Ng tube insertion procedure and Ng tube feeding

1. NASOGASTRIC TUBE
INSERTION PROCEDURE

2. ROUTES OF FEEDING

3. DEFINATION
Insertion of a small-bore tube to the stomach through the nasopharynx.

4. TYPES OF NG TUBE
LEVIN TUBE/ RYLES TUBE SALEM SUMP TUBE

5.  SIZE OF TUBE
• Adult :- 16 - 22 French
• Child :- 10 - 14 French
• Infant:- 4 - 10 French

6.  PURPOSES
• Decompression of stomach (to remove fluids and gas).
• To give gastric lavage (to irrigate the stomach in case of active
bleeding or poisoning).
• To obtain specimen (gastric contents) for laboratory studies.
• To give gastric gavage (feed directly into the stomach).

7.  PURPOSES
• To prevent or relieve nausea and vomiting after surgery or
traumatic events by decompressing the stomach.
• To determine the amount of pressure and activity of GI tract
(diagnostic studies).
• To administer medication.

8.  CONTRAINDICATION
• Severs midface trauma
• Recent nasal surgery
• Coagulation abnormality
• Esophageal varices
• Recent banding of esophageal varices.

9.  PATIENT POSITION
High Fowler’s position Semi Fowler’s position
COMATOSE

10.  ARTICLES
1. Kidney trays – 2.
2. Mackintosh and towel.
3. Cotton-tipped applicators.
4. Saline.
5. Levine’s tube or Ryle’s tube.
6. Water-soluble lubricant such as
glycerin or liquid paraffin.
7. Adhesive tape and scissors.
8. Gauze pieces.
9. Clean syringe, size 10-20ml
10. Measuring cup
11. Clamp for occluding the NG
tube.
12. Bowl with water.
13. Penlight/flash light.
14. Tongue blade.
15. Glass of water.
16. Suction apparatus (optional).

11. PROCEDURE

12.  Preliminary Assessment
Check
1. Doctors order.
2. Identify the patient.
3. General condition of patient.
4. Articles available in the unit.

13.  Preparation of the Patient and Unit
1. Wash hands
2. Explain the sequence of procedure.
3. Arrange the articles at bed side.
4. Provide privacy.
5. Provide comfortable position.
6. Place the Mackintosh and towel across the chest.
7. Clean the nostrils.
8. Give mouth wash and clean the teeth.

14.  Procedure
Nursing action
• Wash hands
• Measure the length of tube, i.e.
from tip of nose to tip of the ear
lobe and to the tip of xiphoid
process and mark with tape.
(NEX)
• For orogastric intubation, the
tube is measured from the lips to
xiphoid process of sternum.
Rationales
• The measured length approx. the
distance from the nose to
stomach
(For duodenal or jejunal place
ment, additional 20 cm to 30 cm
is required).
(NEX + 20 cm to 30 cm)

15. MEASURING LENGTH OF NG TUBE
NEX

16. • Cut the adhesive tape 10 cm long
and keep ready to fix the tube
• Put on clean gloves.
• Lubricate the tip of the tube
about 6-8 inches with water
soluble lubricant, using a gauze
piece.
• Insert the tube through the left
nostril to the back of the throat,
aiming back and down toward the
ear.
• Prevents contamination.
• Lubrication reduces friction
between mucous membrane and
the tube.
• Natural contours facilitate the
passage of the tube.

18. • Flex the patient’s head toward the
chest after the tube has passed the
nasopharynx.
• Encourage patient to swallow by
giving sips of water when possible.
• Advance tube 3-4 inches each time
patient swallows until desired
length has been passed.
• Do not force tube. When resistance
is met or patient starts to gag,
cough, choke or become cyanosed,
stop advancing tube and pull tube
back.
• Reduce the risk of tube entering
the trachea.
• Swallowing closes the epiglottis
over the trachea and facilitates
passage of tube into esophagus.
• Reduce discomfort and trauma.
Tube may be coiled or kinked in
oropharynx or trachea.

19. • If there are signs of distress such
as gasping, coughing or cyanosis,
pull back the tube for some
length and check if patient’s
distress is relieved. If it is
relieved, reinsert after few
seconds. If patient develops
respiratory distress again,
immediately remove the tube.
• The tube may have entered the
trachea.

20. • Perform one of the following
measures to check for the
placement of the tube:
a. Aspirate gastric contents and
check pH using litmus paper.
b. Place the end of the tube in a
bowl of water to check for
continuous air bubbles in water.
c. Ask the patient to speak.
d. X-ray may be done.
a. Aspirated contents indicate that
the tube is in the stomach.
b. Continuous air bubbles indicate
that tube is in the respiratory
tract.
c. Patient will not be able to speak
if tube is in the trachea.

