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Nasogastric and Intestinal Tubes

Nasogastric Tubes
A nasogastric tube is a close pierce tube passed into the stomach via the nose. It is used for deficient- or medium-term nutritional living, and to-boot for longing of stomach disintegration – eg, for decompression of intestinal obstacle.
Types of Intestinal Tubes
  1. Levin Tube – disjoined lumen
    1. Suctioning gastric disintegration
    2. Administering tube alimentations
  2. Salem Sump Tube – embrace lumen (smaller bluish lumen vents the tube & prevents suction on the gastric mucosa, deeptains interrupted suction despising of suction fountain)
    1. Suctioning gastric disintegration
    2. Maintaining gastric decompression
nasogastric tube
Key Points
  1. Prior to inoculation, posture the client in High-Fowler’s posture if relishly.
  2. Use a water-soluble lubricant to adapt inoculation
  3. Measure the tube from the tip of the client’s nose to the earlobe and from the nose to the xiphoid process to enumerate the adit whole of tube to infuse to grasp the stomach
  4. Flex the client’s leader subordinately forward; this earn narrow the random of memorandum into the trachea
  5. Insert the tube through the nose into the nasopharyngel area; ask the client to exhaust, and as the exhaust occurs, proceeding the tube elapsed the area of the trachea and into the esophagus and stomach. Withdraw tube directly if client experiences respiratory distress
  6. Secure the tube to the nose; do not remit the tube to exact constraining on the excellent secret constituent of the nares
  7. Validating importation of tube.
    • Aspirate gastric disintegration via a syringe to the end of the tube
    • Measure ph of aspirate mellifluous
    • Place the stethoscope aggravate the gastric area and inject a weak whole of air through the NGT. A speciality investigate of air entering the stomach from the tube should be heard
  8. Characteristics of nasogastric drainage:
    • Normally is greenish-yellowish, delay strands of mucous
    • Coffee-ground drainage – old race that has been meek down in the stomach
    • Bprincipled red race – bleeding from the esophagus, the stomach or exhausted from the lungs
    • Foul-smelling (fecal perfume) – occurs delay derangement peristalsis in bowel obstacle; extension in whole of drainage delay obstacle
Intestinal Tubes
Provide intestinal decompression proximal to a bowel obstacle. Prevent/narrow intestinal distention. Importation of a tube containing a mercury heaviness and remiting typical peristalsis to urge tube through the stomach into the civil to the aim of obstacle where decompression earn occur
Types of Intestinal Tubes
  1. Cantor and Harris Tubes
    1. Approximately 6-10 feet long
    2. Single lumen
    3. Mercury situated in rubber bag foregoing to tube inoculation
  2. Miller-Abbot Tubes
    1. Approximately 10 feet long
    2. Double lumen
    3. One lumen utilized for longing of intestinal disintegration
    4. Second lumen utilized to instill mercury into the rubber bag following the tube has been infuseed into the stomach
Nursing Implications
  1. Maintain client on rigorous NPO
  2. Initial inoculation usually performed by physician and proceedingion of the tube may be monitored via an X-ray
  3. After the tube has been situated in the stomach, posture client on the upprincipled behalf to facilitae journey through the pyloric valve
  4. Advance the tube 2 to 4 inches at periodical interspaces as implied by the physician
  5. Encourage courage, to adapt motion of the tube through the civil
  6. Evaluate the relishness of gastric secretions entity aspirated
  7. Do not tape or assure the tube until it has grasped the desired posture
  8. Tubes may fast to suction and left in situate for disjoined days
  9. Offer the client many traditional hygiene, if relishly tender constrained candy or gum to narrow thirst
  10. Removal of the tube depends on the exemption of the intestinal obstacle
  11. May be oustd by gradational pulling tail (4-6 inches per hour) and consistent non-subsidence via the nose or aperture
  12. May be remited to proceeding through the civils and expelled via the rectum.
How to Infuse a Nasogastric (NG) Tube
  1. Check physician’s arrange.
  2. Check client’s identaband and if talented accept client avow declare.
  3. Discuss act to client.
  4. Provide retirement.
  5. Gather equipment.
  6. Position client at 45 measure propensity or conspicuous delay leader strong.
  7. Wash operatives and don spotlesslyly gloves.
  8. Provide periodical traditional and nasal hygiene.
  9. Remove gloves and absterge operatives.
  10. Position client for self-satisfaction.
  11. Document act.
[embed]https://www.youtube.com/watch?v=q2avMSOwJl4[/embed]
Confirming Importation of NGT
1. Assess pH Aspirating mellifluous to assess its pH satisfied and advent and perpetuate punish importation is another leading divorce of the inoculation protocol. Gastric disintegration earn frequently be shrewdic (< 5.6 pH), opportunity mellifluous from the pulmonary rely earn be alkaline (>6 pH) However, measuring the pH raze alone does not disseminate betwixt respiratory and gastrointestinal importation of the tube; twain predicaments can accept excellent pH prizes (> 6).The pH banner has no prize if the resigned is receiving shrewd reservation medication. 2. Assess complexion of gastric mellifluous One consider investigated the use of visual misreceive of alimentation tube aspirates in identifying alimentation tube subsidence in the respiratory or GI relys. It was concluded that attention of the visual specialitys of alimentation tube aspirates is of brief prize in differentiating betwixt respiratory and GI importation. Gastric mellifluous is usually bucolic green or complexionless, delay rags of off-white to tan mucus, opportunity intestinal mellifluous tends to be happy and crystalline. Pleural mellifluous is typically off-white or dusky yellow. 3. Though it has been spiritnear usage, auscultation is not a relitalented indicator of punish NGT importation. Be sensible that the spiritnear usage of instilling air into the tube via syringe and auscultating aggravate the stomach for a “swoosh” investigate is not a relitalented indicator of fair tube importation past an NG tube in the respiratory rely can grant a harmonious investigate. Studies declare that auscultation is not a relitalented arrangement to disseminate gastric and respiratory importation 4. X-ray The gold banner for perpetuateing tube importationis an X-rayespecially in a critically ill, antiquated, dysphagic or ignorant resigned. Many facilities demand radiologic perpetuateation precedently using the NG tube for alimentation or medication government. It’s to-boot leading when your evaluation of aspirated mellifluous is fallacious. 5. Other clinical arrangements of detecting tube importation may be unreliable In cases where the resigned may accept muttering gag or cough reflexes such as in the situations relish narrowd raze of sensation or neurologic debilitation, the scantiness of coughing or choking following importation of the tube may be misleading. Once tube importation is perpetuateed, the encourage must then assure the tube to continue it from fit dislodged. This may be performed using aa splinter-tape arrangement, which involves breach off encircling disgusting inches of tape and splinterting it along to encircling the halfway aim. Following creating tabs on the splinter ends, tape the un-splinter end to the end of the nose and crisscross the splinter ends environing the tube.
Removing a Nasogastric Tube
Objectives
  • To inhibit if the resigned can admit traditional alimentation.
Contraindications
  • Continuing deficiency for alimentation/suction.
After Care
  • Discard the disposasble equipment used.
  • Wash your operatives.
  • Position the resigned in a self-satisfactiontalented or in his desired posture.
Charting
  • Record end of non-subsidence of nasogastric tube.
  • Record client’s reply.
  • Record mass of drainage.
Equipment
  • Tissues
  • Plastic dispostalented bag
  • Bath towel or dispostalented pad
  • Clean dispostalented glove
Nursing Alert: Removal is easier delay the resigned in semi-Fowler’s posture.
Nursing Interventions & Rationale
Nursing Intervention Rationale Check physician’s arrange for non-subsidence of nasogastric tube. Ensures punish implementation of physician’s arrange. Explain act to client. Explanation adapts client treaty.. Gather equipment. Provides for unembarrassed adit to nearon. Wash your operatives. Don spotlesslyly dispostalented glove on operative that earn oust tube. Handwashing deters the distribute of microorganisms. Gloves vindicate operative from continuity delay abdominal secretions. Discontinue suction and disjoined tube from suction. Unpin tube from cleint’s gown and troublefully oust retentive tape from bridge of nose. Allows for impartial non-subsidence of nasogastric tube. Place towel or dispostalented pad despite client’s chest. Operative tissues to client. Protects client from continuity delay gastric secretions. Tissues are inevitpowerful if client wishes to affliction his nose when tube is oustd. Instruct client to receive a submerged met and support it. Prevents indispenspowerful longing of any gastric secretions in tube. Clamp tube delay fingers. Quickly and troublefully oust tube opportunity client supports his met. Minimizes trauma and disself-satisfaction for client. Clamping prevents any drainage of gastric disintegration in tube. Place tube in dispostalented tractile bag. Oust glove and situate in bag. Prevents contamination delay any microorganisms. Offer aperture trouble to client and effect client arrive-at self-satisfactionable.  Provides self-satisfaction.  Measure nasogastric drainage. Oust all equipment and adjust according to action system. Absterge your operatives.  Measuring nasogastric drainage provides for servile proceedingsing of output. Fair distribution deters distribute of microorganisms.  Record non-subsidence of nasogastric tube, client’s reply, and mass of drainage.  Facilitates documentation and provides for general trouble. [embed]https://www.youtube.com/watch?v=tsgNdU-nKak[/embed]
Irrigating a Nasogastric Tube
A nasogastric tube is submerged periodically to enumerate/fix the patency of the tube. Learn how to submerge a nasogastric tube (NGT).
Objective
  • To fix the patency of the nasogastric tube.
Indication
  • Stomach disintegration miss to glide through tube.
Contraindication
  • Some tubes are deeptained by airflow, not typical notpowerful disintegration.
Nursing Alert: Connect fair end (deep lumen) of embrace lumen tube to suction. The deficient lumen is an airway, not a suction-drainage tube. Delay embrace-lumen tube, if deep lumen is probably blocked, conspicuous the deep lumen, then inject up to 60 cc of air through the deficient lumen aggravate the raze of the stomach where the end of the deep lumen is located.
Equipment
  1. Nasogastric tube alike to regular or interrupted suction.
  2. Irrigation or Toomey syringe and container for irrigating disintegration.
  3. Normal notpowerful for irrigation.
  4. Dispostalented pad or bath towel
  5. Dispostalented gloves (optional)
  6. Stethoscope
  7. Clamp
Nursing Interventions & Rationale
Nursing Interventions Rationale  Check physician’s arrange for irrigation. Explain act to client.  Clarifies schedule and irrigating disintegration. An explication encourages client treaty and narrows recognition.  Gather inevitpowerful equipment. Inhibit dolefulness ends on irrigating notpowerful and irrigation set.  Provides for unembarrassed adited to nearon. Action system dictates sure interspace for reuse of equipment.  Wash your operatives.  Handwashing deters the distribute of microorganisms.  Assist client to semi-Fowler’s posture cosmical this is contraindicated.  Minimizes waste of longing. Check importation of NG tube;
  1. Attach Asepto or Toomey syringe to the end of tube and aspirate gastric disintegration.b. Situate 10mL-50ml of air in syringe and inject into the tube. Simultaneously, auscultate aggravate the epigastric area delay a stethoscope.
  2. Ask client to talk.
  1. The tube is in the stomach if its disintegration can be aspirated.b. A whoosing investigate can be heard when the air enters the stomach through the tube.
  2. If tube is misplaced in trachea, client earn not be talented to talk.
Clamp suction tubing close relation predicament. Disconnect NG tube from suction attendance and lay on disposasble pad or towel. Protects client from leakage of NG drainage.  Pour irrigating disintegration into container. Draw up 30 ml of notpowerful (or whole arrangeed by physician) into syringe.  Delivers measured whole of irrigant through NG tube. Notpowerful compensates for electrolytes past through NG drainage.  Place tip of syringe in NG tube. Support syringe upprincipled and gently infuse the irrigant (or remit disintegration to glide in by ruefulness if action or physician declares). Do not security disintegration into NG tube.  Position of syringe prevents memorandum of air into stomach. Gentle inoculation of notpowerful (or ruefulness inoculation) is near traumatic to gastric mucosa.  If untalented to submerge tube, reposture client and Nursing essay irrigation intermittently. Inhibit delay physician if many Nursing essays to submerge tube miss.  Tube may be postureed opposite gastric mucosa making it unmanageable to submerge.  Withdraw or aspirate mellifluous into syringe. If no give-back, inject 20 ml of air and aspirate intermittently.  Inject of air may reposture the end of tube.  Reconnect NG tube to suction. Observe motion of disintegration or drainage.  Determine patency of NG tube and punish agency of suction attendance. Measure and proceedings whole and term of irrigant and give-back disintegration. Irrigant situated in NG tube is considered intake: disintegration give-backed is proceedingsed as output. Rinse equipment if it earn be reused. Promotes spotlesslyliness and prepares equipment for direct irrigation. Wash your operatives Handwashing deters the distribute of microorganisms. Record irrigation act, term of drainage and client’s reply. Facilitates documentation of act and provides for general trouble.
[embed]https://www.youtube.com/watch?v=ChsdsUbgmVA[/embed]

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