2. R.T.INSERTION
DEFINITION: - NASOGASTRIC TUBE
INSERTION MEANS THE
INTRODUCTION OF A TUBE INTO THE
STOMACH FOR THERAPEUTIC OR
DIAGNOSTIC PURPOSES.
GASTRIC GAVAGE – IS A ARTIFICIAL
METHOD OF GIVING FLUID AND
NUTRIENT THROUGH A TUBE, THAT
HAS PASSED THROUGH THE NOSE.
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3. INDICATION –
PERFORMING A GAVAGE – FOR ARTIFICIAL
FEEDING THE PATIENT
ADMINISTRATION OF ORAL MEDICATIONS THAT
CANNOT BE SWALLOWED.
ASPIRATION OF GASTRIC CONTENT (LAVAGE) –
FLUID, FOOD, OR GAS.
TO CORRECT FLUID AND ELECTROLYTE
IMBALANCE.
ALLEVIATES DISCOMFORT DUE TO
NAUSEA, VOMITING & REDUCES THE POSSIBILITY
OF ASPIRATION
OBTAINING A SAMPLE OF SECRETION FOR
DIAGNOSTIC TESTING.
CONTROLLING GASTRIC BLEEDING A PROCESS
CALLED COMPRESSION. ON TAMPONADE (
PRESSURE)
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4. EQUIPMENT: -
NASOGASTRIC TUBE (E.G. LEVIN, SALEM) 14, OR 16
FT. NG TUBE
SYRINGE
WATER SOLUBLE LUBRICANT
TOWEL
EMESIS BASIN
STETHOSCOPE
GLASS OF WATER
CLEAN GLOVE
FLASHLIGHT
TAPE
SCISSOR
BOWEL WITH WATER
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5. PREPARATION OF PATIENT—
EXPLAIN THE PROCEDURE TO THE PATIENT AND
ASK FOR PATIENT’S CO-OPERATION
PROVIDE PRIVACY
PLACE THE PATIENT IN FOWLER’S POSITION,
MAKE THE PATIENT COMFORTABLE
PLACE MACKINTOSH AND TOWEL ACROSS THE
CHEST AND UNDER THE CHIN
GIVE A MOUTH WASH AND HELP HIM TO CLEAN
THE TEETH.
CLEAN THE NOSTRILS, IF THERE IS SECRETION OR
CRUST FORMATION, USING SWAB STICK DIPPED
IN SALINE OR SODA BICARB SOLUTION.
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6. PREPARATION OF UNIT—
ARRANGE THE ARTICLES
CONVENIENTLY ON THE BEDSIDE
LOCKER.
ROOM SHOULD BE WELL VENTILATED
SEND VISITORS AWAY FROM THE ROOM
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11. PROCEDURE
STEPS RATIONALE
WASH HANDS
ELEVATE HEAD END
OF BED TO 45º ANGLE
PLACE THE TOWEL
OVER CLIENTS CHEST
AND EMESIS BASIN
WITH IN REACH
TO PREVENT CROSS
INFECTION
HEAD ELEVATION
PROMOTES SAFETY DURING
TUBE INSERTION.
CLIENT MAY EXPERIENCE
DISCOMFORT OR MAY GAG
OR VOMIT DURING TUBE
INSERTION. AND AVOID
SOILING OF CLOTHES
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12. STEPS RATIONALE
INSPECT CLIENTS NOSE
TO DETERMINE LENGTH OF
TUBE TO BE INSERTED,
MEASURE FROM TIP OF
CLIENTS NOSE TO EARLOBE
AND FROM EARLOBE TO
XIPHOID PROESS OF
STERNUM MARK
DETERMINED DISTANCE ON
TUBE WITH TAPE OR PEN.
CHECK FOR NASAL
INFECTION OR ANY
DEVIATION.
THIS LENGTH
SHOULD BE
SUFFICIENT TO
ADVANCE TUBE INTO
CLIENT’S STOMACH.
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13. STEPS RATIONALE
LUBRICATE THE 6 TO 8
INCH OF TUBE WITH
WATER SOLUBLE
LUBRICANTS
WITH CLIENTS HEAD
UPRIGHT OR SLIGHTLY
EXTENDED, CAREFULLY
INSERT TUBE INTO
CLIENTS NOSTRIL AIM IT
TOWARDS CLIENT’S EAR
AND DOWNWARD AND
GENTLY ADVANCE IT
TOWARDS CLIENT’S
NOSOPHARYNX
THIS FACILITITATES
ADVANCEMENT
THROUGH NASAL
PASSAGE, AND PREVENTS
DAMAGE TO MUCOSA
TURNING AND
DIRECTING TUBE, IT
CONFORMS TO ANATOMIC
PASSAGEWORK WHEN
TUBE REACHES
NASOPHARUNX
RESISTANCE WILL BE
FELT.
