Nasal gastric tube
(NG tube)
Naso gastric tube is a tube pass through
the nose to the stomach for feeding or to get gastric(stomach) contend.
nasogastric tube has three main word; Nasal meaning the nose, Gastric meaning
the stomach and Tube meaning hallow object allowing fluid to pass through.
Passing of nasal gastric tube
This is the process of passing nasogastric
tube from the nose to reach the stomach. The main reason a nurse pass a
nasogastric tube or doctor may order for nasogastric tube are for feeding a
patient, aspiration of gastric content, administering oral medication.
Indications
These are the conditions where passing
nasogastric tube is necessary.
Unconscious patient.
Operation in the pharynx or larynx, mouth.
Severely burn patient that can bot eat by
him/her self.
Obstruction of oesophagus could be because
of inflammation, tumour or other condition that may block the oesophagus example
foreign body.
Stricture of the oesophagus.
Baby too weak to feed or too weak to suckle
the breastmilk
Persistent vomiting
Mentally ill patient who can not eat
Severely Malnourished child who can not
take F75.
Patient who can not eat
Positioning
Intestinal obstruction
Post operatively on nil per os patient
contraindications
this are condition that nasogastric tube
can not be pass
tumour
foreign body in the nose
epistaxsis
patient with low platelets count
comlications of nasogastric tube
Preparation of a tray for passing a nasogastric
tube(setting a tray for pass nasogastric tube)
A tray should contain the following
Nasogastric tube in a bowl plus spigots
A bowel of warm water to soften the nasogastric
tube
Orenge stick for cleaning the nose stril
A galipot with a gauze for cleaning the
nostril or putting lubricant (ky jelly).
Receiver with a blue litmus paper for testing
the stomach content
Mackintosh with a towel to protect the
patient’s bed sheet from getting wet
A 20 mills Syringe for aspirating a stomach
content and blowing air in the stomach to if the tube is in.
A cup of warm water for softening of the
tube.
Trapping for securing the tube
Scissor for cutting the strapping
A receiver for used gauze
A receiver for used glove
At the bed site
A screen for privacy.
Hand washing equipment for washing hand.
A vomit bowel with a cover for receiving
any vomiters in case the patient vomit.
Passing nasogastric
tube to a conscious patient
Procedure
Explain the procedure to patient to a allay
anxiety.
Screen the bed to provide privacy.
Bring the tray next to the patient’s bed
for easy accesses of the equipment
Wash hand to prevent crossed infection and
minimise the risk of infections
Put on glove to protect both the nurse and
a patient.
Put the patient in sitting up position for
easy swallowing of the nasogastric tube
Place the mackintosh and the towel at the
patient neck to prevent patient linen and gown from getting soiled from
vomiters.
Assess the condition of the nostril and
clean with the orange sticks.
Get the nasogastric tube and Measure the
right length to be inserted(start from the tip of the nose to ear lobe then
down to the xiphoid process)
Mark the measured length with a marker or
small strapping to prevent over pushing of the tube or prevent the hanging of
the tube prevent the risk of aspiration.
Lubricate the nasogastric tube with ky
jelly or warm water to enable the tube to be inserted easily and prevent injury
to the passage from friction.
Insert the tube in the clear nose directing
it backward and downward.
Ask the patient to breath steadily and
swallow in between the breath this prevent the tube from going into the airway
and allow easy passing of the tube.
Continue pushing the tube until the measure
length is reach (the mark). If you meet any resistant rotate the tube gently
avoid using force to prevent trauma, if the patient start to cough remove the
tube, and start again
Check if the tube is inside by aspirating
gastric content test with litmus paper or blow 10 mills of ear inside while
listening with stethoscope to prevent pushing food in to the airway
Secure the tube using trapping at the cheek
to prevent it’s from getting out.
Thank the patient and clear away
Record the procure indicating the date ,the
time, the length and the nostril for continuous care
Passing nasogastric tube to a unconscious patient
Procedure
Explain the procedure to care giver to a
allay anxiety.
