Diagnostic indications for NG intubation include the following: Evaluation of upper gastrointestinal (GI) bleeding (ie, presence, volume) Aspiration of gastric fluid content. Identification of the esophagus and stomach on a chest radiograph. Administration of radiographic contrast to the GI tract.
- Evaluation of upper gastrointestinal (GI) bleeding (ie, presence, volume)
- Aspiration of gastric fluid content.
- Identification of the esophagus and stomach on a chest radiograph.
- Administration of radiographic contrast to the GI tract.
When to clamp an NG tube?
“Clamping” an NG tube is done to determine if a patient can safely have an NG tube removed. Here’s how to decide: When the patient has had less than 200 cc of output over an 8-hour shift, you can attempt the clamping trial! Check on the patient in 4 hours, and release the clamp and turn on suction to see how much residue comes rushing out.
How to confirm NG tube placement?
How to check the position of an NG tube. 1. Aspiration of gastric contents. Before removing the guide wire, aspirate from the NG tube and check for gastric pH. a pH of between 0 and 5 confirms placement of NG tube. If pH confirmed, remove guide wire and tape tube in place.
How to insert a nasogastric (NG) tube?
Steps on Nasogastric Tube Insertion
- Wash the hands thoroughly and dry them before donning sterile gloves. ...
- Explain the procedure to the patient and answer any of their questions before moving forward with the procedure.
- The nurse should now position an unconscious patient in a lying position on the left side of the body, and position a patient who is awake in a sitting position.
How should a nasogastric (NG) tube be inserted and advanced?
- Before removing the guide wire, aspirate from the NG tube and check for gastric pH (0-5). ...
- If unable to aspirate from the NG tube, do not remove guide wire, tape wire in place.
- Attach drainage bag or spigot (as appropriate) to end of tube and secure for patient’s comfort.
- Discard gloves and wash hands.
What are the indications for insertion of a nasogastric tube?
Indications for Nasogastric Tube InsertionTo decompress the stomach and gastrointestinal (GI) tract (ie, to relieve distention due to obstruction, ileus, or atony)To empty the stomach, for example, in patients who are intubated to prevent aspiration or in patients with GI bleeding to remove blood and clots.More items...
When would a patient need an NG tube?
An NG tube may be used for treatments such as sucking excess fluids out of the stomach and delivering medicines. It also can deliver fluid that contains nutrients directly into the stomach. This is called tube feeding.
Who needs NGT insertion?
If you can't eat or swallow, you may need to have a nasogastric tube inserted. This process is known as nasogastric (NG) intubation. During NG intubation, your doctor or nurse will insert a thin plastic tube through your nostril, down your esophagus, and into your stomach.
Why would a nurse insert a nasogastric tube?
YOU MAY INSERT a nasogastric tube in an adult to administer tube feedings and medications, remove and suction stomach contents, or lavage his stomach.
What are the 2 types of nasogastric tubes?
Two types of NG tubes are in common use—the single-lumen tubes (Levin) and the double-lumen sump (Salem's sump) tubes. The single-lumen tubes are best for decompression, and the double-lumen sump tube is best for continuous lavage or irrigation of the stomach. Both may be used for either purpose.
What are the complications of NG tube?
Nasogastric Tube Complications Common complications include discomfort from placing and removing the tubes, sinusitis, or epistaxis. When placed incorrectly, tubes may puncture your child's esophageal tissue, make a hole, and cause damage. Placing the tube into the lung instead of the stomach can be life-threatening.
How long can patient stay on NG tube?
Gastrointestinal access for up to 4–6 weeks is usually achieved using NG or NJ tubes, although placement of percutaneous gastrostomy or jejunostomy access should be considered sooner if feeding is very likely to be prolonged (see section 7.3).
Does NG tube help bowel obstruction?
Most obstructions resolve by allowing the small bowel to rest and shrink back to its normal size, thus making the adhesions less problematic. This is accomplished by inserting a nasogastric (NG) tube(athinplastictubethatgoesthroughanostrilandintothestom- ach) that suctions fluid from the stomach.
