NG Insertion & Irrigatation checklist PDF

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Summary

NUR 1212C - Health Alterations Across the Lifespan I 5...

Description

INSERTION & IRRIGATION of NASOGASTRIC TUBE

first attempt

1.

Implement Standard Protocol. Check medical record for physician’s order, type of nasogastric tube to be placed, and tube purpose (ie. whether for suction or tube feeding)

2.

Assess client’s nares and oral cavity for deviated nasal septum, nasal surgery, inability to breathe well when either nasal opening is occluded or irritation/bleeding; Assess ability to cooperate.

3.

Measure estimated length of tube to reach well into stomach. Mark this distance on the tube with a removable piece of tape and/or Sharpie marker.

4.

Measure from tip of nose, to ear, to xiphoid process (N.E.X). (Typical tube size #12-18). Cut a piece of tape about 4 inches long and split one half of it into two pieces forming a Y.

5. 6. 7. 8.

Apply clean gloves.

9.

Lubricate ~ 4 inches of the distal end of the NG tube with a water-soluble lubricant. Place towel on patient’s chest. Tell client insertion is about to begin and ask to extend head back against pillow. (Bed in High-Fowlers position) Insert tube slowly through nares with curved end pointing downward toward ear. If resistance is met, apply gentle pressure downward to advance tubing. Check back of throat for coiling of tube with pen light. Ask client to bend head forward (chin on chest) and swallow with/without water as allowed and advance tube with each swallow.

10.

If gagging or coughing occurs, withdraw tube a little, allow client to rest and continue again to advance. Continue advancing with swallowing tubing until tape marker has been reached. Temporarily tape the tube to cheek until placement had been checked 11. Placement checks include: (check agency policy for preference methods)  Ask client to speak.  Inspect posterior pharynx for presence of coiled tube.  Attach catheter-tipped syringe to end of tube and aspirate gently back on syringe to obtain gastric contents, observing color. Test pH of aspirant if hospital policy.  Re-inject aspirant or air bolus and listen with stethoscope over gastric area for swishing sound. (not a solely reliable method to determine placement, call for Chest X-ray if hospital policy or any concern for placement)  Measure the amount of exposed tubing from nose to end of tube and compare to baseline.

12.

Anchor tube to nose with tube fixation device or apply tape to nose that was previously prepared using two ends to wrap around tubing. Apply a second piece of tape across the bridge of the nose over the first tape.

13.

Fasten rubber band to end of NG tube in a slip knot, and pin rubber band to client’s gown, allowing enough slack for movement of head. Keep head of bed elevated at least 30 degrees unless otherwise ordered

14.

Attach NG tube to suction source and establish suction at low intermittent setting unless otherwise ordered. Provide oral hygiene every 2-3 hours. Use Completion Protocol

STATE: INSERTION DOCUMENTATION: Use the appropriate chart forms and indicate: The time of insertion; The NGT length, size, and type of gastric tube inserted; The color and consistency of drainage. The Client’s response to treatment and Instructions that you gave to the client. Use the intake and output record (I & O) and record: Amount of drainage. If pH was tested, the value obtained.

IRRIGATION of a NASOGASTRIC TUBE

first attempt

1.

Implement Standard Protocol. Position client in semi/ high-fowlers position Apply clean gloves.

2.

Disconnect the NGT from suctioning connection. Lay tube on towel.

3.

Check placement of NGT. Use a 30ml syringe & obtaining gastric secretions by aspiration.

4.

Then place stethoscope over left epigastric area and reintroduce gastric aspirant/air bolus and simultaneously auscultate for a swishing sound Instill 30 ml. of sterile water/normal saline and withdraw solution. Measure and discard amount of instilled water/saline solution returned Reconnect NG tube to suction and reestablish suction to ordered level, usually low intermittent suction. Inspect the color, volume, and character of NG secretions STATE: IRRIGATION DOCUMENTATION Use the appropriate chart forms and indicate: The type and amount of irrigation solution; The difference in volume between what was instilled & volume withdrawn; the characteristics of the returned solution and any difficulty irrigating the tube. Record the client’s response to the irrigation and any teaching performed.

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