NASOGASTRIC TUBE Purposes1. To decompress stomach by removing fluids and/or gas to promote abdominal comfort 2. To allow surgical anastamoses to heal without distention 3. To decrease risk of aspiration 4. To administer medications to clients who are unable to swallow 5. To provide nutrition by acting as a temporary feeding tube 6. To irrigate the stomach and remove toxic y Place patient in a High Fowlers position y Measure: NEX (usually 22-26 inches for adults) 22y y y y y y y y plus 2 inches for tall patients. Lubricate with water soluble Ask the client to hyperextend the neck, advancing the tube toward the nasopharynx Instruct client to tilt the head forward when the tube is felt in the oropharynx(throat) Offer small sips of water from a glass with straw and encourage to swallow Stop if the patient gags, wait for few min. before proceeding Withdraw if gagging continues Assess for correct placement by: y Check pH: should be less than 4.0 y Inserting 5-10 ml of air into a stethoscope placed over the stomach and listen for a swooshing sound y Taking X-ray: MOST RELIABLE METHOD Secure tube to the bridge of the nose with tape and to the gown y Usually up to 2 weeks use only (short term) y Clean but not sterile procedure y Mouth care needed y Report coffee ground material (digested blood) y Check for placement and patency y Clamp tube when ambulating y Hold feeding if >50% residual from previous hour (adults) or >25% (children) y Flush tube with water before and after feeding y Use pump to control rate of tube feeding y Administer fluid at room temperature y Change bag Q8 hours for continuous feeding y Elevate head of bed while feeding is running Nasogastric Tubes: Linton-Nachlas 4-lumen, used for bleeding esophageal varices Keofeed/Dobhoff soft silicone, used for long-term feedings LEVIN TUBE - Single lumen Example Key Points of Use Inserted Any Low into stomach abdominal or intermittent to other sx after suction decompress which Irrigate prn by removing peristalsis is with NSS gastric absent for a contents and few days air GI hemorrhage Used for feeding when CA of the unable to esophagus swallow Early postop for pt who Purpose Example of Key Points Use Same as With Gastric SALEM decompress levin tube continuous SUMP suction ion with continuous (25mmHg) - Double If leak lumen air suction occurs in vented tube the vent to provide (blue constant tubing), inflow of instill 30 ml athmospheric air, air into vent and to and irrigate Purpose NG Irrigation Tubing: y Verify placement of tube y Insert 30-50 cc of normal saline into tube 30y If feel resistance, change patient position, check for kinks y Withdraw solution or record amount as input NG removal: y Clamp tube y Remove tape y Instruct patient to exhale y Remove tube with smooth, continuous pull LAVAGE TUBES Example of Key Points Use LAVACUA Orogastric Ingestion of Continuous TOR w/ large poison suction suction Irrigation lumen and solution smaller enters the lavage vent lavage lumen Removes while toxic stomach substances contents are from removed stomach through the Purpose What is the position of the patient when inserting the NGT? y Low Fowler s position y Semi-Fowler s position y Trendelenberg position y High Fowler s position What is the position of the patient when inserting the NGT? y Low Fowler s position y Semi-Fowler s position y Trendelenberg position y High Fowler s position Rationale: D Nurse Quick Check Skills 320 How do you measure the length of the NGT before inserting it to the patient? y From the earlobe to the xiphoid process to the tip of the nose y From the xiphoid process to the tip of the nose to the earlobe y From the tip of the nose to the xiphoid process to the earlobe y From the tip of the nose to the earlobe to the xiphoid process How do you measure the length of the NGT before inserting it to the patient? y From the earlobe to the xiphoid process to the tip of the nose y From the xiphoid process to the tip of the nose to the earlobe y From the tip of the nose to the xiphoid process to the earlobe y From the tip of the nose to the earlobe to the xiphoid process y Rationale: D Nurse Quick Check Skills 320 What is the initial thing to do when administering a drug to a client with NGT? y Wash your hands y Put on gloves y Verify the order y Explain the procedure the client What is the initial thing to do when administering a drug to a client with NGT? y Wash your hands y Put on gloves y Verify the order y Explain the procedure the client y Rationale: C Nurse Quick Check Skills 318 What is the important thing that you should advice a client when inserting the NGT? y Don t move y Hold your breathe y Swallow y Cough What is the important thing that you should advice a client when inserting the NGT? y Don t move y Hold your breathe y Swallow y Cough y Rationale: C Nurse Quick Check Skills 320 To minimize esophageal reflux what is the recommended position of the client? y Flat in bed with head slightly elevated y Right lateral position with head slightly elevated y Left lateral position with head slightly elevated y High fowler s position To minimize esophageal reflux what is the recommended position of the client? y Flat in bed with head slightly elevated y Right lateral position with head slightly elevated y Left lateral position with head