How long can a patient have an NG tube?
The use of a nasogastric tube is suitable for enteral feeding for up to six weeks. Polyurethane or silicone feeding tubes are unaffected by gastric acid and can therefore remain in the stomach for a longer period than PVC tubes, which can only be used for up to two weeks.
How does an NG tube clear a bowel obstruction?
The tube removes fluids and gas and helps relieve pain and pressure. You will not be given anything to eat or drink. Most bowel obstructions are partial blockages that get better on their own. The NG tube may help the bowel become unblocked when fluids and gas are removed.
What is an NG Tube?
A nasogastric or NG tube is a plastic tubing device that allows delivery of nutritionally complete feed directly into the stomach; or removal of stomach contents. It is passed via the nose into the oropharynx and upper gastrointestinal tract.
Where to place NG tube?
Measure the NG tube. Place the NG tube in a position running from the bridge of the patient’s nose, to the ear lobe and down to the xiphisternum.
How to check pH before removing guide wire?
Before removing the guide wire, aspirate from the NG tube and check for gastric pH (0-5). If pH confirmed, remove guide wire and tape tube in place.
How many hours of drainage into bile bag?
A standard management protocol is free drainage into bile bag with 4 hourly aspirations.
What is NG feeding?
Occasionally, NG feeding is used to prepare malnourished patients for major abdominal surgery in the pre-operative period
When should NG tubes be removed?
The need for the NG tube should be reassessed regularly and it should be removed as soon as possible, either when symptoms resolve, when clinical decisions render it defunct (for example the decision for operative intervention for bowel obstruction instead of “drip and suck”) or after 4 weeks, as per NICE guidelines.
Where to insert a nasal tube?
Insert the tube into the more patent nostril, advancing along the base of the nasal canal directly horizontal towards the nasopharynx.
How to place a NG tube?
The individual placing the tube should put on nonsterile gloves and lubricate the tip of the tube. A common error when placing the tube is to direct the tube in an upward direction as it enters the nares; this will cause the tube to push against the top of the sinus cavity and cause increased discomfort. The tip should instead be directed parallel to the floor, directly toward the back of the patient's throat. At this time, the patient can be given the cup of water with a straw in it to sip from to help ease the passage of the tube. The tube should be advanced with firm, constant pressure while the patient is sipping. If there is a great deal of difficulty in passing the tube, a helpful maneuver is to withdraw the tube and attempt again after a short break in the contralateral nares as the tube may have become coiled in the oropharynx or nasal sinus. In intubated patients, the use of reverse Sellick's maneuver (pulling the thyroid cartilage up rather than pushing it down during intubation) and freezing the NG tube may help facilitate placement of the tube.[15] Once the tube has been inserted an appropriate length, typically around 55 cm as previously noted, it should be secured to the patient's nose with tape. [16]
Why do people use NG tubes?
NG tubes have been used for various reasons in patients with GI bleeding. In the past, NG lavage was thought to help control GI bleeding. However, recent studies have shown that this is not helpful.[7] Another indication for placement of a nasogastric tube is in the setting of massive hematochezia. Given that up to 15% of massive hematochezia is caused by an upper GI bleed, placement of a nasogastric tube, after initiating resuscitation may potentially aid in diagnosis. Of note, an upper GI source of bleeding is only ruled out after aspiration of gastric contents from a nasogastric tube if the fluid is bile tinged. If the fluid is not bile tinged, it is possible that a duodenal ulcer has caused bleeding but also scarred the pylorus causing a gastric outlet obstruction, which prevents the blood from being aspirated from the stomach.[8] However, the placement of an NG tube has not shown to improve patient outcomes in patients with GI bleed. [9]
What are the complications of nasogastric tubes?
