Procedure checklist inserting nasogastric and nasoenteric. Download a printfriendly pdf version of this article here. There are several absolute contraindications for insertion so you should be aware of these. Saskatoon health region shr cannot guarantee the currency or accuracy of any printed policy. Carefully docu ment the procedure and method you used to verify tube placement. The placement of an ng tube can be uncomfortable for the patient if the patient is not adequately prepared with anesthesia to the nasal passages and specific instructions on how to cooperate with the operator during the procedure 23.
Infants and children insertion and confirmation of placement of nasogastric and orogastric tubes summary this guideline represents a best practice guide for the insertion and confirmation of placement of nasogastric and orogastric tubes in children and infants in the acute care setting. It discusses the indications, patient preparation, insertion technique and various methods of confirming the tube s position. Nasogastric tubes are commonly inserted by a variety of practitioners including nurses, doctors and allied health professionals who for the purpose of this guideline, will be termed practitioner. Insert a nasogastric tube and feed your child with these instructions. Although this procedure can safely be undertaken by one competent practitioner it is advisable to have a second person present to assist with positioning of. Creative commons licensing attribution, noncommercial, sharealike. Nasogastricorogastric tube insertion, verification, and. Measure the length of tube in cm that remains out of the nostril. Provide a signal for the patient to stop the procedure. Nasogastric intubation and feeding definition and patient.
Nasogastric tubes has varying sizes measured in french 8, 10, 12, 14, 16 and 18 fr nasogastric tube insertion procedure. Using hypoallergenic tape, mark the distance which the tube is to be passed by measuring the distance on the tube from the bridge of the patients nose around the ear lobe and down to the bottom of the xiphisternum. Lubricate 24 inches of tube with lubricant preferably 2% xylocaine. Clinical specialist services area locssip describing all natssip principals which apply to this invasive procedure and checklist. A nasogastric tube ngt is a flexible tube that provides access to the stomach through the nose. Note the placement of the amt bridle in the patients chart. Pediatric nasogastric tube placement and verification. Thus, it is important for the practitioner to be aware of how to prevent these complications so that nasogastric tube feeding can be administered successfully and safely. Nasogastric tube insertion parentcaregiver information christchurch hospital a nasogastric tube, also known as an ngt is a thin soft tube that is inserted through the nose into the food pipe until it reaches the stomach. Insertion involves passing the tube through the nose, along the nasal floor, through the pharynx and down the esophagus until the proximal tip of the tube rests in the patients stomach. Adult nasogastric tube ngt insertion and removal procedure. Marks the length with tape or indelible ink on the ng tube. Date and time of enteral feeding tube insertion and size of tube used.
This topic focuses on the steps involved in inserting and verifying placement. Monitor the clip and nasal tube position regularly for feeding tube migration. This procedure is very uncomfortable for many patients. Active learning templates therapeutic procedure a9 nursing skill. Wash hands and prepare materials to be used in the nasogastric tube insertion. This article explains what an ng tube is, and how to insert it. Measures from the tip of the nose to the earlobe, and from the earlobe to the xiphoid process. External tube length measurement for confirmation of tube placement. Before undertaking this procedure the practitioner should have completed training and demonstrated competency in nasogastric tube insertion in accordance with local policy. A 2016 study reported that approximately 25% of hospitalized pediatric patients require a temporary feeding tube. That said, some of these procedures are considered to have a theoretical risk of aerosolisation, and therefore are.
If resistance is met, withdraw tube a little and try again with the wire. A nasogastric ng tube is a flexible plastic tube inserted through the nostrils, down the nasopharynx, and into the stomach or the upper portion of the small intestine. Lippincott procedures is your online source for instant, evidencebased procedure guidance at the point of care. Elevate the head of the bed as tolerated by the child. Nasogastric tube insertion noaa office of marine and. Curve 10 to 15cm4 to 6 inches of end of tube tightly around index finger, then release. Nurse for ryle tube insertion nasogastric incubation. Nasogastric tube ngt insertion gastrointestinal osce.
Assessing nasogastric ng tube placement geeky medics. Nasogastric ng tubes or orogastric og tubes are small tubes placed either through the nose or the mouth and end with the tip in the stomach. Nasogastric ng tube insertion is an important skill youll be required to demonstrate in your osce exams. May 26, 2018 nasogastric ng tubes may be used for feeding or for drainage read your instructions thoroughly as this will dictate the type of tube you need to use. Appendix 3 additional guidelines of nasogastric tube placement. The procedure requires excellent procedural and communication skills to perform the task effectively whilst reassuring the patient. Note a nasogastric ng tube is used for the procedure. Inserting and verif ying placement in the adult patient what is involved in inserting and verifying placement of a nasogastric tube in the adult patient. When the tip of the tube reaches the carnia stop and listen for air exchange from the distal end of the tube. Nasogastric ng tubes may be used for feeding or for drainage read your instructions thoroughly as this will dictate the type of tube you need to use.
