Why do we need to use a large bore NGT?
- Selected surigcal procedures
- gastric distention
- irrigation of stomach (lavage)
- lack of peristalsis post surgery or trauma
- administration of medications
- tube feedings (gavage)
- aspiration of stomach contents for analysis
what is the general size of a large-bore NGT?
What are the two types of NGT?
- Levin (single lumen)
- Salem Sump (central lumen with separate air vent lumen)
Describe a levin tube?
- Single lumen
- made of plastic or rubber
- 14-18 fr in size
- has circular markings for insertion guides
- connected intermittent suction (low intermittent 80-120 mm Hg)
Describe a salem Sump tube?
- double lumen-central for gavage/lavage, sump for air vent
- made of plastic
- 12-18 fr in size
- small inner tube (blue pigtail) vents the larger suction-drainage tube to the atmosphere by way of an opening at the distal end of the tube
- low continuous or intermittent suction OK
What is the rule for the air vent on the salem sump tube?
Never clamp off, connect to suction, or use for irrigation.
What is the Anti-reflux valve for?
To prevent the reflux of gastric contents out of the vent lumen.
What should you do if leakage from vent lumen is noted and why?
- 1. instill 10 ml of air into vent
- 2. irrigate suction lumen with normal saline
- Reason:Reestablishes a buffer of air between the gastric contents and the valve
What do you need to assess for in the patient before inserting a NGT?
- Condition of the nares, which is the best naris.
- Why the client needs a NGT.
- Has the cline had NGT before.
- whats the clients LOC
- The MD order
- Type and size of tube and whether it will be on suction
What are some expected outcomes for inserting an NGT?
- decompression of the stomach
- adequacy of fluid volume
- adequacy of nutrition
- prevent complications r/t NGT intubation
What are some key points while inserting?
- have suction equipment, emesis basin, and towel ready
- stand on client's right side if right handed, vice versa
- teach the client a way to establish communication
What should you do if you feel resistance while inserting?
- Never FORCE
- use gentle downward pressure
- try to rotate tube slowly
- pull back slightly and try again
- remove, relubricate, retry
True/false. If the patient eyes start to water up quickly stop and remove quickly.
False. watery of the eyes is a natural body response.
What is the best way to verify placement?
what are the ways to verify placement?
- ask client to speak
- check to see if tube is coiled in posterior pharynx
- aspirate gastric fluid to check ph
- air insufflation
What are the ph levels for placement?
- Gastic = 4 or less
- intestinal = greater than 4
- respiratory= greater than 5.5
How do you use air insufflation?
Instill 30 ml of air and listen to the upper left quadrant of the abdomen for a "whoosing" sound.
When should you verify placement?
- For intermittent feedings=before feedings, medication, and fluid
- For continous feedings=every 4-12 hours and before meals
When and what should you elvaulate for?
- Evaluate every 2-3 hours
- For: BS (must turn off suction)
- abdominal distention/pain
- discomfort in the abdomen, thorat, or nasal
- color and amount of drainage
- position and patency of NGT and air vent
- oral and nasal mucosa
What should the height of the head of the bed be at all times?
HOB 30 or greater
What should you do if the tube is placed into the respiratory tract?
- remove tube and report it to the doctor
- obtain order for reinsertion
What should you do if stomach contents were aspirated into the respiratory tract with s/sx of regurgitaion with coughing, dyspnea, cyanosis, or decrease in O2?
- postion patient on side to protect airway
- suction nose and mouth to remove aspirated substance
- report to MD
What should you do if stomach contents were aspirated into the respiratory tract with s/sx of crackles or wheezes in lungs, dyspnea, or fever?
- report changes to MD
- request CXR, if one not already done
- prepare to initate antibiotics
What are the reasons to remove the NGT?
- no longer needed for decompression of stomach
- gastric or intestinal motility resumed
How do you determine if a patient is ready to be DC from the tube if all gastric and intestinal motility resumed and no abdominal discomfort or distention?
Turn off suction for 4 hours and client tolerates it by no vomiting, no distention, and has BS. It's okay.
What are some expected outcomes when removing NGT?
- Minimizing discomfort caused by the removal
- BS active and bowel function is normal
What do you evaluate for after removing tube?
- Clients LOC
- any decrease BS
- any problems while DC
- If abdominal disetention/nausea/discomfort returns
Why do you irrigate a NGT?
to maintian patency
What are signs that show that the tube may not be patent?
- Decreased volume of gastric secretions
- Abdominal distention
- Abdominal pain
What type of fluid do you use to irrigate with?
sterile water for neonates, before and after meds, critically ill, and immunocompromised patients.
What are the steps in irrigation?
- 1. place a towel over client chest
- 2. DC suction/ turn off feeding
- 3. verify placement
- 4. kink tube
- 5. slowly instill 30 ml of fluid keeping syringe tip down
- 6. aspirate fluid
- 7. reconnect NGT to suction
- 8. instill 10 ml of ain into air vent (if necessary)
What should you do if you are unable to instill the fluid to irrigate?
- repostion patient on left side and try again
- notify md
- may need to be removed
What should you do if you have red or brown color fluid that is aspirated which means new or old blood in GI tract?
What should you do if patient develops severe respiratory distress?
- stop feeding
- Notify MD
- obtain CXR
What should you do if fluid and electrolyte imbalance develops?