slightly elevated y High fowler s position What is the best way to verify the position of the NGT? y Auscultating air y Aspirate gastric content y X-ray y Place the end of the tube in the container with water. What is the best way to verify the position of the NGT? y Auscultating air y Aspirate gastric content y X-ray y Place the end of the tube in the container with water. y Rationale: C Nurse Quick Check Skills 321 What is the measurement of the NGT to a child or to an infant? y 14 to 18 French y 5 to 10 French y 21 to 25 French y 11 to 13 French What is the measurement of the NGT to a child or to an infant? y 14 to 18 French y 5 to 10 French y 21 to 25 French y 11 to 13 French y Rationale: B Delmar s Fundamentals and Advance Nursing Skills Second Edition 715 A 70 year old client with a Nasogastric tube (NGT) was given a continuous feeding. What position will the nurse place the client at all times? y Side Lying y Semi Fowler s y High Fowler s y Prone A 70 year old client with a Nasogastric tube (NGT) was given a continuous feeding. What position will the nurse place the client at all times? y Side Lying y Semi Fowler s y High Fowler s y Prone y Answer: B Saunders 4th Edition Pg.252 A client asks the nurse what is the purpose of having a Nasogastric tube. The nurse knows that the purpose of NGT is: prioritize y To irrigate the stomach y To decrease the risk for aspiration y To provide nutrition y To decompress the stomach Order the above according to prioritization: A client asks the nurse what is the purpose of having a Nasogastric tube. The nurse knows that the purpose of NGT is: prioritize 1. To decompress the stomach 2. To provide nutrition 3. To decrease the risk for aspiration 4. To irrigate the stomach Order the above according to prioritization: y Answer: DCBA Saunders 4th Edition While assessing the client s doublelumen NGT the nurse noticed a leakage through the air vent. What should the nurse initially do? y Clamp the lumen y Call the physician y Irrigate the main lumen with tap water y Instill 30 ml of water into the air vent While assessing the client s doublelumen NGT the nurse noticed a leakage through the air vent. What should the nurse initially do? y Clamp the lumen y Call the physician y Irrigate the main lumen with tap water y Instill 30 ml of water into the air vent y Answer: D Saunders 4th Edition Pg.252 Which of the following action/s is/are correct in NGT irrigation: y Instill 20-30mL of water or NS with an irrigation syringe y Instill 30-50mL of water or NS with an irrigation syringe y Perform irrigation every 8 hours to assess patency of the tube y Pull back on the syringe plunger to withdraw fluid, repeat if the tube flow is sluggish Which of the following action/s is/are correct in NGT irrigation: y Instill 20-30mL of water or NS with an irrigation syringe y Perform Instill 30-50mL of water or NS with an irrigation syringe y irrigation every 8 hours to assess patency of the tube ---every 4 hours y Pull back on the syringe plunger to withdraw fluid, repeat if the tube flow is sluggish y Answer: BD Saunders 4th Edition Pg.252 The nurse is about to give a bolus feeding to a client, what will indicate the nurse to withhold the feeding? y Residual amount of 100mL y Residual amount of 120mL y pH measuring 3.5 y pH measuring 2.5 The nurse is about to give a bolus feeding to a client, what will indicate the nurse to withhold the feeding? y Residual amount of 100mL y Residual amount of 120mL y pH measuring 3.5 y pH measuring 2.5 y Answer: A Saunders 4th Edition Pg.252-254 Which of the following actions are correct in NGT insertion to a 2 year old client: y Place the infant in an infant seat or position the client with rolled towel or pillow under the head and shoulders y Do not hyperextend or hyper flex the patients neck y Restrain can be use during tube insertion y Tape the tube to the area between the Which of the following actions are correct in NGT insertion to a 2 year old client: y Place the infant in an infant seat or position the client with rolled towel or pillow under the head and shoulders y Do not hyperextend or hyper flex the patients neck y Restrain can be use during tube insertion y Tape the tube to the area between the end of the nares and upper lip as well as to the cheek In NGT insertion, the neck should be: y Extended y Hyperextended y On the side y Neutral position In NGT insertion, the neck should be: y Extended y Hyperextended y On the side y Neutral position Answer: B Hyperextension of the neck reduces the curvature of the nasopharyngeal junction --Fundamentals of Nursing 7th Ed. Pg.1206 While inserting a Nasogastric tube to an adult client, the client begins to have difficulty of breathing. What is the most appropriate nursing action? y Notify the physician y Continue to insert the tube y Remove the tube and reinsert immediately y Immediately withdraw and wait until DOB subsides While inserting a Nasogastric tube to an adult client, the client begins to have difficulty of breathing. What is the most appropriate nursing action? y Notify the physician y Continue to insert the tube y Remove the tube and reinsert immediately y Immediately withdraw and wait until DOB subsides A prioritize nursing diagnosis to a client receiving tube feeding is: y Risk for deficient fluid