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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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