Screen the bed to provide privacy.
Bring the tray next to the patient’s bed
for easy accesses of the equipment
Put on the apron for protecting the uniform
Wash hand to prevent crossed infection and
minimise the risk of infections
Put on glove to protect both the nurse and
a patient.
Put the patient in recumbent position/lateral
position for easy passing of the nasogastric tube
Place the mackintosh and the towel at the
patient neck to prevent patient linen and gown from getting soiled from
vomiters.
Assess the condition of the nostril and
clean with the orange sticks.
Get the naso gastric tube and Measure the
right length to be inserted(start from the tip of the nose to ear lobe then
down to the xiphoid process)
Mark the measured length with a marker or
small strapping to prevent over pushing of the tube or prevent the hanging of
the tube prevent the risk of aspiration.
Lubricate the nasogastric tube with ky
jelly or warm water to enable the tube to be inserted easily and prevent injury
to the passage from friction.
Insert the tube in the clear nose directing
it backward and downward.
Ask the patient to breath steadily and
swallow in between the breath this prevent the tube from going into the airway
and allow easy passing of the tube.
Continue pushing the tube until the measure
length is reach (the mark). If you meet any resistant rotate the tube gently
avoid using force to prevent trauma, if the patient start to cough remove the
tube, and start again
Check if the tube is inside by aspirating
gastric content test with litmus paper or blow 10 mills of ear inside while
listening with stethoscope to prevent pushing food in to the airway
Secure the tube using trapping at the cheek
to prevent it’s from getting out.
Thank the patient and clear away
Record the procure indicating the date ,the
time, the length and the nostril for continuous care
Passing nasogastric tube to a baby(new born)
Procedure
Explain the procedure to the mother to
allay anxiety.
Screen the bed to provide privacy.
Bring the tray next to the patient’s bed
for easy accesses of the equipment
Wash hand to prevent crossed infection and
minimise the risk of infections
Put on glove to protect both the nurse and
a baby.
Make the mother hold the baby if see strong
hearted if not put the baby on the baby’s coach
Place the mackintosh and the towel at the
baby’s neck to prevent mother’s and gown from getting soiled from vomiters.
Assess the condition of the nostril and
clean with the orange sticks.
Get the naso gastric tube and measure the
right length to be inserted (start from the tip of the nose to midline of
umbilicus and the xiphoid process)
Mark the measured length with a marker or
small strapping to prevent over pushing of the tube or prevent the hanging of
the tube prevent the risk of aspiration.
Lubricate the nasogastric tube with expressed
breast milk to enable the tube to be inserted easily and prevent injury to the
passage from friction.
Insert the tube in the clear nose directing
it backward and downward.
Ask the patient to breath steadily and
swallow in between the breath this prevent the tube from going into the airway
and allow easy passing of the tube.
Continue pushing the tube until the measure
length is reach (the mark). If you meet any resistant rotate the tube gently
avoid using force to prevent trauma, if the patient start to cough remove the
tube, and start again
Check if the tube is inside by aspirating
gastric content test with litmus paper or blow 10 mills of ear inside while
listening with stethoscope to prevent pushing food in to the airway
Secure the tube using trapping at the upper
nose to prevent it’s from getting out.
Thank the patient and clear away
Record the procure indicating the date, the
time, the length and the nostril for continuous care
Point to note while passing nasogastric tube
Swallowing allow epiglottis to open and
trachea to close this allow tube to go into oesophagus.
If there is resistance don’t force passing
of the tube
If the patient is coughing don’t push the
tube further remove it, it is in the air way
Chack to make sure the tube is in the
stomach not air way.
How to check if the nasogastric tube is in the stomach
Aspirate the gastric content using the 20
mils syringe see what will come but in some case where absorption as taken
place you will aspirate northing from the stomach.
Aspirate 10 mills of air in a syringe the
blow in to the tube and then listen with stethoscope you will hear air entering
the stomach.