volume related to hypertonic dehydration y Deficient knowledge about home tube feeding regimen y Imbalanced Nutrition: Less than body requirements y Risk for diarrhea related to dumping syndrome A prioritize nursing diagnosis to a client receiving tube feeding is: y Risk for deficient fluid volume related to hypertonic dehydration y Deficient knowledge about home tube feeding regimen y Imbalanced Nutrition: Less than body requirements y Risk for diarrhea related to dumping syndrome Answer: C Brunner & Suddarth s Which of the following action/s is/are incorrect in providing oral and nasal hygiene to a client with NGT: SATA y Frequent mouth care y Clean the nose with moistened cottontipped swabs y Cleansing the nose using water soluble lubricant y Changing nasal tapes every 3-5 days Which of the following action/s is/are incorrect in providing oral and nasal hygiene to a client with NGT: SATA y Frequent mouth care y Clean the nose with moistened cottontipped swabs y Cleansing the nose using water soluble lubricant y Changing nasal tapes every 3-5 days 3Answer: D Brunner & Suddarth s Medical Surgical Nursing 10th Ed. Pg.991 In removing the NGT, the nurse should instruct the client to do which of the following action? y Exhale y Inhale then hold breath y Exhale and hold breath y Inhale and exhale quickly In removing the NGT, the nurse should instruct the client to do which of the following action? y Exhale y Inhale then hold breath y Exhale and hold breath y Inhale and exhale quickly Answer: C Fundamentals of Nursing 7th Ed. Pg.1208 Which of the following actions are incorrect in removing a Nasogastric tube: SATA y Put on sterile gloves y Pinch the tube with the gloved hand y Slowly and smoothly withdraw the tube y Observe the intactness of the tube Which of the following actions are incorrect in removing a Nasogastric tube: SATA y Put on sterile gloves ---disposable ---disposable y Pinch the tube with the gloved hand y Slowly and smoothly withdraw the tube -- quickly y Observe the intactness of the tube Answer: A & C Fundamentals of Nursing 7th Ed. Pg.1208 Before removing, the nurse may intermittently clamp and unclamp the NG tube for a trial period to ensure that the client does not experience N/V, or distention. How long is the trial period? y 12 hours y 24 hours y 32 hours y 48 hours Before removing, the nurse may intermittently clamp and unclamp the NG tube for a trial period to ensure that the client does not experience N/V, or distention. How long is the trial period? y 12 hours y 24 hours y 32 hours y 48 hours Answer: B Brunner & Suddarth s In removing the NG tube, the tube is gently withdrawn for: y 5-10 cm y 10-15 cm y 15-20 cm y 20-25 cm In removing the NG tube, the tube is gently withdrawn for: y 5-10 cm y 10-15 cm y 15-20 cm 15y 20-25 cm Answer: C Brunner & Suddarth s Medical Surgical Nursing 10th Ed. Pg.991 a) Lubricate the first 3 (7.6cm) of the tube with petroleum jelly b) have the patient take sips of water and swallow as you advance the tube c) Watch for signs of respiratory distress d) Keep an emesis basin and tissues available for the patient a) Lubricate the first 3 (7.6cm) of the tube with petroleum jelly b) have the patient take sips of water and swallow as you advance the tube c) Watch for signs of respiratory distress d) Keep an emesis basin and tissues available for the patient y Rationale y Only water soluble lubricants are used for NG tube insertion because of the risk of pneumonia when it enters the respiratory cavity y Saunders 2004 a) Measure the residual contents in the stomach every morning b) Clean and lubricate the external nares c) Administer the feeding over 1 to 2 hours d) Check the patient s blood glucose level before each feeding a) Measure the residual contents in the stomach every morning b) Clean and lubricate the external nares c) Administer the feeding over 1 to 2 hours d) Check the patient s blood glucose level before each feeding Rationale y Measure the residual every before feeding, the time 1 to 2 hours is too long for feeding and the question doesn't state that the patient has problems with sugar levels. y Nurse should maintain a clean and unobstructed nares because of the presence of tube it may irritate the a) Confirm proper NGT placement b) Determine patency of the tube c) Assess fluid and electrolyte status d) Evaluate absorption of the last feeding a) Confirm proper NGT placement b) Determine patency of the tube c) Assess fluid and electrolyte status d) Evaluate absorption of the last feeding Rationale y Aspirating the residual content evaluates the gastrointestinal absorption rate. y Kozier nutrition a) Feeding bag is hung 1 foot higher than tube s insertion point into the client b) Nurse administers the next feeding only if there is less than 25 ml of residual volume from the previous feeding c) Client is placed in the left lateral position to promote feeding flow into the intestines d) Feeding is administered at a refrigerated temperature to reduce bacterial growth during feeding a) Feeding bag is hung 1 foot higher than tube s insertion point into the client b) Nurse administers the next feeding only if there is less than 25 ml of residual volume from the previous feeding c) Client is placed in the left lateral position to promote feeding flow into the intestines