Week 12: Nasogastric Tube (NG Tube)

Question 1

Air Vent

Answer 1

a device or aperture that allows the entry or exit of air; on a NG tube, a branch of the main tube that is always open to the air, providing continuous atmospheric air irrigation

Question 2

Anti-reflux valve

Answer 2

a device that can also be inserted into a lumen of some types of NG tubes to prevent the seepage of gastric contents out of the vented lumen

Question 3

Aspiration

Answer 3

inadvertent inhalation of fluid or other substances into the lungs; also, the withdrawal or removal, via a syringe or other apparatus, of a substance or material from the body

Question 4

Decompression

Answer 4

removal of stomach contents to relieve distention of the stomach and intestines caused by the accumulation of gastrointestinal air and fluid

Question 5

Epiglottis

Answer 5

the lid-like cartilaginous structure overhanging the entrance to the larynx and preventing food from entering the larynx and the trachea during swallowing

Question 6

Esophagitis

Answer 6

inflammation of the esophagus

Question 7

Esophagus

Answer 7

the musculomembranous passage extending from the pharynx to the stomach

Question 8

Flatus

Answer 8

gas or air generated in the stomach and/or intestines and expelled via the anus

Question 9

Ileus

Answer 9

mechanical or functional obstruction of the intestines

Question 10

Irrigant

Answer 10

a solution used for therapeutic irrigation or washing out of a body cavity or part

Question 11

Lavage

Answer 11

therapeutic irrigation or washing out of a body cavity or part

Question 12

lipid pneumonia

Answer 12

lung inflammation that develops when fat particles enter the bronchial tree

Question 13

lumen

Answer 13

a cavity or bore of a tubular organ or part

Question 14

Methemoglobinemia

Answer 14

the presence of excessive methemoglobin (a non-oxygen carrying pigment) in the blood

Question 15

Parotid glands

Answer 15

two salivary secreting organs located on either side of the face just below and in front of the ears

Question 16

Patency

Answer 16

state of being open or unobstructed

Question 17

Peristalsis

Answer 17

the waves of contraction that propel contents through the GI tract

Question 18

Uvula

Answer 18

the small, fleshy mass hanging from the soft palate above the root of the tongue

Question 19

Pre-procedure for Inserting an NG tube

Answer 19

• check providers orders and patients care plan
• assess relevant diagnostic data such as coagulation studies and verify patients history
• explain purpose of tube placement to the patient and let them know that discomfort is likely as the tube passes; agree on a signal the patient can use if she wants you to stop briefly during procedure
• inspect each naris for patency; note polyps, irritated mucosa, or other problems that may complicate insertion; select more patent naris
• test patients gag reflex if you plan to use water during procedure
• patient may experience nausea as tube passes down the back of the throat; be sure to have suction equipment incase of vomiting
• place patient in high-fowlers position and drape a towel or disposable pad across chest to protect clothing and linen
• if prescribed, a topical anesthetic is used before inserting to provide pain relief, reduce risk of nausea + vomiting, and promote successful passage of NG tube

Question 20

What position should you place the patient before insertion?

Answer 20

high-fowlers

Question 21

How to select the more patent naris?

Answer 21

have patient breathe through one naris at a time

Question 22

Patients at high risk for complications?

Answer 22

-history of craniofacial surgery or trauma

>may require special insertion technique or equipment (fluoroscopy)

Question 23

What is used to eliminate sensation in the nasal mucosa?

Answer 23

lidocaine gel

• sniff and swallow medication
• 5 to 10 minutes for effectiveness
• can be given by nebulizer via face mask
• to minimize allergic reactions, a preservative-free lidocaine (IV lidocaine) can be prescribed
• having the patient hold ice chips in mouth can have similar effect; after anesthetizing mucosa, prepare equipment for nasal intubation

Question 24

How to determine the length of tube?

Answer 24

measuring NG tube from the tip of the patients nose, to the tip of the patients ear, then to the xiphoid process of the sternum

• mark the tubing with adhesive tape or note the striped markings already on the tube
• when using a dual purpose tube, add 10 to 12 inches to allow reach for duodenum or jejunum

Question 25

Purpose of a dual purpose tube

Answer 25

used for gastric decompression and one for enteral feeding

Question 26

Inserting a NG tube

Answer 26

- lubricate the tip of the tube with water-soluble lubricant - encourage to breathe deeply through her mouth - gently insert the tube into the nostril and advance it toward the posterior pharynx - have the patient tilt her head forward and encourage her to drink water slowly; advance the tube without using force as the patient swallows until the desired tube length is inserted - temporarily tape the tube to the patients nose, then assess tube placement via radiographically (x-ray), or pH testing depending on protocol

Question 27

What to do if the patient experiences respiratory distress, is unable to speak, has significant nasal bleeding, or if the tube meets resistance?

Answer 27

stop advancing the tube and withdraw it

Question 28

Gold standard for tube placement confirmation?

Answer 28

radiographic confirmation (x-ray)

Question 29

Determine the placement by pH

Answer 29

by aspirating fluid from the tube at the time of insertion and testing pH - if pH is 0 to 5, the tube is most likely in the stomach - you can auscultate air over the stomach if the tube is inserted in the lung

Question 30

What to do after confirming placement of the tube?

