NASOGASTRIC TUBE INSERTION

INDICATIONS:

By inserting a nasogastric tube, you are gaining access to the stomach and its contents. This
enables you to drain gastric contents, decompress the stomach, obtain a specimen of the gastric
contents, or introduce a passage into the GI tract. This will allow you to treat gastric immobility,
and bowel obstruction. It will also allow for drainage and/or lavage in drug overdosage or
poisoning. 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. NG tubes can also be used for enteral
feeding initially.

CONTRAINDICATION:

Nasogastric tubes are contraindicated in the presence of severe facial trauma 

(cribriform plate disruption), due to the possibility of inserting the tube intracranially. In this
instance, an orogastric tube may be inserted.

COMPLICATIONS:

The main complications of NG tube insertion include aspiration and tissue trauma. Placement of
the catheter can induce gagging or vomiting, therefore suction should always be ready to use in
the case of this happening.

UNIVERSAL PRECAUTIONS:

The potential for contact with a patient's blood/body fluids while starting an NG is present and
increases with the inexperience of the operator. Gloves must be worn while starting an NG; and
if the risk of vomiting is high, the operator should consider face and eye protection as well as a
gown. Trauma protocol calls for all team members to wear gloves, face and eye protection and
gowns.

EQUIPMENTS:

All necessary equipment should be prepared, assembled and available at the bedside prior to
starting the NG tube. Basic equipment includes:

Personal protective equipment

NG/OG tube
Catheter tip irrigation 60ml syringe
Water-soluble lubricant, preferably 2% Xylocaine jelly
Adhesive tape
Low powered suction device OR Drainage bag
Stethoscope 
Cup of water (if necessary)/ ice chips
Emesis basin
pH indicator strips

PROCEDURES:

1. Gather equipment

2. Don non-sterile gloves

3. Explain the procedure to the patient and show equipment

4. If possible, sit patient upright for optimal neck/stomach alignment 

5. Examine nostrils for deformity/obstructions to determine best side for insertion

6. Measure tubing from bridge of nose to earlobe, then to the point halfway between the end
of the sternum and the navel

7. Mark measured length with a marker or note the distance

8. Lubricate 2-4 inches of tube with lubricant (preferably 2% Xylocaine). This procedure is
very uncomfortable for many patients, so a squirt of Xylocaine jelly in the nostril, and a
spray of Xylocaine to the back of the throat will help alleviate the discomfort.

9. Pass tube via either nare posteriorly, past the pharynx into the esophagus and 
then the stomach.

Instruct the patient to swallow (you may offer ice chips/water) and advance the tube as
the patient swallows. Swallowing of small sips of water may enhance passage of tube
into esophagus.

If resistance is met, rotate tube slowly with downward advancement toward closes ear.
Do not force.

10. Withdraw tube immediately if changes occur in patient's respiratory status, if 
tube coils in mouth, if the patient begins to cough or turns pretty colours

11. Advance tube until mark is reached

12. Check for placement by attaching syringe to free end of the tube, aspirate sample of
gastric contents. Do not inject an air bolus, as the best practice is to test the pH of the
aspirated contents to ensure that the contents are acidic. The pH should be below 6.
Obtain an x-ray to verify placement before instilling any feedings/medications or if you
have concerns about the placement of the tube.

13. Secure tube with tape or commercially prepared tube holder

 14. If for suction, remove syringe from free end of tube; connect to suction; set machine on
type of suction and pressure as prescribed. 

15. Document the reason for the tube insertion, type & size of tube, the nature and amount of
aspirate, the type of suction and pressure setting if for suction, the nature and amount of
drainage, and the effectiveness of the intervention.

NASOGASTRIC TUBE REMOVAL

OBJECTIVE: To check if the patient can tolerate oral feeding.

CONTRAINDICATION: Continuing need for feeding/suction.

AFTER CARE:

a. Discard the disposable equipment used.

b. Wash your hands.

c. Position the patient in a comfortable or in his desired position.

CHARTING:

a. Record date of removal of nasogastric tube.

b. Record client’s response.

c. Record measurement of drainage.

NURSING ALERT: Removal is easier with the patient in semi-Fowler’s position.

EQUIPMENT:

1. Tissues

2. Plastic disposable bag

3. Bath towel or disposable pad

4. Clean disposable glove

ACTION

1. Check physician’s order for removal of nasogastric tube.

Rationale: Ensures correct implementation of physician’s order.

2. Explain procedure to client.

Rationale: Explanation facilitates client cooperation..

3. Gather equipment.

Rationale: Provides for organized approach to task.

4. Wash your hands. Don clean disposable glove on hand that will remove tube.

Rationale: Handwashing deters the spread of microorganisms. Gloves protect hand from contact
with abdominal secretions.