d) Feeding is administered at a refrigerated temperature to reduce bacterial growth during feeding y Rationale y Feeding bag is hung 1 foot higher than tube s insertion point into the client too low height of feeding bottle may lead to slow feeding and high may cause increase tube emptying a) Assist the client in sitting position b) Explain the procedure to the client c) If the client has a denture, make sure that they are in place in the clients mouth d) Have the stethoscope available to listen for the proper placement a) Assist the client in sitting position b) Explain the procedure to the client c) If the client has a denture, make sure that they are in place in the clients mouth d) Have the stethoscope available to listen for the proper placement y Rationale y Explaining the procedure to the client will prepare him/her not only physically but holistically. Also the nurse will gain cooperation when inserting the NG tube. A patient with cancer receives his bolus tube feeding. Which of the following is the most appropriate position to decrease the risk of aspiration? A. Sitting upright in a chair for 1 hour B. Supine in bed with head elevated at 60 degrees for 2 hours C. Placing on his left side with head of bed elevated at 45 degrees for 15 minutes D. Supine with head of bed elevated to 30 degrees for 20 minutes A patient with cancer receives his bolus tube feeding. Which of the following is the most appropriate position to decrease the risk of aspiration? A. Sitting upright in a chair for 1 hour B. Supine in bed with head elevated at 60 degrees for 2 hours C. Placing on his left side with head of bed elevated at 45 degrees for 15 minutes D. Supine with head of bed elevated to 30 degrees for 20 minutes Rationale: A. As long as the patient can get out of bed, the preferred position and time frame for preventing aspiration after a bolus tube feeding is sitting upright out of bed for 30 to 60 minutes. A post gastrectomy patient ask the nurse when will his NG tube will be removed. The nurse tell the patient A. After the fourth post-operative day B. Thirty-six hours after the cessation of bloody drainage C. When the patient already gains weight D. When patient is able to pass flatus or stool A post gastrectomy patient ask the nurse when will his NG tube will be removed. The nurse tell the patient A. After the fourth post-operative day B. Thirty-six hours after the cessation of bloody drainage C. When the patient already gains weight D. When patient is able to pass flatus or stool Rationale: D. NGT is removed after bowel sound is reestablished (usually after 3 days) and after pt has passed flatus or stool. A patient with NGT after gastric resection complains of severe nausea and absence of drainage for the past 4 hours is noticed. The most appropriate nursing action would be to A. Repositioning the patient B. Irrigating the tube with NSS C. Notifying the physician D. Giving antiemetic medication A patient with NGT after gastric resection complains of severe nausea and absence of drainage for the past 4 hours is noticed. The most appropriate nursing action would be to A. Repositioning the patient B. Irrigating the tube with NSS C. Notifying the physician D. Giving antiemetic medication Rationale: C. N&V is not a normal observation after NGT insertion. The most appropriate action is to notify the physician. Positioning the tube or irrigating is not prescribed because the NGT is placed directly in the suture line and may cause pressure on it. Which statement by the nurse accurately describes the Levin tube? A. A double lumen tube with one lumen leading to the inflatable balloon and other luman used for aspiration. B. A single lumen plastic or rubber tube with holes near its tip facilitating withdrawal of fluids from the stomach. C. A single lumen, saline, air or water-weighted tube approximately 6 feet long D. A 10 foot long rubber tube with a saline, air, or water bag at its end. Which statement by the nurse accurately describes the Levin tube? A. A double lumen tube with one lumen leading to the inflatable balloon and other luman used for aspiration. B. A single lumen plastic or rubber tube with holes near its tip facilitating withdrawal of fluids from the stomach. C. A single lumen, saline, air or water-weighted tube approximately 6 feet long D. A 10 foot long rubber tube with a saline, air, or water bag at its end. Rationale: B. Choice A refers to a Miller-Abbot tube; choice C is a Harris tube ; and choice D is a Cantor tube used for intestinal decompression. Which statement accurately describes a Salem sump tube? A. A short double-lumen tube with small vent used for stomach decompression B. A double-lumen tube with an inflatable balloon used for stomach decompression C. A single-lumen tube used to evacuate stomach content D. A large-bore tube used to evacuate stomach content. Which statement accurately describes a Salem sump tube? A. A short double-lumen tube with small vent used doublefor stomach decompression B. A double-lumen tube with an inflatable balloon used for stomach decompression C. A single-lumen tube used to evacuate stomach content D. A large-bore tube used to evacuate stomach content. Rationale: A. Choice B refers to a Miller-Abbot tube; choice C is a Levin tube; and choice D is an Ewald tube.