Verify the order for tube placement with medical staff senior nursing staff before proceeding. Vivek shrihari assistant professor department of surgery mgmcri puducherry 2. There is potential risk for ngt misplacement with each insertion. Testing placement wash hands and put on clean gloves draw up 30cc of air into the syringe and attach to end of the ng tube. The nasogastric or ryles tube insertion procedure is a detailed one and should be followed diligently to avoid any complication and. Volume a policies and procedures nasogastric tube insertion policy authorised by.
This video demonstrates nasogastric tube insertion and considers. Clinical indicatorspurpose for nasogastric tube insertion. The ability to safely assess nasogastric ng tube placement is a key skill that medical students are required to learn. Ng tube clamp tube ng tube stethoscope stomach nasogastric ng tube feeding instructions bolus gravity feeding. A nasogastric ng tube is a flexible plastic tube inserted through the nostrils, down the nasopharynx, and into the stomach or the upper portion of the small. Learn why this procedure is used and what it involves. Nasogastric ng tube feeding instructions bolus gravity.
Nursing management of nasogastric tube feeding in adult patients. Page 1 of 14 any printed version of this document is only accurate up to the date of printing 20nov 17. Insert the proximal end of the tube into the clearer nostril and slide it backwards and inwards along the floor of the nose to the nasopharynx. Nasogastric ng tube insertion osce guide geeky medics. Bridle ng tube amt bridle retaining system pocket guide. Improving the documentation of nasogastric tube insertion. Check with mrp prior to insertion both ng og tubes 2. Nasogastric intubation is a medical process involving the insertion of a plastic tube nasogastric tube or ng tube through the nose, past the throat, and down into the stomach. Swallowing facilitates the passage of the tube through the oropharnyx.
To be completed by the individual who is inserting the ngt. Nasogastric tube insertion parentcaregiver information. Appendix 4 competency for nasogastric tube ng insertion and. In this instance, an orogastric tube may be inserted. Use a 5 to 10 ml syringe to push 2 to 5 ml air into tube and listen over stomach with stethoscope for whoosh or gurgle sound. Identify patient and explain the procedure to the client to gain cooperation. The main complications of ng tube insertion include aspiration and tissue trauma. Ng tubes are inserted for a number of reasons from feeding to drainage. Infants and children insertion and confirmation of placement. Nasogastric ng tube placement oxford medical education. Essentially you are inserting a tube from the patients nose into their stomach. Jul 10, 2017 note a nasogastric ng tube is used for the procedure. Infants and children insertion and confirmation of. We sought to determine the clinical evidence for the risk of transmission of aris to hcws caring for.
Place the end of the ng tube with the 2 small holes in it at the tip of the childs nose and measure to his ear lobe. Aerosol generating procedures and risk of transmission of. If an obstruction is felt, withdraw the tube and try again in a slightly different direction or use the other nostril. Ng og tubes may be used for feedings, medication administration, or removal of contents from the stomach via. Insertion of an ngt is usually a blind procedure i. Aug 20, 2018 simple steps for inserting an ng tube. In nasogastric ng intubation, a thin tube is placed through your nose into your stomach.
How to insert a ng tube instructions plus video tips. If indicated, enlist a second person to help keep the child immobile during the procedure andor encourage parental presence for support. Section 2 insertion of a large bore nasogastric tube salem sump a salem sump tube is a double lumen ngt with an air vent blue pigtail, which allows atmospheric air to enter the patients stomach so the tube can flow freely, thus preventing the ngt from adhering to and damaging the gastric mucosa. Aerosol generating procedures agps may expose health care workers hcws to pathogens causing acute respiratory infections aris, but the risk of transmission of aris from agps is not fully known. Using ng tube to be inserted,measure distance from tip of nose to earlobe to xiphoid process of the patient and mark with a small piece of tape. Common indications for nasogastric intubation include decompression of.
