Transcript Naso-gastric tube insertion

Naso-gastric tube insertion
Mem Van Beek
Clinical Educator
Bradford Teaching Hospitals
AIM
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To enable the student to understand
the principles of safe NG tube use.
Objectives
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By the end of this session students
should be able to:
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State:
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Types of NG tubes & their uses
Indications for insertion
Complications
Legal aspect around NG tube insertion
Insert a naso-gastric tube safely and
competently
Types of NG tubes
Fine –bore feeding tube
Feeding
Ryle’s tube for gastric drainage
Draining
INDICATIONS
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FINE BORE NG TUBE
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Short term enteral feeding (4-6 weeks)
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Malnutrition
Head & neck surgery
Ca Head & neck / oesophagus
Inadequate intake
Oral cavity fistulae
To prolong & sustain life
INDICATIONS cont
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RYLE NG TUBE
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To drain gastric contents
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Abdominal distension
Unconscious pt
Major surgery
Intestinal obstruction
To stop vomiting & prevent aspiration
Contraindications
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Head injury – basilar skull #
Rhinorrhea –CSF
Obstructing oesophageal ca
Epistaxis
Feeding above an obstruction
Recent gastro oesophageal anastomosis
Hx of nasal or sinus surgery
occlusions
Cautions
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Neck & buccal flap repair
Laryngectomy
Oesophageal ca
Head & neck surgery
Uncooperative pts
Complications of NG feeding
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Aspiration
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Nausea & vomiting
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due to feed regurgitation
or incorrect tube placement
due to rapid feeding
poor gastric emptying
Diarrhoea
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Type of feed ie Jevity
Gut infection
Complications cont
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Constipation
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Blocked tube
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inadequate fluid intake
immobility
use of opiates
inadequate or no flushing of tube
administering meds via tube
Unstable BMs
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↑BMs esp with high carb feed
↓BMs esp if feed is stopped quickly or interupted
Complications cont
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Deranged electrolytes- re feeding syndrome
Fluid overload
Intestinal obstruction
Dislodged tube
Weight loss/ gain
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Due to feed imbalances – poor regime
Excoriation of skin around tube
Risks associated with NG tubes
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Pneumothorax
Coiling of tube in the throat
Parotiditis
Retropharyngeal Abscess
Sinusitis
Acid reflux
Aspiration pneumonitis
Severe sepsis (the most serious risk)
Legal Aspect
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2005 NPSA – 11 deaths due to
misplaced NG feeding tubes
Correct & clear documentation
National & Local guidelines
Measuring length of feeding tube
From bridge of nose to ear lobe to
bottom of xiphisternum
Position of pt during insertion
Equipment required
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Tray
Fine bore with introducer / Ryle’s tube
Receiver
Sterile water
Glass of water
20ml syringe
Tape (hypoallergenic)
Lubricating jelly
Indicator strips ( pH fix, 0-6, Fisher scientific)
Procedure
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Clinically clean procedure
Wash hands
Introduce self
ID patient
Gain informed consent
Arrange a signal of communication
Pt to sit in high Fowler’s position
Prepare equipment
Measure tube (as previously stated) & mark with
tape.
Procedure
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Lubricate tube
Check for nostril patency
Insert the rounded end of tube into the clearer
nostril & slide it backwards & inwards along the
floor of the nose to the nasopharynx.
When tube reaches nasopharynx (back of throat),
ask pt to sip & swallow some water using a straw.
Advance the tube through the pharynx (as pt
continues to swallow) till the predetermined mark
has been reached
If at any point pt shows signs of distress/ cyanosis –
remove tube.
Procedure
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Secure the tube to nostril & cheek with tape
Check the position of the tube to confirm that it is in
the stomach by
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Check pH
Do X-ray of chest & upper abdomen
NO OTHER METHODS ARE ACCEPTED (NPSA 2005)
If position is correct;
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Mark the tube at the exit site & record the tube length in
the notes
remove guide wire from fine-bore tube & start feeding per
regime
Connect drainage bag to Ryle’s tube for free drainage or
spigot for prn aspiration.
Checking pH
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Flush the NG tube with 20ml of air – to clear any
substance already in tube
Aspirate 2ml of stomach content and test on pH
strip. (blue litmus paper should not be used)
pH should be ≤5.5 (acidic)
If checking pH in tube already in place, wait 1hour
after feed or medication as these can affect pH
reading.
If pH of >5.5 is obtained – & pt is asymptomatic
send for X-ray
REMEMBER
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DO NOT use the ‘whoosh’ test
DO NOT use blue litmus paper
DO NOT use absence of respiratory distress
DO NOT monitor bubbling at end of tube
DO NOT use appearance of fluid aspirate
NPSA 2005
Document
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Date
Time
Type of tube inserted
Reason
Length inserted & how it is marked
pH of aspirate
Nursing instructions