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Nasogastric Tube Insertion & Gastric Lavage - Coggle Diagram
Nasogastric Tube Insertion & Gastric Lavage
NGT Insertion
A process of placing a soft plastic nasogastric (NG) tube through a patient's nostril, the pharynx and down to the oesophagus into a patient's stomach
Purposes
To remove fluid and gas from GIT (decompress)
To prevent or relieve nausea and vomiting
To determine the amount of pressure and motor activity in the GIT (diagnostic study)
To administer medications and feeding directly into the GIT
To obtain a specimen of gastric contents for laboratory studies
Assessment
Assess overall status necessitating NG insertion e.g. decompression → gastric op, intestinal obstruction
Assess GI function e.g. nausea, vomiting, flatus/BO
Validate order, purpose and correct patient
Patency of nares
Risk of aspiration
Electrolyte balance
Privacy
Patient’s understanding of purpose
Planning
Items required (tray containing)
Water soluble lubricant
Stethoscope
NGT 12-18 FG with stopper
Syringe 10cc,20 cc
Gloves
Tape
Penlight
Tissue, towel
Glass of water with straw
Kidney dish
Prepare the patient
Place towel across chest
Position 45° angle or high fowler’s
Select most patent nostril
Determine the appropriate length for tube insertion
Note the marking point
Lubricate 10cm from tip
Measure from tip of nose to earlobe to xiphoid
Coil end of tube over fingers
Implementation
Technique of inserting a NGT
Ask patient to swallow / drink water → advance the tube as patient swallow → Repeat swallowing until tube is at the desired level
If obstructed, do not force → rotate gently, if still fail → remove and try another nostril
Once tube in the posterior pharynx have patient flex head forward while supporting back of patient's head to maintain position
If patient in distress e.g. choking, coughing and unable to speak→ immediately stop
Tilt back patient’s head → gently and carefully insert tube into nostrils aiming downward (ear) and backward (nasopharynx)
Confirm tube in stomach
Place stethoscope over epigastrium and push in 5-10cc air → ‘whooshing’ sound heard (less reliable)
Test gastric content using litmus paper (less reliable)
Aspirate gastric contents with 20cc syringe to check for colour & pH → pH 5 or less, green or clear with tan mucus shreds
X-ray (most reliable)
Secure NGT
Unsplit end over bridge of nose, wrap each end of tape around tube
Anchor tubing to patient’s gown
Cut tape 7.5cm, split ½ lengthwise
Evaluation
Documentation
Any problems during insertion
Volume and characteristic of drainage
Date, time and size of NGT used
Gastric Lavage
Definition
Refers to washing out or irrigation of the stomach →generally ineffective for poison or drug ingestion if > 1 hour have passed
Method
Intermittent open system
Closed system irrigation
Assessment
Perform baseline assessment i.e. vital signs, abdominal inspection, girth and bowel sounds
Confirm Dr’s order for gastric lavage and solution to be used
Assess whether patient is alert or comatose
Determine patient’s level of understanding regarding the procedure and its purpose
Purpose
To stop haemorrhage
To remove ingested non-corrosive poisons
To collect and examine gastric contents for identification of poison
To relieve persistent vomiting
To clean stomach in preparation for gastric surgery
Contraindications
Poisoning due to ingestion of petroleum products e.g. kerosene → chemical pneumonia
Poisoning due to corrosive agent → introduction of stomach tube can cause perforation of the inflamed oesophagus & risk of aspiration
In an unconscious patient unless he has been intubated
Planning
Prepare items required
Lavage fluid, normal saline / lukewarm water
Activated charcoal for drug/toxin absorption
Syringe 20 & 50cc
Container for aspirate
Orogastric tube/ NGT 16-18 G
Specimen bottle
Water soluble lubricant
Towel
Gloves
Implementation (Procedures)
Aspirate gastric contents with syringe before instilling
solution→ save specimen for analysis
Perform lavage
Intermittent open system
Repeatedly instill 50-100mL normal saline/water and aspirate contents
Carefully monitor volume instilled, character and volume of aspirated contents
Continue repeating process until gastric return is clear or as ordered
Stomach will be left empty for decontamination e.g. activated charcoal/ saline cathartic
Closed system irrigation
Attach drainage/ suction tube to other arm of connector
Empty stomach, clamp drain tube or turn off suction and allow 50-200mL of solution to run into stomach by gravity
Wear clean gloves, connect Normal Saline to NGT using Y connector
Stop solution and allow to drain or suction out
Preparation of patient for tube insertion
Position patient in Semi Fowlers/Fowlers/left latera
Lubricate tube with water soluble lubricant
Insert tube nasogastrically or orogastrically
Determine length for tube insertion
Verify tube position before securing tube
Removal of tube
Pinch tube for removal, hold with gauze, withdraw quickly and gently and dispose of equipment
Remove and dispose of gloves and perform hand
hygiene
Obtain baseline data
Vital signs, abdominal inspection/ girth and bowel sounds
Evaluation
Monitor and document
Observe patient closely for first 24 hours
Seal specimen for toxicological analysis and dispatch
immediately
Document procedure including amount and type of irrigation used, gastric output character and amount, client’s condition and tolerance of the procedure