Hand Out For NGT

Submitted by: Cuerda, Roeder

Submitted to: Mrs. Julyn Marie Galardo RN.

NGT
Enteral feedings deliver nourishment through a tube directly into the GI tract. They’re ordered
for patients with a functioning GI tract who can’t ingest enough nutrition orally to meet their
needs. The feeding tube may stay in place as briefly as a few days or permanently, until the
patient’s death
Defining malnutrition

 People experiencing the physiologic stress of illness may have increased metabolic
demands with reduced capacity to take in nutrition. Prolonged calorie restriction can
lead to malnutrition.

 According to the Academy of Nutrition and Dietetics and the American Society for
Parenteral and Enteral Nutrition (A.S.P.E.N.), patients with at least two of the
following criteria are malnourished:

 insufficient energy intake

 weight loss

 muscle mass loss

 subcutaneous fat loss

 localized or generalized fluid accumulation that may mask weight loss

 diminished functional status as measured by handgrip strength.

 A nasogastric (NG) tube is a flexible plastic tube inserted through the nostrils, down
the nasopharynx, and into the stomach or the upper portion of the small intestine.
Placement of NG tubes is always confirmed with an X-ray prior to use (Perry, Potter, &
Ostendorf, 2014).

NG tubes are used to:

 Deliver nutrients to the patient via a feeding pump

 Remove gastric contents

 An NG tube used for feeding should be labelled. The tube is used to feed patients who
may have swallowing difficulties or require additional nutritional supplements These
tubes are narrower and smaller bored than a Salem sump or Levine tube.

 An NG tube can also remove gastric content, either draining the stomach by gravity or
by being connected to a suction pump.
  The NG tube is fastened to the patient using a nose clip, and is taped and pinned to
the patient’s gown to prevent accidental removal of the tube and to prevent the tube
from slipping from the stomach area into the lungs.

 When working with people who have nasogastric tubes, remember the following care
measures:

 Maintain and promote comfort.

 Because one nostril is blocked, patients tend to mouth breathe.

 If the patient complains of abdominal pain, discomfort, or nausea, or begins to vomit,

report it immediately. The drainage flow is probably obstructed and the tube will need
to be irrigated.

 These patients should never be allowed to lie completely flat. Lying flat increases the
patient’s risk of aspirating stomach contents.

Indications

 By inserting an NG tube, you are gaining an entry or direct connection to the stomach
and its contents. Therapeutic indications for NG intubation include:

 Gastric decompression. The nasogastric tube is connected to suction to facilitate

decompression by removing stomach contents. Gastric decompression is indicated for
bowel obstruction and paralytic ileus and when surgery is performed on the stomach
or intestine.

 Aspiration of gastric fluid content. Either for lavage or obtaining a specimen for
analysis. It will also allow for drainage or lavage in drug overdosage or poisoning.

 Feeding and administration of medication. Introducing a passage into the GI tract will
enable a feeding and administration of various medications. NG tubes can also be
used for enteral feeding initially.

 Prevention of vomiting and aspiration. In trauma settings, NG tubes can be used to aid
in the prevention of vomiting and aspiration, as well as for assessment of GI bleeding.

Contraindications

 Nasogastric intubation is contraindicated in the following:

  Recent nasal surgery and severe midface trauma. These two are the absolute
contraindications for NG intubation due to the possibility of inserting the tube
intracranially. An orogastric tube may be inserted, in this case.

 Other contraindications include: coagulation abnormality, esophageal varices, recent

banding of esophageal varices, and alkaline ingestion.

 As with most procedures, NG tube insertion is not all beneficial to the patient as
certain risks and complications are involved:

 Aspiration. The main complication of NG tube insertion include aspiration.

 Discomfort. A conscious patient may feel a little discomfort while the NG tube is
passed through the nostril and into the stomach which can induce gagging or
vomiting. A suction should always be present and ready to be used in this case.

 Trauma. The tube can injure the tissue inside the sinuses, throat, esophagus, or
stomach if not properly inserted.

Risks and Complications

 As with most procedures, NG tube insertion is not all beneficial to the patient as certain
risks and complications are involved:

 Aspiration. The main complication of NG tube insertion include aspiration.

 Discomfort. A conscious patient may feel a little discomfort while the NG tube is passed
through the nostril and into the stomach which can induce gagging or vomiting. A
suction should always be present and ready to be used in this case.

 Trauma. The tube can injure the tissue inside the sinuses, throat, esophagus, or
stomach if not properly inserted.

