stomach
Gastric lavage position
left side
Single-lumen (Levin) tubes are connected to
low intermittent suction (25 mm Hg) to avoid erosion of stomach lining
Enteral tubes has various
material, sizes, and purposes
Gastric decompression is removed when
normal bowel function resumes - active bowel sounds - pass flatus
Dual-purpose tube uses
remove excess feeding formula from the stomach, thereby reducing reflex
Three-lumen tube
sengstaken-blakemore
Single-lumen (Levin) tubes have
several drainage holes near the gastric end of the tube (12 French)
Dual-purpose tubes are used fro
short-term (primarily undergoing surgery)
Dual-purpose tubes
simultaneous gastric suction and enteral feeding
Gastric decompression define
stomach contents are removed to relieve the stomach and intestines of pressure caused by the accumulation of gastrointestinal air and fluid
Gastric decompression is connected to
suction
Measure tubing from
top of nose to earlobe to end to xiphoid process
Three-lumen tubes are used to
treat upper gastrointestinal bleeding from esophageal varies when endoscopy is not available (temporary)