Orogastric Tube Insertion
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Transcript of Orogastric Tube Insertion
OROGASTRIC TUBE INSERTION
INDICATIONS
By inserting a nasogastric tube, you are gaining access to the stomach and its
contents. This enables you to drain gastric contents, decompress the stomach,
obtain a specimen of the gastric contents, or introduce a passage into the GI tract.
This will allow you to treat gastric immobility, and bowel obstruction. It will also
allow for drainage and/or lavage in drug overdosage or poisoning. In trauma
settings, NG tubes can be used to aid in the prevention of vomiting and aspiration,
as well as for assessment of GI bleeding. NG tubes can also be used for enteral
feeding initially.
Contraindications
Nasogastric tubes are contraindicated in the presence of severe facial trauma
(cribriform plate disruption), due to the possibility of inserting the tube
intracranially. In this instance, an orogastric tube may be inserted.
Complications
The main complications of NG tube insertion include aspiration and tissue
trauma. Placement of the catheter can induce gagging or vomiting, therefore
suction should always be ready to use in the case of this happening.
Universal precautions:
The potential for contact with a patient's blood/body fluids while starting an
NG is present and increases with the inexperience of the operator. Gloves must be
worn while starting an NG; and if the risk of vomiting is high, the operator should
consider face and eye protection as well as a gown. Trauma protocol calls for all
team members to wear gloves, face and eye protection and gowns.
Equipment:
All necessary equipment should be prepared, assembled and available at the
bedside prior to starting the NG tube. Basic equipment includes:
Personal protective equipment NG/OG tube Catheter tip irrigation 60ml
syringe Water-soluble lubricant, preferably 2% Xylocaine jelly Adhesive tape
Low powered suction device OR Drainage bag Stethoscope Cup of water (if
necessary)/ ice chips Emesis basin pH indicator strips.
1. Gather equipment
2. Don non-sterile gloves
3. Explain the procedure to the patient and show equipment
4. If possible, sit patient upright for optimal neck/stomach alignment
5. Examine nostrils for deformity/obstructions to determine best side for insertion
6. Measure tubing from bridge of nose to earlobe, then to the point halfway
between the end of the sternum and the navel
7. Mark measured length with a marker or note the distance
8. Lubricate 2-4 inches of tube with lubricant (preferably 2% Xylocaine). This
procedure is very uncomfortable for many patients, so a squirt of Xylocaine
jelly in the nostril, and a spray of Xylocaine to the back of the throat will help
alleviate the discomfort.
9. Pass tube via either nare posteriorly, past the pharynx into the esophagus
and then the stomach.
Instruct the patient to swallow (you may offer ice chips/water) and advance the
tube as the patient swallows. Swallowing of small sips of water may enhance
passage of tube into esophagus.
If resistance is met, rotate tube slowly with downward advancement toward
closes ear. Do not force.
10.Withdraw tube immediately if changes occur in patient's respiratory status, if
tube coils in mouth, if the patient begins to cough or turns pretty colours
11.Advance tube until mark is reached
12.Check for placement by attaching syringe to free end of the tube, aspirate
sample of gastric contents. Do not inject an air bolus, as the best practice is to
test the pH of the aspirated contents to ensure that the contents are acidic. The
pH should be below 6. Obtain an x-ray to verify placement before instilling
any feedings/medications or if you have concerns about the placement of the
tube.
13.Secure tube with tape or commercially prepared tube holder
14.If for suction, remove syringe from free end of tube; connect to suction; set
machine on type of suction and pressure as prescribed.
15.Document the reason for the tube insertion, type & size of tube, the nature and
amount of aspirate, the type of suction and pressure setting if for suction, the
nature and amount of drainage, and the effectiveness of the intervention.