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NT Skills Update: NASOGASTRIC TUBES

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VOL: 98, ISSUE: 47, PAGE NO: 31

DESCRIPTION

DESCRIPTION
A nasogastric (NG) tube travels from the nose to the stomach and is inserted to instil liquids and foods, or to withdraw gastric contents from the stomach. The incorrect length of tubing may cause feeding difficulties or inadequate aspiration of contents.

INDICATIONS
Bowel obstruction; paralytic ileus; preoperative insertion before gastric or abdominal surgery; postoperative use after cholecystectomy or partial gastrectomy, for example.

BEFORE INSERTION
- Ensure the patient is semi-upright and explain the procedure.

- Measure the tube against the patient from ear lobe to bridge of nose and from bridge of nose to bottom of the xiphisternum then wash hands and put on non-sterile gloves.

- Check the patency of nostrils by asking the patient to sniff through one nostril at a time.- Apply lubricating jelly to 15-20cm of the tube.

INSERTION
- Insert the tube into the clearest nostril, sliding it gently towards the nasopharynx. If there is an impasse, withdraw the tube and try a different angle or change nostril.

- Ask the patient to drink water via a straw. As the tube passes the nasopharynx, advance it through the pharynx until the correct length of tube is sited.

- Secure the tube to the nostril and cheek once the correct siting is confirmed; syringe 20ml of air into the tube before aspirating.

- Document the procedure in the patient's notes, observe the patient for after-effects and report abnormal findings immediately.

- Medical staff will recommend continuous or intermittent aspiration of the NG tube.

- The patient with an NG tube may experience dryness in the mouth, so regular mouthcare should be encouraged or provided.

PLACEMENT
- Aspirate 2ml of contents from tube and test with pH indicator strips.

- The correct placement of radio-opaque tubes can be confirmed by X-ray.

- Syringe 5ml of air into the tube and, using a stethoscope placed over the epigastrium, listen for air. (Note: this test is unreliable in isolation.)

THREE PROBLEMS
1. Patient begins coughing and is distressed

- Cause: the tube has entered the bronchus.

- Treatment: remove the tube immediately and reassure the patient.

2. Tube is not draining

- Cause: the tube's position has altered.

- Treatment: gently rotate or pull back the tube. (Note: do not reposition a tube after gastric surgery as this could damage the anastomosis.)

3. Uncertainty about the position of the tube

- Test: pH indicator strips can differentiate between gastric acid (pH <3) and="" bronchial="" secretions="" (ph="">6).

WEBSITES
British Society of Gastroenterology: www.bsg.org.uk

Digestive Disorders Foundation: www.digestivedisorders.org.uk

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