To be completed by the individual inserting the ngt before procedure is commenced. You may need to wrap your baby in a blanket to keep his arms down during the procedure. Ensuring correct ng tube placement be sure to use the correct method for determining if the ng tube is inserted to the correct distance. Throughout the useful life of the amt bridle, the clip must be visually inspected for signs of damage or loose attachment to the nasal tube. Nursing clinical skills are very important to learn, and the ng tube insertion is among one of the frequent tasks a registered nurse or nursing student will encounter on the job. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Pur is tissue compatible and the material of choice in fine bore nasogastric tubes as it remains soft and. Improving the documentation of nasogastric tube insertion and. Placement of the catheter can induce gagging or vomiting, therefore suction should always. Check with mrp or ordering physician prior to insertion both ng og tubes. Nasogastric ng orogastric og ng tube og tube ph verification. Place a towel across the patients chest and inform himher that the tube is to be withdrawn. The gi doctor performed a egd in the endoscopy suite and inserted a ng feeding tube. Indications for nasogastric tube insertion, the procedure for inserting a nasogastric.
Sample narrative charting about patients with ctt, et and. Babies and children usually require a ngt because they need further nutritional support to meet the needs of. Nasogastric ng tube insertion osce exam demonstration. Common indications for nasogastric intubation include decompression of the gi tract in patients with bowel obstruction and gastric emptying in intubated patients to prevent. How to insert a nasogastric ng tube is an important skill to master as a medical student. Advance tube each time client swallows until desired length has been reached. As ng tube insertion is principally a procedure that falls to nurses and junior doctors, it was decided that an intervention should be aimed at these two groups. Supplementary material for improving the documentation of. Good practice guideline safe insertion and ongoing care of. Implementation of lidocaine for nasogastric tube insertion. Sit the patient in a semiupright position with the head supported with pillows and tilted neither backwards nor forwards. Nasogastric tube insertion, medically referred to as nasogastric intubation, is the process of inserting a nasogastric tube through a patients nose, past the throat and down into the patients stomach.
It is essential that you apply a systematic approach to your assessment and ask for senior input if you have any doubts. Orogastric intubation is a similar process involving the insertion of a plastic tube orogastric tube through the mouth. In extenuating circumstances, there may be a need to perform insertion of fine bore nasogastric tube in the above conditions. It is passed via the nose into the oropharynx and upper gastrointestinal tract. A nasogastric or ng tube is a plastic tubing device that allows delivery of nutritionally complete feed directly into the stomach. Different options for interventions were considered, including a pro forma to improve documentation, or a change to the way chest x rays were reported. Verify the order for tube placement with medical staff.
Nasogastric and dobhoff tubes stritch school of medicine. Flush tube with 30cc of air prior to attempting to aspirate fluid. Acceptable ph ranges also vary between hospitals, so consult local guidelines. Verifying ng feeding tube placement in pediatric patients. Nursing management of nasogastric tube feeding in adult.
Check out the nasogastric tube ngt insertion mark scheme here. Esophageal guidewireassisted nasogastric tube insertion in anesthetized and intubated patients. Before undertaking this procedure the practitioner should have completed training and demonstrated competency in nasogastric tube insertion in. Improving the documentation of nasogastric tube insertion and adherence to local enteral nutrition guidelines. In this instance only a medical officer experienced in the insertion of fine bore nasogastric tube may perform the procedure. Unless clinically urgent, if there is insufficient, experienced staff available for. The ability to carry out ng tube insertion is something every medic needs to. Learn the proper technique for placement of a nasogastric tube for feeding or air removal. The placement of a nasogastric tube ngt in a pediatric patient is a common practice that is generally perceived as a benign bedside procedure. Fine bore nasogastric feeding tubes for adults policy. Nasogastric tube gastrointestinal intubation deals with the inserting of a rubber or plastic tube into the stomach, duodenum or small intestine.
Nasogastric tube feeding may be accompanied by complications. Nasogastric insertion and management procedure last amended. Nasogastric ng intubation is a procedure in which a thin, plastic tube is inserted into the nostril, toward the esophagus, and down into the stomach once an ng tube is properly placed and secured, healthcare providers such as the nurses can deliver food and medicine directly to the stomach or obtain substances from it. Digestive insertion and removal of nasogastric ng tube section. Guideline for the insertion and management of nasogastric tubes in adults and children guidcss0014. Turn off suction or continuous feeding, if applicable. Nasogastric tube insertion how to insert a ng tube. Draw back on the syringe to obtain 5 to 10 cc of gastric aspirate. Insertion of ng feeding tube medical billing and coding. Nasogastric tube feeding is defined as the delivery of nutrients from the nasal route into the stomach via a feeding tube. With over 1,700 procedures and skills from a wide variety of nursing specialties including allied health, it combines the most trusted clinical content with powerful online workflow functionality that will enable your clinical staff to save time, standardize care and deliver. It is very important that the procedure must be done by a trained medical practitioner like doctors or nurses. Corpaku nasogastric placement and certification cddft lifelong learning directory. Sample narrative charting about patients with ctt, et and ngt new article contest.