What is nasogastric (NG) tube?
A nasogastric (NG) tube is a flexible tube of rubber or plastic that is passed through the nose, down through the esophagus, and into the stomach. The tube is placed into your digestive system in order to deliver or remove substances to and from the stomach.
How long does a nasogastric tube stay in after surgery?
On average, the nasogastric tube was maintained for 3.2 +/- 2.1 days (range 1-8) after surgery. The average daily nasogastric output was 440 +/- 283 mL (range 68-1565). What color is gastric secretions? In their normal state, gastric juices are usually clear in color. HCl is an important component in gastric juice.
What are the signs and symptoms of nasogastric tube removal?
These include flatus, bowel movements, decrease in nasogastric tube output amount, change of nasogastric tube output color from bilious (green) to more gastric (yellow) or salivary (clear/foamy) quality. Some physicians prefer to perform a clamp trial before removal of the nasogastric tube.
What is the role of an RN in nasogastric tube placement?
It is within an RN’s scope of practice to place, monitor and maintain a nasogastric tube, although most facilities require a physician order to initiate or discontinue an NG tube, or to change the type of feeding administered via an NG tube.
How much should an NG tube drain?
Once the NG tube output is less than 500 mL over a 24 hour period with at least two other signs of return of bowel function the NG tube will be removed. Other signs of bowel function include flatus, bowel movement, change of NG tube output from bilious to more clear/frothy character, and hunger.
How many mL Do you aspirate from NG tube?
Aspirate minimum 0.5 - 1ml of gastric content (or sufficient amount to enable pH testing).
What should NG tube aspirate be?
aspirating fluid from the tube and checking pH is 5.5 or below. checking for anything unusual about your tube.
How do you check NG tube output?
0:121:56How to Check Placement of an NG Tube - YouTubeYouTubeStart of suggested clipEnd of suggested clipClamp the ng tube and remove the syringe push some of the stomach contents on the ph paper and watchMoreClamp the ng tube and remove the syringe push some of the stomach contents on the ph paper and watch it change colors.
How much residual is OK for tube feeding?
If using a PEG tube, measure residual every 4 hours (if residual is more than 200 ml or other specifically ordered amount, hold for one hour and recheck; if it still remains high, notify doctor). If using a PEG tube, reinstall residual. Hang tube feeding (no more than 8 hours' worth if in bag set up).
How much gastric residual is normal?
A limit of 500 ml is not associated with adverse effects in gastrointestinal complications or in outcome variables. A value of 500 ml can be equally recommended as a normal limit for GRV.
How often do you aspirate NGT?
Section 6 – Flushing a NGT Flushing NGT is required: After each feed (if bolus feeding) Prior to restarting feed. Before and after medications.
What is gastric residual volume?
Gastric residual volume is the amount of liquid drained from a stomach following administration of enteral feed; this liquid consists mainly of infused nutritional formula or water, and secreted GI juice.
How do you know if NGT is not in place?
Methods of confirming NG tube positionAuscultation of air insufflated through the feeding tube ('whoosh' test)Testing the acidity/alkalinity of aspirate using blue litmus paper.Interpreting the absence of respiratory distress as an indicator of correct positioning.Monitoring bubbling at the end of the tube.More items...•
What causes high NG tube output?
Factors that were associated with high-volume NGT drainage included nausea, tachycardia, abdominal distension, tympany, air-fluid levels, and dilated loops on ab- dominal radiographs and free fluid on CT scan (Tables 3 and 4).
Why do we aspirate NG tube?
The source of aspiration is due to the accumulation of secretions in the pharynx of reflux gastric contents from the stomach into the pharynx.
What does Brown drainage from NG tube mean?
This tube will be set to suction and will drain out brownish colored stomach acid. When it runs from brown to light green to clear, this is an indication that things are moving through the stomach and feedings may be possible.
How often do you aspirate NGT?
Section 6 – Flushing a NGT Flushing NGT is required: After each feed (if bolus feeding) Prior to restarting feed. Before and after medications.
What is gastric residual volume?
Gastric residual volume is the amount of liquid drained from a stomach following administration of enteral feed; this liquid consists mainly of infused nutritional formula or water, and secreted GI juice.
Why do we aspirate NG tube?