The most common complications related to the placement of nasogastric tubes are discomfort, sinusitis, or epistaxis, all of which typically resolve spontaneously with the removal of the nasogastric tube. As noted previously in the contraindications, nasogastric tubes may cause or worsen a perforation in the setting of esophageal trauma, particularly after caustic ingestion, where extreme caution must be used if the placement is attempted. Blind placement of the tube in patients with injury to the cribriform plate may lead to intracranial placement of the tube.[20] If the tube is being placed for the administration of medications or nutrition, intragastric placement must be confirmed. Introducing medication or tube feeds to the lungs can cause major complications, including death.[2] Even in intubated patients, the NG tube can still be accidentally placed into the airway.[21] Another complication that all those managing nasogastric tubes should be aware of is specifically for the double-lumen nasogastric tubes. These large diameter tubes stent the lower and upper esophageal sphincter open while in place. If the tube becomes obstructed or otherwise malfunctions and is unable to decompress the stomach, it potentially increases the risk of an aspiration event secondary to this stenting effect.[22] Prolonged use of NG tube can cause irritation to the gastric lining, causing gi bleeding.[23] Patients with extensive irrigation with an NG tube can develop electrolyte abnormalities such as hypokalemia.[24] Prolonged pressure on one area of the nare can cause nasal pressure ulcers or necrosis.[25] The tube should be retaped intermittently to prevent this complication.
Why should a nasogastric tube be connected to a suction bucket?
The nasogastric tube should be connected to the suction tubing and the suction tubing connected to a suction bucket before placement of the tube to minimize the risk of spillage of gastric contents. All supplies should be close at hand to minimize unnecessary movement during the procedure. Technique.
What is the standard nasogastric tube used for?
For decompression, the standard tube used is a double-lumen nasogastric tube. There is a double-one large lumen for suction and one smaller lumen to act as a sump.
Why do you need a nasogastric tube?
Less commonly, nasogastric tubes can be placed to administer medications or nutrition in patients who have a functional gastrointestinal tract but are unable to tolerate oral intake. This is most commonly in patients who have suffered a stroke or other malady, which has left them unable to swallow effectively.[3] .
Where are nasogastric tubes inserted?
Nasogastric tubes are, as one might surmise from their name, tubes that are inserted through the nares to pass through the posterior oropharynx, down the esophagus, and into the stomach. Dr. Abraham Levin first described their use in 1921.
What position is the nasogastric tube placed in?
If unable to sit upright, patient lies in the left lateral decubitus position. If patient is ventilated through an endotracheal tube that protects the airway, the nasogastric tube can be placed with patient upright or, if needed, supine.
How to stop gagging in nasogastric tube?
Asking the patient to take sips of water when passing the nasogastric tube through the pharynx into the esophagus and through the esophagus into the stomach can greatly improve the chance of success and reduce gagging. This technique allows the patient to swallow the tube.
What is a nasogastric tube?
Videos (1) A nasogastric tube placed into the stomach allows for access to the inside of the stomach. Sometimes the tube is passed into the small intestine to allow enteric feeding. (See also Nasogastric or Intestinal Intubation and Enteral Tube Nutrition .)
Why do you need a chest x-ray?
Sometimes a chest x-ray is needed to definitively confirm the location of the tube in the stomach. If the tube will be used for infusing any substances, such as a radiopaque contrast agents or liquid feedings, a chest x-ray is highly recommended.
How deep should a mandible be inserted?
Estimate the proper depth of insertion—about the distance to the earlobe or angle of the mandible and then to the xiphoid, plus 6 inches; note which of the black marks on the tube correspond to this distance.
What is the purpose of a radiopaque contrast tube?
To give oral radiopaque contrast agents. To provide feeding of nutrients into stomach or feeding directly into small intestine with a long, thin, flexible enteral feeding tube.
What is the purpose of GI decompression?
To decompress the stomach and gastrointestinal (GI) tract (ie, to relieve distention due to obstruction, ileus, or atony) To empty the stomach , for example, in patients who are intubated to prevent aspiration or in patients with GI bleeding to remove blood and clots. To obtain a sample of gastric contents to assess bleeding, volume, or acid content.
What traumas can be caused by NG tubes?
Local facial or esophageal trauma (including cribriform plate disruption if considering an NG tube specifically)
What is the path of NG tube?