Feeding the patient using nasogastric tube
Before feeding you need first pass the NG
Tube, if the has already been pass we need the following requirements
Feeding syringe in a receiver for feeding the patient
Feeds/food/soup/porridge etc in a container
A cup with a drinking water for rinsing the
tube
Towel for protecting the patient gown and
linen from food
Procedure
Explain the procedure to care giver to a
allay anxiety.
Screen the bed to provide privacy.
Bring the tray next to the patient’s bed
for easy accesses of the equipment
Put on the apron for protecting the uniform
Wash hand to prevent crossed infection and
minimise the risk of infections
Put on glove to protect both the nurse and
a patient.
Put the patient in sitting up position to
from the food from flowing back from the stomach and prevent aspiration tube
Place the towel at the patient neck to
prevent patient linen and gown from getting soiled from food.
Check for the mark if it in place, if the
marked has changed position push it back or pass a new tube.
Pin the end of the tube and remove the
spigot to prevent the air from entering the stomach and prevent back flow of
the gastric content
Using a syringe aspirate the stomach
content to check for absorption.
Position the syringe above the head to
provide food flow by gravity
Pure the prescribe amount of food and allow
it to flow by gravity do not push by force
Do not allow the feeding syringe to be
empty completely to prevent air from entering the stomach
Repeat the process until the prescribe
amount is over
pour drinking water in the feeding syringe
to rinse the tube.
Remove the feeding syringe and close the
nasogastric tube with spigot.
Thank the attendant
Clear away
Record in the feeding chart and fluid
balanced chart
How to administer oral medication to the patient using
nasogastric tube
Before giving oral medications to
unconscious patient, you need first pass the NG Tube, if the has already been
pass we need the following requirements
Feeding syringe in a receiver for
administering the oral medication
Prescribe medications in a container
A cup with a drinking water for rinsing the
tube
Towel for protecting the patient gown and
linen from food
Procedure
Explain the procedure to care giver to a
allay anxiety.
Screen the bed to provide privacy.
Bring the tray next to the patient’s bed
for easy accesses of the equipment
Put on the apron for protecting the uniform
Wash hand to prevent crossed infection and
minimise the risk of infections
Put on glove to protect both the nurse and
a patient.
Put the patient in sitting up position to
from the
Place the towel at the patient neck to
prevent patient linen and gown from getting soiled from medication in case of
accident.
Check for the mark if it in place, if the
marked has changed position push it back or pass a new tube.
Pin the end of the tube and remove the
spigot to prevent the air from entering the stomach and prevent back flow of
the gastric content
Using a syringe aspirate the stomach
content to check for absorption.
Position the syringe above the head to
provide medication flow by gravity
Pure the prescribe amount of medications
and allow it to flow by gravity do not push by force
Do not allow the feeding syringe to be
empty completely to prevent air from entering the stomach
pour drinking water in the syringe to rinse
the tube.
Remove the syringe and close the
nasogastric tube with spigot.
Thank the attendant
Clear away
Record in the feeding chart and fluid
balanced chart
How to remove the nasogastric tube
Requirement
A tray containing a receiver for receiving
the tube
Cotton in the galipot for pinching the tube
Cean water for rinsing the mouth
Procedure
Explain the procedure to care giver to a
allay anxiety.
Screen the bed to provide privacy.
Bring the tray next to the patient’s bed
for easy accesses of the equipment
Put on the apron for protecting the uniform
Wash hand to prevent crossed infection and
minimise the risk of infections
Put on glove to protect both the nurse and
a patient.
Put the patient in sitting up position
Pinch the tube tight near the nose to
prevent fluid from entering the larynx
Using cotton swab gently and steadily
withdraw the tube
Discard it in the receiver
Give the patient water to rinse the mouth
What makes the food not to go during
feeding using NG tube?
Blockage of the tube
Food too thick to pass through the tube. make
the food semi liquid or liquid for easy passing.
Tube coiled in the mouth. check for the
tube in the mouth.