5. Discontinue suction and separate tube from suction. Unpin tube from cleint’s gown and
carefully remove adhesive tape from bridge of nose.

Rationale: Allows for unrestricted removal of nasogastric tube.

6. Place towel or disposable pad across client’s chest. Hand tissues to client.

Rationale: Protects client from contact with gastric secretions. Tissues are necessary if client
wishes to blow his nose when tube is removed.

7. Instruct client to take a deep breath and hold it.

Rationale: Prevents accidental aspiration of any gastric secretions in tube.

8 Clamp tube with fingers. Quickly and carefully remove tube while client holds his breath.

Rationale: Minimizes trauma and discomfort for client. Clamping prevents any drainage of
gastric contents in tube.

9 Place tube in disposable plastic bag. Remove glove and place in bag.

Rationale: Prevents contamination with any microorganisms.

10. Offer mouth care to client and make client feel comfortable.

Rationale: Provides comfort.

11. Measure nasogastric drainage. Remove all equipment and dispose according to agency
policy. Wash your hands.

Rationale: Measuring nasogastric drainage provides for accurate recording of output. Proper
disposal deters spread of microorganisms.

12. Record removal of nasogastric tube, client’s response, and measurement of drainage.

Rationale: Facilitates documentation and provides for comprehensive care.

BASIC WOUND CARE

PROCEDURES:

* Remove the soiled dressing. Roll or lift an edge of the dressing, then gently remove it while
supporting the surrounding skin. When possible, remove the dressing in the direction of hair
growth.

* Inspect the dressing and wound. Note the color, amount, and odor of drainage and necrotic
debris.

* Clean the wound. Moisten gauze pads either by dipping the pads in wound cleaning solution
and wringing out excess or by using a spray bottle to apply solution to the gauze. Move from the
least contaminated area to the most contaminated area and use a clean gauze pad for each wipe.
To clean a linear-shaped wound, such as an incision, gently wipe from top to bottom in one
motion, starting directly over the wound and moving outward. For an open wound, such as a
pressure ulcer, gently wipe in concentric circles, starting directly over the wound and moving
outward (see Wound cleaning techniques).

The type of cleaning agent you'll use depends on the wound type and characteristics. Sterile
0.9% sodium chloride solution is the most commonly used cleaning agent. It provides a moist
environment, promotes granulation tissue formation, and causes minimal fluid shifts in healthy
adults. Antiseptic solutions, such as chlorhexidine, povidone-iodine, and hydrogen peroxide, are
sometimes used to clean infected or newly contaminated wounds. Be aware that antiseptic
solutions may damage healthy tissue and delay wound healing.

* Dry the wound. Using the same procedure as for cleaning a wound, dry the wound using dry
gauze pads.

* Reassess the condition of the skin and wound. Note the character of the clean wound bed and
surrounding skin.

* Pack or dress the wound as ordered. See Choosing a dressing for questions you can ask
yourself to find the ideal dressing for your patient's wound.

Got the basics covered.

For an open wound (such as a pressure ulcer), gently wipe in concentric circles, starting
directly over the wound and moving outward.

Choosing a dressing

To confirm that you've chosen the proper dressing, answer these questions.
* Does the dressing protect the wound from secondary infection?

* Does it provide a moist wound-healing environment?

* Does it provide thermal insulation?

* Can it be removed without causing trauma to the wound?

* Does it remove drainage and debris?

* Is it free from particles and toxic products?

Basic wound care centers on cleaning and dressing the wound.

DEE HWA LIONG COLLEGE FOUNDATION
SAPANG MAISAC, DUQUIT, MABALACAT PAMPANGA

IN PARTIAL FULFILLMENT IN NCM 105

RELATED LEARNING EXPERIENCE

“NASOGASTRIC TUBE INSERTION AND

REMOVAL”

SUBMITTED BY:

MANITI, CHARMAINE H.

BSN IV-B/ GROUP 5

SUBMITTED TO:

JERRY VILLAPANIA R.N;MAN

CLINICAL INSTRUCTOR
DEE HWA LIONG COLLEGE FOUNDATION
SAPANG MAISAC, DUQUIT, MABALACAT PAMPANGA

IN PARTIAL FULFILLMENT IN NCM 105

RELATED LEARNING EXPERIENCE

“BASIC WOUND CARE PROCEDURES”

SUBMITTED BY:

LAPUZ, XYRHOST

CUYUGAN, RALPH HERVER

BSN IV-B/ GROUP 5

SUBMITTED TO:

JERRY VILLAPANIA R.N;MAN

CLINICAL INSTRUCTOR