The key points to remember about anatomy: The path from the nostril to the back of the nasopharynx is straight posterior. So when inserting an NG tube you direct the tube straight posteriorly. The orientation of the nostrils might lead you to aim superiorly, which is not correct.
What does leaky air/pressure during ventilation through the ETT suggest?
Leaking air/pressure during ventilation through the ETT might suggest the NG tube is sitting next to the ETT and letting air escape.
What happens if a tube enters the trachea?
Also, if the tube does enter the trachea, then the inflated cuff might stop it from being advanced.
Can you turn a tube to get past resistance?
Slight turning of the tube (or withdrawing and advancing) might be occasionally necessary to get past points of resistance. There shouldn’t ever be a lot of resistance. This might indicate it’s up against tissue/other structures and excessive pushing can cause damage.
Does a tube bend?
The tube may have a slight bend to it. Keep track of the orientation of your bend.
What is the purpose of a nasogastric tube feeding?
To prevent distension of abdomen, especially after repair of the incisional hernia. After an esophagus operation, e.g. resection of growth excision of diverticulum, suturing of esophageal tear, correction of tracheoesophageal fistula. Feeding: nasogastric tube feeding in unconscious and comatose patients to maintain nutrition ...
What are the different types of tubes used in a nasogastric tube?
TYPES OF TUBES USED. Ryle’s tube (Nasogastric tube): Old Ryle’s tube was a red rubber tube with one bead of metal at the tip. Now plastic Ryle’s tubes are in use they are made polyvinyl chloride. Levacuator tube: this tube has two lumens.
What is a nasogastric insertion?
Nasogastric insertion is defined as the passage of a tube through the node to the stomach. Inserting a nasogastric tube or feeding tube into the stomach or duodenum allows a patient who cannot eat to receive nourishment.
What is aspiration of gastric juice?
Aspiration of gastric juice to know secretory activity and mobility of the stomach in chronic gastric ulcer, chronic duodenal cancer, pyloric obstruction, gastric carcinoma , and Zollinger-Ellison syndrome.
What is the tip of a tube lubricated with?
Tube: the tip of the tube is lubricated with sterile paraffin or jelly (distal 10-15 cm of the tip is lubricated with water soluble lubricant) Nose: wider nostril is selected. Nostril is cleaned with pledget of cotton wool, moistened with savlon in water.
What is an edlich tube?
Edlich tube: this single lumen tube has four openings near the closed distal tip. A funnel or syringe may be connected at the proximal end. Like the Ewald tube, the Edlich tube lets you withdraw large quantities of gastric contents quickly
How to confirm NG tube placement?
Confirmation of safe NG tube placement can be achieved by testing the pH of NG tube aspirate.
What is the assessment of NG tube placement?
The assessment of NG tube placement requires a systemic approach and a willingness to ask for senior assistance if unsure, to prioritise patient safety. The incorrect placement of an NG tube can result in life-threatening complications (e.g. aspiration pneumonia).
Why does a NG tube curl up?
An NG tube can curl up on itself, meaning the tip is placed higher than it should be which can result in reflux and aspiration of NG tube contents. This demonstrates the importance of confirming you can see the NG tube tip clearly.
Where is the NG tube positioned?
Incorrect placement of an NG tube. An NG tube can be positioned in the left or right main bronchus but to still appear in the midline (hence why the single criterion of an NG tube appearing in the midline is not satisfactory evidence to confirm safe placement).
What are the landmarks on a chest X-ray?
The annotated chest X-ray below highlights these key anatomical landmarks including: Trachea. Right and left main bronchi.
What is a NG tube?
Drainage of the upper gastrointestinal tract in conditions such as small bowel obstruction ( a larger diameter NG tube – known as a ‘Ryles tube’). When inserting an NG tube for feeding and/or administration of medication you need to confirm the safe placement of the tube prior to its use.
Where should a NG tube be located on a chest X-ray?
To confirm an NG tube is positioned safely, all of the following criteria should be met: The chest X-ray viewing field should include the upper oesophagus and extend to below the diaphragm. The NG tube should remain in the midline down to the level of the diaphragm. The NG tube should bisect the carina.