22. • AUSCULTATE:-
Attach syringe to
free end of NG tube, place
diaphragm of stethoscope over
left hypochondrium. Inject 10 ml
of air and auscultate abdomen for
gushing sound.

23. • Secure tube with tape and avoid pressure on nares. Use a 10 cm piece of
tape spilt at one end.

24.  After procedure
• Make patient comfortable in bed and provide oral hygiene every 4-6
hours.
• Discard waste clean and replace reusable articles.
• remove gloves and wash hands.
• record the procedure.

25. ADMINISTRATION OF NASOGASTRIC
TUBE FEEDING
GASTRIC GAVAGE

26. GASTRIC LAVAGE

27. DEFINATION OF NG TUBE FEEDING
Administration of feeding directly into the stomach
through a tube passed into the stomach through the nose or
mouth

28.  PURPOSES
• To provide adequate nourishment to patients who cannot
feed themselves , e.g. surgery in oral cavity , unconscious or
comatose state.
• To administer medication

29.  INDICATIONS
• Head and neck injury.
• Coma
• Obstruction of esophagus or oropharynx.
• Severe anorexia nervosa.
• Recurrent episodes of aspiration.
• Increased metabolic needs – burns , cancer, etc.
• Poor oral intake.

30.  ARTICLES
• Formula feed
• Graduated container
• Large syringe ( 30-60 ml)
• Water in a container.
• Stethoscope
• Kidney tray
• Towel
• Clean gloves

31.  Procedure
• Nursing action
• Before procedure
• Identify patient and explain
procedure to patient and that
feeding will take around 10-20 min
to complete. Also explain that
patient will experience a feeling of
fullness after feeding.
• Assess for food allergies, time of
last feed, bowel sounds, and
laboratory values.
• Rationales
• Proper explanation allays anxiety
and ensures cooperation.
Explanation to be given to patients
who are comatosed or unconscious
as they may hear and perceived the
instructions.
• Proper assessment prevents risk of
complications.

32. • Place the container with
feed in warm water.
• Assist patient to Fowler’s
position (30Ÿ-45Ÿ).
• Warms the fluid to be fed.
• Fowler’s position enhances
gravitational flow of feed
through tube and prevents
risk of aspiration.

33. DURING PROCEDURE

34. • Wash hands.
• Spread towel and mackintosh
over patient’s chest.
• Don gloves and attach syringe to
NG tube.
• Aspirate stomach contents. If
there is doubt about tube
placement inform physician and
obtain an order for X-ray.
• Reduces risk of trasmission of
microbes.
• Protects the patient and bed
linen from soiling.
• If residual gastric contents exceed
100ml for intermittent tube
feeding or greater than 1.5 times
the hourly rate for continuous
feeding, withhold feed and notify
physician.

35. • If the residual contents are within
normal limits and placement of
the tube has been confirmed,
return gastric contents to
stomach through syringe using
gravity to regulate flow.
• If the tube placement is
confirmed in stomach, pinch the
feeding tube and attach barrel of
feeding syringe to tube.
• Fill syringe barrel with water and
allow fluid to flow in by gravity, by
raising barrel above level of
patient’s head
• Returning gastric contents to
stomach prevents fluid and
electrolyte imbalance.
• Pinching of feeding tube prevents
air from entering the stomach
and causing distention.
• Water clears the tube and the
rate of flow is regulated by raising
or lowering the syringe.

36. • Pour feed into syringe barrel and
allow it to flow by gravity. Keep on
pouring feeding /formula tobarrel
when it is three quarters empty.
Pinch tube whenever necessary to
stop when pouring.
• After feeding is completed , flush
tube with at least 30cc of plain
water.
• After tube is cleared, close end of
feeding tube.
• Rinse equipment with warm water
and dry.
• Keep head of bed elevated for 30-
60 min after feeding
• Prevents air from entering tube.
• Prevents clogging of feeding tube.
• Prevents leakage.
• prevents bacterial growth.
• Prevents aspiration.

37.  AFTER PROCEDURE
• Wash hands.
• Document type and amount of
water given , and tolerance of feed.
• Monitor for breath sounds , bowel
sounds , gastric distention ,
diarrhea , constipation, and intake
and output.
• Instruct patient to notify nurse if he
experiences sensation of fullness,
nausea or vomiting.
• Reduces risk of transmission of
microbes
• Evaluates for aspiration effects on
gastrointestinal system and
therapeutic effect of feeding.
• May indicate intolerance of
feeding.

38.  Siphon method