This nasogastric tube insertion guide provides a step-by-step approach to performing NG tube insertion in an OSCE setting with an included video demonstration.
Objectives:
At the end of the lesson students will be able to:
Define the term inserting of nasogastric tube.
Mention any four (4) purpose of inserting nasogastric tube.
List the indication of inserting nasogastric tube.
Enumerate any five (5) requirements of inserting nasogastric tube.
Demonstrate the procedure of inserting nasogastric tube.
Introduction:
The process of inserting NG tube has its risks, but once nurses gain experience in this area, they should be able to insert an NG tube without any level of difficulty.
It is important that nurses know the reason that their patient has an NG tube in order to avoid any pitfalls that can occur as a result of the procedure.
Therefore, nurses should seek to master this nursing skill.
NG tubing is a procedure that nurses use for diagnostic and therapeutic purposes. Patients have an NG tube inserted immediately after any major surgery for approximately 48-72 hours.
An NG tube is intended for short-term used to help prevent vomiting after surgery and to keep the patient’s stomach empty.
Nurses also use the tube to feed critically ill patients and to administer their medications to them.
Nasogastric tubes are also used in the event of drug overdose; the patient’s gut when GI bleeding occurs, and gathering gastric content from the patient’s stomach for lab analysis
It is the process of passing a Naso-gastric tube through the nostril into the stomach.
Purposes:
- For feeding purpose.
- Pre-operatively (G.I.T. operation).
- For diagnostic purpose.
- For gastric lavage (washout).
- For aspiration of gastric content.
Indication:
- Unconscious patient.
- Patient on nill per oral.
- Patient with injury of the mouth.
- Following a major surgery.
Requirement:
Medium size tray containing the following:
- Ryles tube.
- Gallipot with gauze swabs.
- 10mls syringe.
- Litmus paper.
- A lubricant.
- Vomitus bowl.
- Receiver for soiled swabs.
- Spigot.
- Stethoscope.
- Adhesive strapping.
- Small bowl with water.
- Small towel
Procedure of Nasogastric Tube Insertion
- Wash the hands thoroughly and dry them before donning sterile gloves.
- Explain the procedure to the patient and answer any of their questions before moving forward with the procedure.
- The nurse should now position an unconscious patient in a lying position on the left side of the body, and position a patient who is awake in a sitting position.
- To minimize the possibility of aspirated gastric content from coming in contact with the patient, place a towel or protective pad over the chest of the patient.
- Using the NG tube, measure the length from the earlobe to xiphoid process and from the nose to the earlobe to determine the length that the NG tube must be.
- After adding the two measurements together, use a piece of tape to mark the total distance on the tube.
- Inspect the patient’s nostrils for obstructions. An alert patient may need to blow the nose to clear the opening.
- Use a water-soluble lubricant to lubricate the NG tube’s first six inches. Use the nostril with the largest opening to insert the NG tube down the back of the nostril to the nasopharynx.
- Ask the patient to swallow once the tube enters the pharynx. If the patient is not able to mimic the swallowing action, ask the patient to sip water.
- An alert patient should place the chin on the chest to aid the tube’s passage. Continue directing the tube until it reaches the location marked by the tape.
- Verify that the tube is in the stomach by performing two of the following options:
- Submerging the tube’s open end into a cup of water (bubbles indicate the tube passed down the larynx).
- Chest X-ray; request that the patients talk (choking and coughing means the tube passed down the larynx).
- use the irrigation syringe for aspirating gastric contents; or use a stethoscope to listen over the patient’s epigastrium while using an irrigation syringe to install a 30cc air bolus ( a whooshing sound indicates that air entered the stomach).
- If it is not possible to confirm that the NG tube is in the stomach, the nurse should remove the tube immediately and try again.
- After confirming the placement, secure the tube with tape by wrapping one end around the tube and placing the other end at the tip of the patient’s nose.
- Make sure the nose is prepped and clean before applying the tape.
- Connect or clam the NG tube if desired. When using a Salem sump tube, make sure that the blue pigtail remains at the level of the fluid in the patient’s stomach or leakage of gastric contents may occur.
- Point to considered in inserting N.G Tube:
- Wash the hands before and after coming in contact with the tube.
- Never force the NG tube when inserting.
- Retract and rotate the tube if there are problems inserting and start again.
- Clamp or cap the NG tube to prevent air from accumulating in the stomach of the patient.
- Nurses may have to use an oral-gastric tube for patients who have had facial surgery so that no further nasal trauma can take place.
Complication from Inserting a Nasogastric Tube:
Tissue trauma and aspiration are the main common complications from inserting a nasogastic tube.
Some patients experience vomiting and gagging during the placement of the tube.
Other complications include:
Nosebleeds.
Secondary infection.
Pulmonary haemorrhage.
And tissue erosion.
N.B:
- It takes some practice to master the skill of inserting a NG tube.
- Mastering this skill will help ailing patients feel more comfortable while in the care of experienced nursing professionals.
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