INSERTION OF A NASOGASTRIC TUBE

Question 1

What are the primary indications for NG tube insertion?

Answer 1

Feeding, medication delivery, removal of gastric contents, diagnostic, and therapeutic purposes.

Question 2

When is an NG tube indicated for feeding?

Answer 2

When a person is malnourished or at risk of malnutrition with inadequate or unsafe oral intake and a functional GI tract.

Question 3

Give examples of conditions where NG tube feeding may be necessary.

Answer 3

Neurological conditions causing dysphagia, lowered consciousness, or post-operative GI surgery.

Question 4

How is an NG tube used for medication delivery?

Answer 4

Certain medications are delivered directly into the stomach if oral intake is inadequate or unsafe.

Question 5

What are some indications for using an NG tube to remove gastric contents?

Answer 5

Gastric decompression in intubated patients, symptom relief in bowel obstruction, and aspiration of ingested toxins.

Question 6

List diagnostic uses for an NG tube.

Answer 6

Investigating suspected upper GI bleed, aspirating gastric fluid, and administering radiographic contrast.

Question 7

What are therapeutic uses for an NG tube?

Answer 7

Decompressing a distended stomach, preventing aspiration during surgery, nutritional support, GI lavage, and administering medications.

Question 8

What are contraindications for NG tube insertion?

Answer 8

Patient refusal, severe facial trauma, recent nasal or sinus surgery, esophageal or nasal obstructions, bleeding tendencies, and esophageal varices.

Question 9

Why is patient preparation important for NG tube insertion?

Answer 9

To ensure patient safety, comfort, and the effectiveness of the procedure.

Question 10

List the documentation required for NG tube insertion.

Answer 10

Patient notes should include tube size, insertion depth, complications, and placement confirmation method.

Question 11

What equipment is necessary for NG tube insertion?

Answer 11

Non-sterile gloves, linen saver, NG drainage bag, tube, lubricant, syringe, stethoscope, pH litmus paper, tape, emesis basin, water, straw, and suction equipment.

Question 12

How should the patient be positioned for NG tube insertion?

Answer 12

Sit the patient up at a 45° angle with neck flexed forward.

Question 13

How is the NG tube insertion depth determined?

Answer 13

Measure from the nose tip to the earlobe and down to the xiphoid process.

Question 14

What is the first procedural step in NG tube insertion?

Answer 14

Perform hand hygiene and put on non-sterile gloves.

Question 15

What should be placed on the patient before inserting the NG tube?

Answer 15

A linen saver on the chest and an emesis basin for any potential vomit.

Question 16

How should the NG tube be prepared before insertion?

Answer 16

Lubricate the tip with a water-based lubricant like KY jelly

Question 16

Why is it important to inspect the patient’s nostrils?

Answer 16

To ensure there are no obstructions that could hinder tube insertion.

Question 17

What direction should the NG tube be aimed during insertion?

Answer 17

Aim downward and backward toward the opposite ear.

Question 18

Through which nostril should the NG tube be inserted?

Answer 18

Use the most open nostril and insert horizontally.

Question 19

What should the patient do when the NG tube reaches the pharynx?

Answer 19

Flex their head forward and swallow or sip water if allowed.

Question 20

When should you stop advancing the NG tube?

Answer 20

When the tube reaches the pre-measured insertion depth mark.

Question 21

How can you confirm the correct placement of the NG tube?

Answer 21

By chest X-ray, aspirating gastric content for pH, or auscultating the epigastrium with injected air.

Question 22

How should the NG tube be secured?

Answer 22

Secure with tape at the nostril and cheek, ensuring no pressure on the nostril.

Question 23

What are some risks associated with NG tube insertion?

Answer 23

Bodily fluid exposure, trauma, tracheal intubation, nosebleeds, esophageal perforation, and aspiration.

Question 24

What post-procedural considerations should be documented?

Answer 24

Document tube size, insertion depth, complications, and placement confirmation method.

Question 25

What are potential gastrointestinal complications of NG tube insertion?

Answer 25

Mispositioning, coiling or knotting of the tube, reflux leading to esophagitis, strictures, bleeding, or pulmonary aspiration.

Question 26

How can an NG tube cause gastritis or gastric bleeding?

Answer 26

Through chronic irritation or pressure necrosis from the tube against gastric tissues.

Question 26

What pulmonary complications can arise from NG tube insertion?

Answer 26

Aspiration pneumonia, lung abscess, tracheal perforation, or pneumothorax.

Question 27

What intracranial complications can result from NG tube insertion?

Answer 27

Intracranial intubation in cases of maxillofacial trauma or cribiform plate perforation.

Question 27

What nasal complications may occur due to NG tube insertion?

Answer 27

Alar ulcer, necrosis, epistaxis, and discomfort, especially if there is trauma to the nasopharynx.

Question 28

Why might a patient with esophageal varices be at risk during NG tube insertion?

Answer 28

Due to the risk of bleeding, as the varices can be traumatized by the tube.

Question 29

For which condition is an NG tube indicated to provide symptom relief through "drip and suck" management?

Answer 29

Bowel obstruction, to relieve symptoms and allow bowel rest.

Question 30

In what cases might an NG tube be indicated for diagnostic purposes?

Answer 30

Suspected upper GI bleed, obstruction, or aspiration of gastric fluid for testing.

Question 31

Name two neuromuscular conditions where NG feeding may be required.

Answer 31

Stroke (CVA) and multiple sclerosis, both of which may impair safe swallowing.

Question 32

Why is NG feeding sometimes necessary in cancer or sepsis patients?

Answer 32

These conditions can cause physiological anorexia, leading to insufficient oral intake.

Question 33

What GI dysfunctions may indicate the need for NG feeding?

Answer 33

Dysmotility, inflammatory bowel disease, or reduced bowel length, which impact nutrient absorption.

Question 34

Why might a patient with burns have increased nutritional requirements necessitating NG feeding?

Answer 34

Burns increase the body's caloric needs for healing, which may be unmet through oral intake alone.

Question 35

How can an NG tube prevent aspiration during surgery?

Answer 35

By decompressing the stomach and removing contents that might otherwise be aspirated.

Question 36

What specific psychological condition might require NG feeding?

Answer 36

Anorexia nervosa, where severe dietary restrictions could lead to malnutrition.

Question 37

What complication might occur if the NG tube impairs the lower esophageal sphincter?

Answer 37

Reflux, which could lead to esophagitis, strictures, upper GI bleeding, or pulmonary aspiration.