 Wrong placement. Unwanted scenarios such as wrong placement of an NG tube into

the lungs will allow food and medicine pass through it that may be fatal to the patient.

 Other complications include: abdominal cramping or swelling from feedings that are
too large, diarrhea, regurgitation of the food or medicine, a tube obstruction or
blockage, a tube perforation or tear, and tubes coming out of place and causing
additional complications
  An NG tube is meant to be used only for a short period of time. Prolonged use can lead
to conditions such as sinusitis, infections, and ulcerations on the tissue of your sinuses,
throat, esophagus, or stomach.

Nursing Considerations

 The following are the nursing considerations you should watch out for:

 Provide oral and skin care. Give mouth rinses and apply lubricant to the patient’s lips
and nostril. Using a water-soluble lubricant, lubricate the catheter until where it touches
the nostrils because the client’s nose may become irritated and dry.

 Verify NG tube placement. Always verify if the NG tube placed is in the stomach by
aspirating a small amount of stomach contents. An X-ray study is the best way to verify
placement.

 Wear gloves. Gloves must always be worn while starting an NG because potential
contact with the patient’s blood or body fluids increases especially with inexperienced
operator.

 Face and eye protection. On the other hand, face and eye protection may also be
considered if the risk for vomiting is high. Trauma protocol calls for all team members to
wear gloves, face and eye protection and gowns.

 Supplies and Equipment

 Gloves

 Nasogastric tube

 Water-soluble substance (K-Y jelly)

 Protective towel covering for client

 Emesis basin

 Tape for marking placement and securing tube

 Glass of water (if allowed)

 Straw for glass of water

 Stethoscope

 60-mL catheter tip syringe

  Rubber band and safety pin

 Suction equipment or tube feeding equipment

Position client upright or in full Fowler’s position if possible. Place a clean towel over the
client’s chest. Full Fowler’s position assists the client to swallow, for optimal neck-stomach
alignment and promotes peristalsis. A towel is used as a covering to protect bed linens and the
client’s gown.

 Measure tubing from bridge of nose to earlobe, then to the point halfway between
the end of the sternum and the navel. Mark this spot with a small piece of temporary
tape or note the distance. Each client will have a slightly different terminal insertion
point. Measurements must be made for each individual’s anatomy.

 Examine nostrils for deformity or obstruction by closing one nostril and then the other
and asking the client to breathe through the nose for each attempt. If the client has
difficulty breathing out of one nostril, try to insert the NG tube in that one. The client
may breathe more comfortably if the “good” nostril remains patent.The blocked nasal
passage may not be totally occluded and thus you may still be able to pass an NG tube.
It may be necessary to use the more patent nostril for insertion.

 Flex the client’s head forward, tilt the tip of the nose upward and pass the tube gently
into the nose to as far as the back of the throat. Guide the tube straight back. Flexing
the head aids in the anatomic insertion of the tube.The tube is less likely to pass into
the trachea.

 Instruct the client to swallow as the tube advances. Advance the tube until the correct
marked position on the tube is reached. Encourage the client to breathe through his
mouth. Swallowing of small sips of water may enhance passage of tube into the
stomach rather than the trachea.

 If changes occur in patient’s respiratory status, if tube coils in mouth, if the patient
begins to cough or turns cyanotic, withdraw the tube immediately. The tube may be in
the trachea.

 If obstruction is felt, pull out the tube and try the other nostril.

Check tube placement with these methods. Check the tube for correct placement by at least
two and preferably three of the following methods:

 A. Aspirate stomach contents. .

  B. Check pH of aspirate. Measuring the pH of stomach aspirate is considered more
accurate than visual inspection. Stomach aspirate generally has a pH range of 0 to 4,
commonly less than 4. The aspirate of respiratory contents is generally more alkaline,
with a pH of 7 or more.

 C. Inject 30 mL of air into the stomach and listen with the stethoscope for the
“whoosh” of air into the stomach. The small diameter of some NG tubes may make it
difficult to hear air entering the stomach.

 D. Confirm by x-ray placement. X-ray visualization is the only method that is considered
positive.

 https://www.nursingtimes.net/clinical-archive/gastroenterology/nasogastric-tubes-1-
insertion-technique-and-con

 https://www.americannursetoday.com/enteral-feeding-indications-complications-and-
nursing-care/firming-position/5000781.article

https://opentextbc.ca/clinicalskills/chapter/10-2-nasogastric-tubes