Skill 20[1]..Insertion of a Nasogastric Tube.pdf

SKILL 20

Insertion of a Nasogastric Tube

PURPOSE

A nasogastric tube may be used to decompress the stomach,

instill medications or feedings, or to assess gastrointestinal

function.

5. Assess patency of nares.

6. Measure length of tube to be inserted and mark tube

with a piece of tape. Several methods of measuring

length of nasogastric tube to be inserted have been

identified.

a. Measure from the tip of the nose to the earlobe and

from the earlobe to the lower end of the xyphoid

process. This is a commonly used method.

b. Measure from the nose to the earlobe and from the

earlobe to a point halfway between the xyphoid and

the umbilicus. (Figure 21A)

c. Formulas based on height.

EQUIPMENT

Appropriate size nasogastric tube

Water-soluble lubricant

1 / 2 -inch tape

1 Transparent dressing

Syringe

1 Hypoactive dressing

Blanket for restraint, if appropriate

Gloves, nonsterile (exam)

Pacifier, if appropriate

Emesis basis

Pin and rubber band

Towel

Stethoscope

NASOGASTRIC TUBE SELECTION

GUIDELINES

Type of tube

For gavage or lavage use a single lumen

tube.

For intermittent gastric decompression use

a double lumen tube.

For continuous long-term feeding use a sil-

icone tube.

Tube size

2 Kg

5 French

3–9 Kg

8 French

10–20 Kg

10 French

20–30 Kg

12 French

30–50 Kg

14 French

> 50 Kg

16 French

FIGURE 21A Measuring NG tube distance.

PROCEDURE

1. Gather equipment. Select appropriate size and type of

nasogastric tube. Some guidelines are presented above;

however, the nurse must use his or her judgment or fol-

low agency policies. Promotes organization and effi-

ciency.

2. Wash hands. Put on nonsterile gloves. Reduces transmis-

sion of microorganisms and protects from contact with

body fluids.

3. Prepare child and family. Enhances cooperation and

participation and reduces anxiety and fear.

4. Position child supine at a 30°–45° angle if possible.

7. Place a towel over the child’s chest to protect clothing.

8. Lubricate 1 to 3 inches of the tube with water or a

water-soluble gel.

9. Insert tube back and up into nostril; advance using gen-

tle pressure. If resistance is met, withdraw the tube,

relubricate and try the other nostril. (Figure 21B)

10. If the child is able, ask child to swallow as the tube is

advanced. A pacifier may be used for an infant over 3

months of age who does not need to mouth breathe.

Continue to advance the tube until the tape mark is at

the nostril.

continued

SKILL 20

Insertion of a Nasogastric Tube

continued

15. Secure tube by placing hypoactive dressing on child’s

cheek and then securing the tube to the dressing with

the transparent dressing or tape. The tube also may be

taped to the upper lip or nose. Use a 4 inch length of

tape, split about 2 inches of the tape lengthwise, place

unsplit end on nose, wrap spit ends around tube and

secure to nose. (Figure 22)

FIGURE 21B Placement of NG tube.

FIGURE 22 NG tube secured.

11. Check back of mouth for kinking of tube.

12. Remove tube immediately if there is vomiting or signs

of respiratory distress, e.g., cyanosis, tachypnea, nasal

flaring, grunting, wheezing, prolonged coughing or

choking, or if the child is unable to speak or cry. These

symptoms suggest the tube is in the respiratory tract

rather than the gastrointestinal tract.

13. Remove guide wire if applicable.

16. Attach tube to suction, feeding, or clamp as ordered.

17. Remove gloves. Wash hands. Reduces transmission of

microorganisms.

DOCUMENTATION

1. Insertion procedure with date and time.

2. How tolerated by child.

3. Type and size of tube.

4. Which nostril used.

5. Patency.

6. Amount, color, and consistency of returns.

7. Laboratory tests done on gastric contents, if applicable.

NOTE: Some agencies have policies that limit insertion

of nasogastric tubes with guide wires to physicians.

Follow agency policy.

14. Verify placement of nasogastric tube per agency proto-

col. The literature identifies several methods for deter-

mining appropriate placement of nasogastric tubes

(Beckstrand, et al., 1990; Gharib, Stern, Sherbin, &

Rohrmann, 1996; Rakel, et al., 1994). These include

insufflation of air while listening for the sound of the air,

withdrawal of gastric/intestinal contents, checking con-

tents withdrawn for pH and other characteristics, and

inserting end of tube in the water and watching for bub-

bles. Research has demonstrated the listening for air (a

frequently identified method) is the least reliable

method. The most reliable method for confirming

placement is X ray.

Plik z chomika:

Inne pliki z tego folderu:

Inne foldery tego chomika: