NGT lab

• Entry point of NGT: nose
• Tube enters the nose going down the pharynx to trachea

  Position: Much advised to upright, semi-fowler, or high fowler, less pressure on the throat
• Purpose of Inserting a Nasogastric/Nasointestinal Tube

  1. Nutrition/Medication Administration
  2. Gastric contents
  3. Nausea & Vomiting
• Given for detoxification: Activated charcoal - for toxins or poisons
• Regular size of NG tube: 14-16 french
• Assessment: what do you need to know?

  1. presence of doctor’s order
  2. Size of previous tube used, if any history of GI problems requiring use of tube
  3. History of nasal or sinus problems
  4. Gastrointestinal Status
  5. History of nasal surgery or deviated septum
  6. Patency of nares and gag reflex
  7. Mental status or ability to cooperate with the procedure
• The nurse must ensure that the patient has not eaten within 8 hours prior to insertion of an NG tube.
• Insertion of NG tube is contraindicated when there are signs of peritonitis (abdomen distended), bowel obstruction, recent abdominal surgery, active bleeding from esophageal varices, severe coagulopathy, uncontrolled vomiting, and gastric outlet obstructions.
• Gag reflex is needed to instruct to swallow if they are awake, will help to advance tube
• Instruments needed for a procedure:

  • NG TUBE (14-18 FRENCH) or nasointestinal small bore feeding tube (8-12 french)
  • Non-allergenic adhesive tape, 2.5 cm (1 inch) wide
  • Non-sterile gloves for clean procedures, perform medical hand washing
  • Water-soluble lubricant that can be swallowed
  • Facial tissue or towel for wiping or blowing nose
  • Glass of water and drinking straw or ice chips
  • 30-60 ml syringe with an adapter or asepto syringe
  • Emesin Basin
  • Ph test strip to check acidity or alkalinity
  • Stethoscope
  • Disposable pad
  • Pen
• Duodenal tube: no cover, only opened. Used for decompression since they need it opened, not used for feeding but can be used too. Fold the end then kink to cover the open end

  Siliconized tube: no reaction unlike the duodenal made out of latex - has resealable cap - has a blue tip, indicated the starting point, dapat nakikita yung blue baka naiwan sa tiyan. Can be stored in cold places, if patient needs to go home they replace with siliconized, mas matagal di masisira)

  Kid Size: smaller the size, smaller tube, smaller length
• Abdominal status monitoring

  • size of stomach - baseline
  • characteristics of stomach - shiny well-stretched, percussion (drum-like), auscultate (gurgle & bowel sound)
  • nausea & vomiting
• Steps in NGT insertion:

  1. Introduce yourself and verify the client's identity, explain the procedure and its necessity, whether the client is conscious or unconscious

  2. Perform hand hygiene and ensure client privacy, lower siderails, and position the client in semi or high Fowler's position

  3. Check nasal patency, ask the client to breathe through each nostril, clean mucus, and secretions

  4. Prepare the tube by measuring the length needed, marking it, ensuring cleanliness, and lubricating it before insertion

  5. Insert the NGT, secure it, and confirm placement with an X-ray

  6. Store the stylet in a plastic bag, begin suction or tube feeding as ordered, restore or discard equipment, reposition the client, remove gloves, and document all relevant information
• When inserting the NGT, the higher the head part of the client, the easier the insertion
• For unconscious clients, maneuvering is easier, ensure the NGT is well-lubricated and assist in positioning
• After correct placement, store the stylet from the small-bore feeding tube in a plastic bag at the bedside
• Document all relevant information including the date and time of tube insertion, color and amount of drainage return, client tolerance of the procedure, and confirmation of placement by X-ray
• If bright red drainage is observed, it indicates external bleeding, while darkening blood may suggest internal bleeding
• To flush the tube, use cold water for vasodilation, avoid purified or mineral water, and opt for distilled water that has been boiled several times
• Always confirm the placement of the NGT with an X-ray before proceeding with suction or tube feeding
• If gastric content appears abnormal (reddish, yellowish, or black), consult a doctor for further evaluation
• The golden standard for NGT insertion confirmation is an X-ray
• Ensure to reposition the client for comfort after the NGT insertion
• When documenting, include the size and type of tube, the client's tolerance of the procedure, and any suction applied or tube feeding started
• If the client seems to be choking during NGT insertion, use bandage scissors to create a Y in the tape and remove the marked tape to ease the situation
• Before opening the end of the NGT tube, ensure it is closed, kink it, aspirate, check the contents, and use a pH strip to determine acidity
• If the NGT insertion is for a post-op patient with no increased ICP, consider shifting the oxygen delivery system from nasal cannula to face mask or venturi mask
• For unconscious clients, the key to easier maneuvering is a well-lubricated NGT and proper positioning assistance
• If the drainage is consistently black, refrain from feeding through the NGT, while white drainage indicates undigested material
• Purpose of NG T feeding

  • Provides nutrition supplementation to clients who cannot ingest adequate amounts of nutrients orally.
• Materials needed for NGT feeding:

  • Stethoscope
  • Ph paper
  • Irrigation set with a 60 ml piston-type syringe
  • Washcloth and towel
  • Disposable gavage feeding set bag and tubing
  • Appropriate pump
• Steps for NGT feeding:

  1. Insert the tubing for continuous feeding (gavage feeding) and consult the doctor for the desired duration of the continuous feeding

  2. Open the regulator for continuous feeding and follow the specified time, regulating it similar to an infusion drip

  3. Avoid giving undissolved powder, always use warm water

  4. Check the tubing for air by using a syringe, ensuring proper handling

  5. Always start with flushing, avoiding the introduction of air, and continue while there is still fluid present

  6. Flush, administer medication, then flush again
• Assessment in NGT feeding

  • Response to previous enteral nutritional support
  • Medical diagnosis that may affect tolerance to product or administration
  • Doctors order for nutritional product and route of delivery.
• Documentation for NGT feeding

  • Assessment of tube placement and method of confirmation
  • Assessment site of tube feeding
  • Amount of residual feeding
  • Amount and type of product given
  • Amount of water given with and between feedings
  • Route and method of delivery
  • Client position during and after administration of products
  • Clients tolerance of procedure
  • Teaching Performed
• Steps in NGT removal:

  1. Introduce yourself and verify the client's identity

  2. Explain to the client the procedure, its necessity, and the need for cooperation

  3. Perform hand hygiene

  4. Provide privacy

  5. Make the patient comfortable, ensure proper draping, provide tissues for mouth wiping

  6. Determine the time of the last meal to prevent aspiration and inform when the client can eat again

  7. Prepare a trash bin

  8. Slowly remove micropore

  9. Instruct the client to breathe deeply during the removal process

  10. Remove the NGT with proper positioning

  11. Remove the glove with the dominant hand, check for any blood on the tube or nose

  12. Fix any dislodged items

  13. Dispose of the equipment correctly

  14. Document the removal, including the amount and appearance of any drainage, tube connection to suction, and relevant assessments
• • Clear liquid - gelatin - no sugar content, just plain at papakain
  • If nalulunok ang clear liquid that means bumalik na ang gag reflex
  • Neurologist recommended to consume Osteorized feeding
  • Di yan uuwi agad if naremove palang
  • Normal na ADL is di pa nagawa kaya dapat DAT - diet as tolerated
  • Passage of flatus

  Clear liquid - tea, instant coffeee, water, gelatine, broth

  Generalized Liquid - soup. puree

  Soft food - champorado w/o chocolate (baka mukhang dugo), lugaw

  Diet as tolerated (pwede na mag remove)