INP4 Unit 10: Nasogastric Tube Management – Flashcards

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Purposes of Nasogastric Insertion "DFCL"
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Decompression of GI Tract: Removal of secretions/gaseous substances, relieve abdominal distension. Feeding: Provide nutrition, enteral tube feeding. Compression: Application of pressure to prevent esophageal/GI hemorrhage. Lavage: Irrigate stomach, remove irritants/poison.
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Salem Sump NG Tube: Stomach decompression
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Double Lumen: Remove of gastric contents, connected to suction. The other provides air vent (blue pigtail) which allows air to enter stomach to prevent NGT from damaging gastric mucosa.
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NG Insertion (RN SKILL)
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Clean technique, uncomfortable. Position high fowlers, neck back against pillow. Measure distance to be inserted. Insert NG tube slowly and gently with curved end pointing downward past nasopharynx. Swallowing/sip of water aids passage of NG tube into esophagus. Client: Flex head forward, sip water, swallow, closes off upper airway to trachea and opens esophagus. Anchor NG tube. tape to nose. Once confirmed, place a mark on the tube where the tube exits the nose. The mark is used as a guide to indicate displacement. Document.
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Key things to remember about NG tube insertion
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High fowlers. Pillows at back. NG tube pins to gown.
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NG Tube Placement Verification
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1. Measure tube length. 2. Visually assess aspirate. 3. Measure pH of aspirate.
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NGT: Tube Length
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Measure exposed portion and document length.
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NGT: Visually Assessing Aspirate
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1. Gastric aspirate = cloudy and green, tan, brown. 2. Interstinal aspirate = clear and yellow to bile-colored. 3. Pleural fluid = pale yellow and serous. 4. Tracheobronchial secretions = tan or off-white mucus.
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NGT: pH of Aspirate
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1-5 = pH of gastric aspirate is acidic. >6 = pH of interstinal aspirate. >7 = pH of respiratory aspirate is alkaline.
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What do you assess with an NG tube?
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1. NG System: Suction set at prescribed rate (40-80mmHg), connected and working. 2. Condition of nasal mucosa for inflammation and excoriation. 3. NG tube taped securely at bridge of nose and change tape daily; assess condition of nose. 4. NG tube taped securely at bridge of nose and change tape daily. Assess condition of nose. 5. NG tube pinned to gown (air vent above stomach). 6. HOB 30. 7. Observe position of NG tube, tension applied to nares. 8. Throat, lips, mouth. 9. Air vent: never clamped, connection to suction, never used for irrigation. 10. Abdomen: distension, bs. 11. NG drainage amount and characteristics. 12. Empty canister and record amount of NG drainage. 13. Document procedure and total fluid balances.
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How to promote client comfort with a NGT
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1. Water soluble to lubricate lips and nasal mucosa. 2. Mouth care every 1-2hrs and PRN. 3. Cool water to rinse. 4. Ice bag for throat, suck on ice, throat lozenges.
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NGT administering med steps
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1. Turn of NG suction. 2. Flush NGT with 30-50mL of warm water pre and post admin. 3. Mix tables in 5mL of warm water to form a slurry, then further dilute in 30mL of warm water until dissolved. 4. Flush with 30-50mL post med admin. * Do not crush coated or time-released med. * Do not turn NG suction back on until 30 MINUTES after med admin!
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How to maintain NGT patency
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Irrigation and resposition of NG tube. Turning regularly.
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NGT: Potential Complications
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NG tube rests against stomach wall. NG tube can be blocked with thick secretions. Stomach distentions due to client swallowing large amounts of air. Gastric secretions form along side of stomach walls and bypass suction.
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What is NG Replacement?
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Volume of NG losses needs to be monitored. Excessive losses replaced with IV fluids and electrolytes to maintain adequate hydration.
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What should you report to physician regarding NGT?
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1. NG Tube Drainage: coffee grounds, hemolyzed sanguineous drainage, dark brown granular appearance. 2. Excessive losses: More than 500-1000mL per 24/hrs. 3. Removal of NG tube needs order. 4. When bowel function returns: passing gas and stool.