The source of aspiration is due to the accumulation of secretions in the pharynx of reflux gastric contents from the stomach into the pharynx.
What does brown drainage from NG tube mean?
This tube will be set to suction and will drain out brownish colored stomach acid. When it runs from brown to light green to clear, this is an indication that things are moving through the stomach and feedings may be possible.
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] .
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 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]
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.
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]
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.
How long does a nasogastric tube last?
Nasogastric tubes are primarily intended for short-term use, typically for 48 – 72 hours. Patients who require feeding or medication administration via an NG tube for longer than 48 – 72 hours should consider getting a percutaneous endoscopic gastrostomy, or PEG tube, which is a tube that goes directly into the stomach.
Why do we need a nasogastric tube?
Nasogastric tubes may be placed for prophylactic or therapeutic reasons (that is, to prevent problems from occurring, or to fix problems that already exist). Nasogastric tubes can also be used for diagnostic purposes, since it is possible to collect gastric contents using an NG for laboratory analysis.
What are the complications of a nasogastric tube?
More significant complications include erosion of the tube where the tube is anchored, esophageal perforation, pulmonary aspiration, a collapsed lung, or intracranial placement of the nasogastric tube.
What is the tube that carries food?
Nasogastric tubes (NG tubes) are flexible plastic tubes, usually polyurethane or silicone, that carry food or medicine through the nose and down into the stomach, or from the stomach out through the nose.
Why do you need NG tubes after gastric surgery?
To remove gastric secretions (drain the stomach) These patients may have gastrointestinal obstructions (for example, due to cancer), or may have NG tubes inserted immediately after major surgery to help keep the stomach empty and prevent post-operative emesis.
How to insert NG tube?
Your first step in inserting an NG tube is to gain informed consent. The patient should be given an explanation of the insertion procedure, and should know why the tube is necessary. Follow your institution’s guidelines for obtaining verbal or written consent, and document what you have done.
What is NG tube?
NG tubes may also be used to aspirate (i.e. drain) the stomach in case of a gastrointestinal (GI) bleed, or in the case of poisoning or a drug overdose. To administer food or medicine to patients who have difficulty swallowing (i.e. dysphagia) or who are unable to swallow. This may include, for example, patients who recently experienced a stroke, ...
How long does it take for a NG tube to be removed?
Once the NG tube output is less than 500 mL over a 24 hour period with at least two other signs of return of bowel function the NG tube will be removed. Other signs of bowel function include flatus, bowel movement, change of NG tube output from bilious to more clear/frothy character, and hunger.
Is it safe to remove a nasogastric tube?
Signs of return of bowel function can indicate it is safe to remove the nasogastric tube. These include flatus, bowel movements, decrease in nasogastric tube output amount, change of nasogastric tube output color from bilious (green) to more gastric (yellow) or salivary (clear/foamy) quality. Some physicians prefer to perform a clamp trial ...
NG Tube Nursing Care Plans Diagnosis and Interventions
A nasogastric (NG) tube is a flexible rubber or plastic tube inserted via the nose, esophagus, and stomach.
Nasogastric Tube Feeding
A patient on NG tube feeding typically has a condition or injury that prohibits them from eating a regular diet by mouth, but their GI tract is still functioning well.
Types of Nasogastric Tube
The healthcare provider will decide on the type and length of the nasogastric (NG) tube that will better fit the patient’s needs, including lavage, aspiration, enteral therapy, or stomach decompression. The Levin, Salem sump, and Moss tubes are the various types.
Nasogastric Tube Management and Patient Care
The patient’s mouth should be cleaned with a damp towel, a toothbrush, and floss at least once a day, .
Medical Supplies Used in Nasogastric Tube Insertion
Before initiating the NG tube insertion, all necessary medical apparatus or supplies should be prepared, assembled, and ready at the bedside. The following equipment are essential:
Procedure of Nasogastric Tube Insertion
Check the stability of each nostril by closing one and requesting the patient to breathe through the other.
Nursing Considerations for Patients with Nasogastric Tube
Provide oral and skin care for the patient. Apply mouthwash and lubrication to the patient’s lips and nostrils. Lubricate the catheter till it contacts the nostrils using a water-soluble lubricant, as the client’s nose may become itchy and dry.
