Nasogastric Tube Insertion (PowerPoint)

					Nasogastric Tube Insertion
    CHD – 2
    Skills Lab
Uses
   Client that can’t or won’t eat
   Clients that have increased energy needs
       Burns, Trauma, CA, Sepsis
   Clients requiring bowel rest
       Pancreatitis
   Upper GI bleed
   Gastric content for study
   Suspected bowel obstruction
      Nasoduodenal
NGT
                     Nasojejunal
Benefits
   Prevents aspirations
   Administration of meds and nutrition safely
   Suction contents
Concerns
   Aspiration
   Nasal erosion
   Esophagitis
   Gastric ulcer
    Equipment
   NGT (8-12 Fr)                  Safety pin
       Levine – single lumen      Rubber band
       Salem Sump – dual          Towel
        lumen
                                   Gloves
   60 ml syringe
                                   Suction equipment
   Tape
                                   Pen light
   Cup of water with straw
                                   Tongue blade
   Emesis basin
                                   Stethoscope
Procedure
   Check PMD order
   Understand patient’s need for NGT
   Assess patient nares
   Complete abdominal/ GI assessment/ ability to
    swallow
   Assess pt history
       Nares, Med history
   Assess for Gag reflux
   Assess mental status
Procedure
   Intro. Self, Identify pt.
   Assess pt., Explain procedure
   Discuss ways to communicate during
    procedure
   Position pt.
   Don gloves
   Assess NGT
Procedure
   Determine length
      Nares --- earlobe ---to xyphoid process
      Mark with ink
   Lubricate tube with water based lubrication
      4 inches
   Hand water to pt
   Begin insertion– aim back and down
    towards ear
   turn 180 degrees
        Procedure
   Have client flex head towards chest and
    sip water
   Advance tube with swallows
   Instruct pt. To breath through mouth and
    swallow
       DO NOT FORCE TUBE
       If Pt. Coughing, Choking, Cyanotic
                  STOP & PULL BACK

   Advance to measured mark
Check placement
   Ask pt. To talk
   Check mouth with light and tongue blade
   Secure tube
   Check gastric contents/ Air auscultation
   Chest/Abdomen X-ray
Documentation
   Tube size and type
   Time
   Route (nare)
   Residual
   Specimen
   Suction
   Feeding
   Patient response
Risks of Displacement
   Due to
       Vomiting
       Suctioning
       Severe coughing
       Moving/transferring

       THEREFORE, You MUST check placement
        every single time of usage.
Removal
   Check discharge order
   High fowlers
   Instruct to “hold breath”
   Gently and smoothly remove
   Good oral hygiene
   Document
DAR
   D: Pt. resting in semi fowlers position. No
    gag reflex present. PMD ordered NGT for
    nutrition and med. Administration.
   A: Pt. teaching on NGT placement. NGT
    10 F inserted to L nare. 20cc residual
    noted. + placement validated via air bolus.
   R: Pt. tolerated procedure well. Pt. able to
    speak clearly. Resp. even and unlabored.
Nasogastric Tube Insertion
    CHD – 2
    Skills Lab
PEG
PEG administration
   Turn off continuous feeding
   Check for gastric contents
       Greater then 2X feeding – HOLD meds and feeding
   Return gastric contents via gravity
   Flush via gravity 30cc luke warm water
   Dissolve and administer one medication at a time
   Flush with 15cc between meds.
   Final flush of approximately 30 cc
   Prevent introduction of air while administer fluid and
    meds.
   Turn on feeding
   Maintain HOB 45 degrees
NGT Med. administration
   Turn off continuous feeding
   Check for placement via air bolus
   Check for gastric contents
       Greater then 2X feeding – HOLD meds and feeding
   Return gastric contents via gravity
   Flush via gravity 30cc luke warm water
   Dissolve and administer one medication at a time
   Flush with 15cc between meds.
   Final flush of approximately 30 cc
   Prevent introduction of air while administer fluid and meds.
   Turn on feeding
   Maintain HOB 45 degrees
                       Clamp suction tube
Prepare syringe with
                       while disconnecting it
30mL saline for
                       from NG tube.
irrigation.




                       Inject 10-20 cc of air
  Gently instill
  irrigation                 into tube.
Things to Remember
   Do NOT
       Mix medication with formula
       Crush enteric coated, extended release,
        capsules
       Use oily medications
       Use excessive force when administering
        anything
       Use cold water
                   DO:
   Use liquid form of medication
   Finely crush pills
   Check NGT placement every single time
   Keep HOB elevated
   Follow 5 RIGHTS
    If Patient Connected to Suction
   Turn suction OFF
   Follow previous steps.
   Keep Suction OFF for at least ONE HOUR!!

				
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posted:8/25/2011
language:English
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