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Baseline Competencies for NGT Removal (& Steps)
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1. Verify Dr. order/ minimal NG returns. 2. Educate patient on what to expect. 3. Hand hygiene and gloves. 4. Assist to high fowlers. 5. Turn off suction and disconnect NG tube. 6. Remove tape from nose, unpin tube from gown. 7. Ask patient to DB and exhale slow. 8. King tubing and pull out steady, prevents tube contents from draining into oropharynx & reduces mucosa trauma. 9. Provide oral care to patient, provide skin care around nares. 10. Measure drainage and characterisitcs. 11. Document and fluid.
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Key Topics of NGT Management
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1. NG Tubes (Salem Sump). 2. Enteroflex. 3. Replacing Losses. 4. Removing and NG.
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1. NG Tubes (Salem Sump).
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RN only. Usually for removal of air and gas, sometimes short term feeds. Suction: 40-80mmhg. Initial placement check: aspirate, Hx, chest xray (rare). Ongoing placement checks: markings,pH of aspirate. Checking with 50cc air is misleading (this sound may be referred from a tube in lungs). Strict NPO status while NG is in with possible exception of ice! TPN could be started if NG insitu for long time. Crushed pills (leave suction off for 30 mins after meds).
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Total Parental Nutrition
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the intravenous administration of the total nutrient requirements of a patient with gastrointestinal dysfunction.
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2. Enteroflex.
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Physician inserts. Only for feeding and h20/med admin. Initial placement check: MUST have chest xray. Start use for tube only after official order, "enteroflex OK to use". The thin guide wide must be removed by RN. Ongoing checks: check tubing markings/ measurements. Chest xrays if needed again. Can't obtain gastric aspirate as the tube is too thing and collapses upon suction.
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3. Replacing Losses.
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Ex: "Replace NG losses 2:1" with D5NS with MEq of KCL. This means every 12 hours tally NG losses and replace with twice the amount of IC solution over the next 12 hrs. NS is isotonic (GI losses are isotonic), and K replaces K. Excessive gastric content loss may yield metabolic alkalosis but the kidneys may compensate and NG may be short term, so alkalosis may be mild. In the case of long term NG losses and renal failure more complex modalities are needed (beyond scope).
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4. Removing and NG.
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Inject 50cc of air to remove excess secretions from tube (prevent burning of throat upon removal) this intervention is optional. Pinch NG tube while removing (same rationale as above). Patient to hold breath to prevent any aspiration.
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Paralytic Ileus
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Peristalsis stops as a results of surgery that involves direct manipulation of the bowel. Lasts for 24-48 hours.
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Air vent
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what part of an iv set allows air to enter an iv bottle as fluid flows out of it
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Low intermittent suction
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is when the suction pressure cycles on and off which is less likely to harm the mucous membrane (lining) at the location of the end of the tube
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Nasogastric Tube
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A pliable tube that is inserted through the client's nasopharynx into the stomach.
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What are the most common tubes used for stomach decompression?
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Levin and Salem sump tubes. 1. Levin tube is a single-lumen tube with holes near the tip. 2. Sump tube may be connected to either a drainage bag or an intermittent suction device to drain stomach secretions.
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What are the 4 main purposes of nasogastric intubation?
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1. Decompression (removal of secretions and gaseous substance). 2. Feeding (Instillation of liquid nutritional supplement). 3. Compression (Internal application of pressure by means of an inflated balloon to prevent internal esophageal or GI hemorrhage). 4. Lavage (Irrigation of stomach)
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What type of tube is used for decompression?
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Salem pump, Levin, Miller-Abbott.
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What type of tube is used for feeding?
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Duo, Dobhoff, Levin.
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What type of tube is used for compression?
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Sengstaken-Blakemore
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What type of tube is used for lavage?
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Levin, ewald, salem sump.
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What type of technique do you use for NGT insertion?
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Clean technique.
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Excoriation
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A skin sore or abrasion produced by scratching or scraping.
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What is the greatest problem in caring for a client with an NG tube?
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Maintaining comfort. The tube is a constant irritation to the nasal mucosa. Must assess nares and mucosa for inflammation and excoriation.
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Nursing Responsibilities for NGT
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Use tape to anchor the tube often becomes soiled. Change it every day to reduce skin irritation. Frequent lubrication of the nares also minimizes excoriation. Frequent mouth care (every 2 hrs) minimizes dehydration. Water should not be swallowed (NPO!). Ice bag if client complains of sore throat. Maintain patency. Turning client helps to collapse the channels and promote emptying of the stomach contents.
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