Title: NASOGASTRIC TUBE INSERTION
AND CARE OF
I.D. Number: 1040
Authorization:
[ ] Board of Directors
[ ] MAC Motion #:
Source: Nursing
Cross Index:
Date Reaffirmed:
Date Revised: April, 1999
Date Effective: May, 1999
Scope: SASKATOON CITY HOSPITAL
[ ] Tri-Hospital Nursing Practice Committee ROYAL UNIVERSITY HOSPITAL
ST. PAUL’S HOSPITAL
1. POLICY
1.1 Registered Nurses will insert or remove a Nasogastric (NG) tube as ordered by a physician.
1.2 Registered nurses will not insert a NG tube if:
1.2.1 the patient has or is suspected to have a basal skull fracture, cribriform plate fracture or facial fracture.
1.2.2 there is danger of perforation (recent esophageal repair, esophageal varices, esophageal strictures, gastric surgery).
1.2.3 a metal guide or stilette is required for insertion.
1.2.4 the patient does not have a gag reflex unless RN is certified in procedure.
Refer to policy - Insertion of a Nasogastric Tube Without a Gag Reflex.
1.3 Tube placement will be assessed following insertion, q shift, prior to instillation and prn.
1.4 An order must be obtained from a physician for the type and amount of suction or the enteral feed solution and volume.
1.5 Skin condition at tape site will be assessed q shift.
2. PURPOSE
2.1 To remove fluid and gas from the G.I. tract.
2.2 To determine the amount of pressure and motor activity in the G.I. tract
(diagnostic studies).
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Policy & Procedure: Nasogastric Tube Insertion
And Care Of
2.3 To treat patients with mechanical obstruction and bleeding within the upper G.I. tract.
2.4 To administer medications and enteral feeding.
2.5 To obtain a specimen of gastric contents for laboratory studies.
3. PROCEDURE
3.1
Obtain Supplies:
•
Patent NG tube of required size (levine or salem sump)
• water soluble lubricant
•
60ml catheter tip syringe Neonates: 12 - 20 ml syringe
• non-sterile gloves
• stethoscope
• tape or NG tube anchoring device
• thread (optional)
• incontinent pad
• glass of water and straw
• safety pin and elastic band
• anti-reflux valve (for use with salem sump)
• kidney basin
• feeding equipment
• suctioning equipment
3.2 Position patient in high fowler’s position, unless contraindicated. Patient may be positioned in left lateral position if unable to sit up.
Neonates: Place in “sniffing” position.
3.3 Measure to determine the length of tube needed to reach the stomach. Using the nasogastric tube, measure from the tip of the nose to the ear lobe and down to the tip of the xiphoid process. Indicate this length by noting the marking on the tube, or by placing tape at that point.
3.4 Place incontinent pad over patient’s chest and keep kidney basin available.
3.5 Examine the nares and obtain history of nasal trauma if possible to determine which nostril is most patent.
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Policy & Procedure: Nasogastric Tube Insertion
And Care Of
3.7 Lubricate tube along the first 10 cm with water soluble lubricant.
Neonates: Lubricate tube along the first 5cm with sterile water.
3.8 Tilt the head back unless contraindicated and gently insert tube through the nose toward the occiput.
Neonates: Place in “sniffing” position and gently insert tube downwards through mouth or nose.
3.9 When the tube reaches the nasopharynx (back of throat), have patient tilt their chin on their chest and instruct the patient to dry swallow or sip water if not contraindicated. Infants may suck on a soother.
3.10 Continue to advance the tube firmly and steadily while patient swallows until the predetermined length is reached.
3.11 To assess tube placement:
3.11.1
aspirate gastric contents with 60 ml syringe. (pH monitoring of gastric contents may be done)
3.11.2 ausculate for a rumbling sound in the stomach while injecting a volume of air into the NG tube. The volume of air will vary with the patient’s size. i.e. neonates 0.5 ml, infants 1-2 ml, older children 3 - 5 ml, adults 10 - 20 mls
NOTE: This method may be unreliable.
3.11.3 chest x-ray for tube placement as ordered by physician
NOTE: With the salem sump tube, the blue salem port helps keep the mucosa from being drawn into the tube by suction. Only air should be instilled into the blue sump port. Flush or aspirate fluid through the clear port.
3.12 Fasten tube securely. A NG tube anchoring device, tape or a thread and tape may be used.
NOTE: Do not tape the external length of the ng tube to the patient’s face as prolonged taping in this position can cause ulcers of the nasal mucosa.
3.13 Wrap elastic band around nasogastric tube and pin to patient’s gown to secure the tube and decrease tension.
3.14
After confirmation of tube placement, connect NG tube to suction, straight drainage, tube feed or clamp as ordered.
3.15
Connect the anti-reflux valve to the blue salem port to prevent reflux of nasogastric contents (if applicable).
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Policy & Procedure: Nasogastric Tube Insertion
And Care Of
3.16 Chart on the appropriate nursing record:
• date and time of tube insertion
• size of tube used
• name of person performing the procedure
• attachment to suction, straight drainage, tube feed or clamped
3.17 Report to physician if:
• unable to insert the tube
• any complications occur
3.18 Irrigate the tube if:
• gastric content leaks from the blue port or the tube is blocked. Flush the clear lumen with 30 mls of NS and instill 10cc of air into the blue lumen. Record the amount of irrigation on the Fluid Balance Sheet.
3.19 To remove:
• clamp the NG tube by kinking with your hand
• instruct the patient to hold breath, or if unable to follow instruction remove on expiration
• withdraw the tube steadily – then wrap in incontinent pad and dispose
• have patient cough to clear airway of secretions or suction if required
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