Preparation: Indications for NG tube insertion include: Aspiration of gastric contents / emptying of the stomach. Gastric decompression. Administration of feeding or medication. Administration of radiographic contrast to the GI tract. Equipment: Assemble the following: Personal protective equipment. Gown, gloves, eye/face protection. NG tube. Bladder (60ml) syringe. pH indicator strips. Lubricant: Sterile water, KY jelly, Catheter jelly. Cup of water and straw or chipped ice. Vomit bag or bowl (just in case). Towel to cover front of patient during procedure. Tissues. Adhesive securing tape. Drainage bag (if required) or spigot. Procedure: Wash your hands and don gown and eye protection (preferably a face shield). If you are inserting the tube in a patient with influenza also wear a P95 mask. Measure the correct tube length. From the tip of the patients nose to the tragus of the ear and then down to the xiphisternum. The NG tube is marked off in centimeter increments so you can just note the length. I like to wrap a small length of tape around the tube as an extra prompt. Lubricate the tip and the first few centimeters of the tube. Often sterile water is all you will need. (Note: if you are using KY jelly. This is alkaline and has the potential to alter your pH testing if you use a lot of it). Position the patient. Ideal position is sitting upright with the head flexed forward (chin on chest). This tends to allow the tube to advance against the posterior pharyngeal wall facilitating a smooth passage into the oesophagus. Tell the patient that you are going to gently support them, and place your non dominant hand against the back of their head. Advance the tube into the nostril of choice. The mistake made here is to advance the tube upwards (the way your finger goes when you pick your nose). The tube should be advanced at 90 degrees to the face. If there is resistance gently rotate the tube and retry As the tube passes into the nasopharynx, ask the patient to sip a mouthful of water. This is to close the glottis facilitating passage of the tube into the oesophagus rather than the trachea. Smoothly advance the tube until your marker reaches the nostril. Secure with tape. Using a bladder syringe gently withdraw an aspirate sample. Test the pH of this sample1. A pH of less than 5.5 confirms that the tube is in the stomach. If aspirate pH is greater than 5.5 or the patient is showing signs of respiratory distress remove the tube and begin again. Note:There are some limitations to the testing for gastric pH. Stomach pH can be affected by medications particularly proton pump inhibitors (e.g. Omeprazole, Lansoprazole, Pantoprazole) and H2 receptor antagonists (e.g. Cimetidine, Ranitidine, Nizatidine) or by dilution of gastric acid by feed. If you are unable to obtain aspirate and you think you might actually be in the stomach, secure the tape and re-aspirate in 10 minutes. If after 10 minutes you are still unable to obtain an aspirate, consideration to confirm placement with a chest XR should be made. Note: Using the bladder syringe to inject air down the tube whilst auscultating over the stomach is unreliable and should not therefore be….er….relied on. The NG tube must not be used to instil medication or fluid until absolute confirmation is obtained. Check tube security. Take time to well secure your tube. There are plenty of tapes designed specifically for securing them. Contraindications: Any suspected skull fractures (orogastric route must be used). Maxillofacial injuries or disorders. Recent oropharangeal surgery. Documentation: Once the procedure is complete, documentation should be made in the patient notes including: Size of the tube Length of the tube at the nose. pH of aspirate obtained to confirm placement. Any problems or issues during insertion.
Posted on: Thu, 03 Jul 2014 07:41:16 +0000
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