NASOGASTRIC TUBE

Nasogastric intubation is a medical process involving the insertion of a plastic tube (nasogastric tube, NG tube) through the nose, past the throat, and down into the stomach.

BRIEF HISTORY
Fabricius

ab Aquapendente, who was born in Italy in 1537 and died in 1619, was a professor of anatomy and surgery (silver tube)

BRIEF HISTORY
1790

that John Hunter successfully fed a patient via a flexible hollow leather tube inserted into the stomach(tube was made of eel skin)

BRIEF HISTORY
Nasogastric

tubes were used first in humans for the sole purpose of administering nutrition

BRIEF HISTORY
In

1800, Philip Physick, a surgeon from Philadelphia, started to advocate in his lectures the use of a stomach tube as a form of stomach pump.

BRIEF HISTORY
In

1822, Mr. Jukes, an English surgeon, published a description of what he called "a stomach pump"

BRIEF HISTORY
In

1822, Mr. Jukes, an English surgeon, published a description of what he called "a stomach pump"
In

1921, the Levin tube was introduced; this flexible nasogastric tube was made of rubber

BRIEF HISTORY
The

improvement of acute care techniques eventually led to improved patient survival and many more people requiring nutritional support, and this resulted in the practical beginnings of modern enteral nutrition

NASOGASTRIC TUBE

TYPES OF PROCEDURES
GASTRIC GAVAGE GASTRIC LAVAGE INTRACRANIAL NGT

Indications
Diagnostic

Evaluation of upper gastrointestinal (GI) bleed (ie, presence, volume) Aspiration of gastric fluid content Identification of the esophagus and stomach on a chest radiograph Administration of radiographic contrast to the GI tract

Indications

Therapeutic
Gastric decompression, including maintenance of a decompressed state after endotracheal intubation, often via the oropharynx Relief of symptoms and bowel rest in the setting of small-bowel obstruction Aspiration of gastric content from recent ingestion of toxic material Administration of medication Feeding Bowel irrigation

Contraindications
Absolute

contraindications

Severe midface trauma Recent nasal surgery

Relative

contraindications

Coagulation abnormality Esophageal varices or stricture Recent banding or cautery of esophageal varices Alkaline ingestion

EQUIPMENTS

TYPES OF NASOGASTRIC TUBES

The Levin Tube -is a one-lumen nasogastric tube

TYPES OF NASOGASTRIC TUBES

The Salem-Sump Tube.
This tube is a two-lumen piece of equipment. It has a drainage lumen and a smaller secondary tube that is open to the atmosphere.

TYPES OF NASOGASTRIC TUBES

The Miller-Abbott Tube.
This tube is also a two-lumen nasogastric tube. There is a rubber balloon at the tip of one tube; the other tube has holes near its tip.

TYPES OF NASOGASTRIC TUBES

The Cantor Tube - has one lumen and a bag on the end.

SIZES
Adult
Size Colour Code

- 16-18F
FG-8 Blue FG-10 Black FG-12 White FG-14 Green FG-16 Orange FG-18 Red FG-20 Yellow

Pediatric

- In pediatric patients, the correct tube size varies with the patients age.

Infection Control
Hand

Washing Wear a set of gloves Wearing face and eye protection Wear disposable apron.

IMPLEMENTATION
Verify

for physician order. Identify Client & Introduce yourself Explain the procedure Assemble the Materials needed

NURSING RESPONSIBILITY
Inserting

and removing the tube Assessing correct placement Securing the tube Meeting patient comfort needs Monitoring patient responses

IMPLEMENTATION
Explain the procedure, benefits, risks, complications, and alternatives to the patient or the patient's representative. Examine the patients nostril for septal deviation. To determine which nostril is more patent, ask the patient to occlude each nostril and breathe through the other.

POSITION
Position the patient in a High Fowlers position.

MEASUREMENT
Adult Measure from the tip of the nose, around the ear, and down to the xyphoid process.

MEASUREMENT
Infant Measure from the tip of the nose, around the ear and down to the umbilicus.

INSERTION

Lubricate the distal end of the Tube

INSERTION

Instruct the Patient to drink while the tube is inserted

CHECKING FOR PLACEMENT

Auscultation

of air insufflated through the tube

Immersion

of the Proximal end of in a glass of water.

CHECKING FOR PLACEMENT

Aspiration

of fluid from the tube, with pH testing of the aspirate.

pH < 5 GIT pH > 6 - Respiratory

CHECKING FOR PLACEMENT

Chest

X-ray

NG OPTIMIZER

SECURE THE NG TUBE

Anchor the tube securely to the nose and cheek - keeping it out of the patients field of vision.

COMPLICATIONS

Minor complications - Nose Bleeds,Sinusitis, and sore throat More significant complications - Erosion of the nose where the tube is anchored, esophageal perforation, pulmonary aspiration, a collapsed lung, or intracranial placement of the tube.

INTRACRANIAL PLACEMENT OF THE TUBE

Inadvertent

Intracranial Placement of a Nasogastric Tube in a Patient With Severe Craniofacial Trauma

INTRACRANIAL PLACEMENT OF THE TUBE

INTRACRANIAL PLACEMENT OF THE TUBE

INTRACRANIAL PLACEMENT OF THE TUBE

INTRACRANIAL PLACEMENT OF THE TUBE

INTRACRANIAL PLACEMENT OF THE TUBE Complications include: Hemiparesis Intracranial bleeding Decerebrate posturing Respiratory arrest Suctioning of brain parenchyma Blindness Loss of the sense of smell Meningitis Decreased mental status Persistent cerebrospinal fluid fistula.

INTRACRANIAL PLACEMENT OF THE TUBE

35 cases of intracranial nasogastric tube insertion have been reported in the international literature. A complex craniofacial fracture is the most common predisposing factor. Mortality rate of 64%.

Decerebrate Posturing

Decerebrate Posturing

DOCUMENTATION
Date and time of procedure Indication for insertion Type of tube used Distance tube inserted (if appropriate) The nature of the aspirate Methods used to check location of the tube insertion Any procedural comments