Answer 30

apply a skin barrier and then secure the tube by taping it to the bridge of the patients nose or a tube attachment device -anchor tube to gown -clamp end of tube or attach it to suction >if tube has multiple lumens, label each lumen according to its use -ensure patient comfort

Question 31

NG tube purpose

Answer 31

- decompress the stomach and remove gas and fluid - lavage the stomach to remove ingested toxins other than poison - to diagnose problems with gastrointestinal motility and other disorders - to treat an obstruction - to compress a bleeding site when endoscopy is not immediately available - aspirate contents for analysis - administer radiographic contrast media to the GI tract - administer feedings and medications if necessary

Question 32

Gastric Decompression

Answer 32

stomach contents are removed to relieve the stomach and intestines of pressure caused by the accumulation of gastrointestinal air and fluid >the NG tube is connected to suction to facilitate decompression by removing stomach contents >indicated for bowel obstruction and paralytic ileus and when surgery is performed on the stomach or intestine

Question 33

How long does the NG tube usually stay in place?

Answer 33

until normal bowel function resumes | -e/b active bowel sounds on auscultation and/or when the patient is able to pass flatus

Question 34

Gastric Lavage

Answer 34

irrigation of the stomach -performed in acute care settings -in cases of drug overdose for which swift removal of stomach contents is required >in this case, an orogastric or nasogastric tube is inserted to aspirate gastric contents or to administer activated charcoal -may also be used as therapy for hypo or hyperthermia to help stabilize body temperature

Question 35

Types of Tubes

Answer 35

- Large Bore Tubes - Double-Lumen (two channeled) gastric (Salem) sump tube - Single-lumen (Levin) tube - Dual purpose tube - Sengstaken-Blakemore tube

Question 36

Large-Bore Tube

Answer 36

14 to 22 French - used for gastric lavage, aspiration, and decompression ex: orogastric tubes (e.g. Ewald); are large bore tubes with wide proximal outlets for removing gastric contents and are primarily used in emergency departments and intensive care units

Question 37

Double-lumen (two-channeled) gastric (Salem) sump tube

Answer 37

most common nasogastric tube - 14 to 18 French; length of 120 cm( 48 inches) - used for irrigating the stomach but is most often used for drawing out fluid and gas from the stomach - preferred tube for gastric decompression - can be used for continuous suction

Question 38

How to use the Double lumen (two-channeled) gastric (Salem) sump tube

Answer 38

connect larger lumen to suction and collect the aspirated gastric contents in a drainage container - the smaller lumen terminates in a blue vent or "pigtail"; vents the larger suction-drainage tube to the atmosphere via an opening at the distal end of the tube; the blue vent is always open to the air, providing continuous atmospheric air irrigation - a one-way anti-reflux valve can also be inserted into the blue "pigtail" to prevent reflux of gastric contents out of the vent lumen - to prevent reflux, keep the tube above the patients waist - markings along the length of the tube serve as a guide for depth of insertion - when irrigating the large lumen, inject 20 mL of air into blue vent to re-establish a buffer of air between the gastric contents and the vent; never clamp off the air vent, connect it to suction, or use it for irrigation

Question 39

How to prevent reflux with a nasogastric tube?

Answer 39

keep the tube above the patients waist

Question 40

Single lumen (Levin) tube

Answer 40

nasogastric tube - 14 to 18 French - made of plastic or rubber with several drainage holes near the gastric end of tube - used for: decompressing the stomach, withdrawing specimens for diagnostic analysis, washing the stomach free of toxic substances other than poison, and for irrigating the stomach to diagnose and treat upper GI bleeding during emergencies when endoscopy is not immediately available - also for medications and feedings - connected to low intermittent suction (25 mmHg) to avoid erosion or tearing of the stomach lining, which can result from constant adherence of the tubes lumen to the mucosal lining of the stomach

Question 41

Dual-purpose: >Nasoenteric (Keofeed, Moss, Dobbhoff) >Nasojejunal (Miller-Abott)

Answer 41

provide simultaneous gastric suction and enteral feeding - inserted nasally and extend into duodenum or jejunum - allow for removal of excess feeding formula from the stomach, reducing reflux - used short-term, primarily undergoing surgery

Question 42

Sengstaken-Blakemore tube

Answer 42

3 lumen tube - used to treat upper gastrointestinal bleeding from esophageal varices when endoscopy is not available - made of rubber; has 2 lumens used to inflate the gastric and esophageal balloons, with one reserved for gastric suction or drainage - orally or nasally, and endotracheal intubation is strongly advised to secure the airway before insertion - temporary measure for treating upper GI bleeding and reserved for emergency setting when endoscopy is not immediately available

Question 43

Contraindications to NG tubes

Answer 43

severe midface trauma, recent nasal surgery, and esophageal peforation

Question 44

Higher risk for complications

Answer 44

head trauma or brain surgery, deviated septum, esophageal varices or strictures, recent banding or cautery of esophageal varices, coagulation abnormalities, alkaline ingestion, or nasal polyps

Question 45

Maintaining Gastric Decompression

Answer 45

- before irrigating, assess tube placement by verifying the marking on the tube at the level of the naris or by measuring the external tube length and comparing to what is documented - check aspiration pH - measure amount of irrigant in a 60 mL syringe (usually 20 to 30 mL of tap water, sterile water, or normal saline) - disconnect the proximal end of the NG tube from the distal end of the suction tube over a towel or disposable pad - slowly instill irrigant into NG tube - reconnect tub to suction - when using gastric sump tube, irrigate air vent with 20 mL of air to re-establish a buffer between gastric contents and vent

Question 46

What to do before irrigating a tube?

Answer 46

assess tube placement by verifying the marking on the tube at the level of the naris or by measuring the external tube length and comparing it to what is documented - check aspiration pH - measure amount of irrigant in a 60 mL syringe (usually 20 to 30 mL of tap water, sterile water, or normal saline)