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14. STEPS RATIONALE
HAVE CLIENT OPEN
MOUTH AND CHECK
WITH LIGHT TO
VISUALIZE TUBE.
ENCOURAGE CLIENT TO
SWALLOW.
TO VERIFY THAT TUBE
IS AT BACK OF THROAT,
AND NOT COILED UP IN
MOUTH.
ADVANCE TUBE AS
CLIENT SWALLOWS.
SWALLOWING OPENS
UPPER ESOPHAGEAL
SPHINCTER AND ALLOWS
TUBE TO ENTER
ESOPHAGUS.
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15. STEPS RATIONALE
ONCE TUBE IS ADVANCED
TOWARD BACK OF THROAT,
HAVE CLIENT FLEX HEAD
FORWARD, THEN ROTATE
TUBE 180ºINWARD.
ASPIRATE 20 TO 30 ML OF
AIR INTO SYRINGE, ATTACH
SYRINGE TO FREE END OF
NASOGASTRIC TUBE, TO
CHECK FOR TUBE POSITION
THIS HELPS DIRECT
TUBE PAST
NASOPHANYNX
TUBE MUST BE
PLACED IN CLIENT’S
ALIMENTARY CANAL
NOT RESPIRATORY
TRACT.
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16. STEPS RATIONALE
PLACE STETHOSCOPE
OVER CLIENT’S
EPIGASTRIC REGION,
THEN INJECT AIR AND
THEN LISTEN FOR
SWOOSHING SOUND.
AUSCULTATION IS NO
LONGER. CONSIDERED A
RELIABLE METHOD FOR
VERIFICATION OF TUBE
PLACEMENT.
THIS INDICATE
THAT TUBE HAS
PROBABLY REACHED
STOMACH
TUBE
INADVERTENTLY
PLACED IN THE
LUNGS, PHARYNX, OR
ESOPHAGUS CAN
TRANSMIT A SOUND
SIMILAR TO THAT
ENTERING THE
STOMACH.
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17. STEPS RATIONALE
KEEPING SYRINGE
ATTACHED, PULL
BACK ON PLUNGER
TO ASPIRATE GASTRIC
CONTENT. CHECK FOR
COLOR AND PH OF
CONTENTS.
WRAP THE
SECURING TAPE
AROUND
NASOGASTIC TUBE.
SECRETION MAY BE
OBTAINED FROM TUBE
INADVERTENTLY PLACED
IN CLIENT’S AIRWAY OR
PLEURAL SPACE PH
TESTING OF ASPIRATED
SECRETION HELPS
DETERMINE WHERE TUBE
HAS BEEN PLACED.
TO STABILIZE TUBE
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18. STEPS RATIONALE
PIN TAPE OR RUBBER
BAND TO CLIENT’S
GOWN TO SECURE TUBE
ABOVE CLIENT’S
STOMACH.
PLUG END OF TUBE,
OR CONNECT END OF
TUBE TO INTERMITTED/
CONTINUOUS SUCTION
DEVICE
IF THE TUBE IS
PULLED TENSION
WILL BE PLACED AT
PINNED SITE RATHER
THAN CLIENTS NAIRS.
FOR
DECOMPRESSION.
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19. RECORDING AND REPORTING
RECORD AND REPORT TYPE AND SIZE OF
TUBE PLACED, CLIENTS TOLERANCE OF
PROCEDURE CONFIRMATION OF TUBE
POSITION BY X- RAY.
CHECKING PLACEMENT –
ASPIRATION FLUID – ASPIRATED FLUID
APPEARS CLEAR, BROWNISH – YELLOW
ON GREEN.
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20. AUSCULTATION OF ABDOMEN – NURSE I
INSTILLS 10 ML OF AIR WHILE LISTENING
WITH THE STETHOSCOPE OVER THE
ABDOMEN, IF A SWOOSHING SOUND IS
HEARD THE NURSE CAN REFER THAT IT
WAS CAUSED BY THE AIR ENTERING THE
STOMACH. BLEACHING OFTEN INDICATES
THAT THE TIP IS STILL IN THE ESOPHAGUS
CONTINUES BUBBLE SHOWS PLACEMENT
OF TUBE IN LUNGS
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21. TESTING PH OF ASPIRATED FLUID
ASPIRATE SMALL VOLUME OF FLUID FROM
THE TUBE WITH A CLEAN SYRINGE
DROP A SAMPLE OF GASTRIC FLUID ONTO
AN INDICATION STRIP.
COLOUR OF TEST STRIP CHANGES
ACCORDING TO THE HYDROGEN ION
CONCENTRATION OF LIQUID . STOMACH
FLUID USUALLY HAS PH OF 1 – 3 ACIDIC IF
PH 5 TO 6 , PATIENT RECEIVING
MEDICATION TO DECREASE GARTNIC
ACIDITY OF FLUID MAY BE FROM
DUODENUM PH OF 7, OR GREATER
INDICATES THAT TUBE IS IN RESPIRATORY
TRACT.
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