Air in the tube
Care for the tube
Rinse the tube after every feed or
medication administration
Keep the tube close to prevent air from
getting in the stomach
Make sure the tube is always at the mark
Replaced the tube when old
Use water to flash in case it is blocked
Frequently ask questions(FAQ) about nasogastric tube
What is nasogastric tube?
Nasogastric tube is a tube pass through the
nose to the stomach for feeding or to empty the stomach
What is nasogastric tube use for?
nasogastric tube use for feeding a patient, aspiration of gastric
content, administering oral medication.
What are the reasons for passing
nasogastric tube?
the reasons for passing nasogastric tube
are: feeding a patient, aspiration of gastric content, administering oral
medication, to reduce gas in the stomach, to decompress the stomach.
What are the inductions for nasogastric
tube(NG tube)?
Ng tube is indicated in the; Unconscious
patient, Operation in the pharynx or larynx, mouth, Severely burn patient that
can bot eat by him/her self, Obstruction of oesophagus could be because of
inflammation, tumour or other condition that may block the oesophagus example
foreign body, Stricture of the oesophagus, Baby too weak to feed or too weak to
suckle the breastmilk, Persistent vomiting, Mentally ill patient who can not
eat ,Severely Malnourished child who can not take F75, Positioning, intestinal
obstruction, Post operatively on nil per os patient.
Summery on Nasal Gastric Tube (NG Tube)
Definition
Nasogastric tube is a tube passed through
the nose to the stomach for feeding or removing gastric contents.
The term has three words:
- Nasal – nose
- Gastric – stomach
- Tube – hollow object allowing fluid
to pass
Passing of Nasogastric Tube
This is the process of passing a tube
through the nose into the stomach.
It is done for:
- Feeding a patient
- Aspiration of gastric contents
- Administering oral medication
Indications
Passing a nasogastric tube is necessary in:
- Unconscious patients
- Operations of the pharynx, larynx, or mouth
- Severely burned patients unable to eat
- Oesophageal obstruction (tumour, inflammation, foreign body)
- Oesophageal stricture
- Babies too weak to feed or suckle
- Persistent vomiting
- Mentally ill patients unable to eat
- Severely malnourished child unable to take F75
- Patients unable to eat
- Intestinal obstruction
- Post-operative patients on nil per os
Contraindications
Nasogastric tube should not be passed in:
- Tumour
- Foreign body in the nose
- Epistaxis
- Low platelet count
Preparation of Tray
A tray should contain:
- Nasogastric tube with spigots
- Warm water for softening the tube
- Orange sticks for cleaning nostrils
- Gauze and lubricant (KY jelly)
- Receiver with blue litmus paper
- Mackintosh and towel
- 20 ml syringe
- Strapping and scissors
- Receivers for used gauze and gloves
At bedside:
- Screen for privacy
- Hand washing equipment
- Vomit bowl with cover
Passing NG Tube to a Conscious Patient
(Summary)
- Explain procedure and provide privacy
- Wash hands and wear gloves
- Sit patient upright
- Measure tube (nose → ear → xiphoid process)
- Lubricate tube
- Insert through clear nostril
- Ask patient to swallow
- Advance to marked length
- Check placement by aspiration or air insufflation
- Secure tube
- Record procedure
Passing NG Tube to an Unconscious
Patient (Summary)
- Explain to caregiver
- Place patient in recumbent/lateral position
- Follow same steps of measuring, lubricating, inserting,
checking, securing
- Record procedure
Passing NG Tube to a Baby (Summary)
- Explain to mother
- Measure from nose to umbilicus/xiphoid
- Lubricate with expressed breast milk
- Insert gently
- Confirm placement
- Secure at upper nose
- Record procedure
Points to Note
- Swallowing allows tube to enter oesophagus
- Do not force tube if resistance occurs
- If patient coughs, remove tube
- Ensure tube is in stomach, not airway
Checking Tube Position
- Aspirate gastric content
- Inject air and listen with stethoscope
Feeding Through NG Tube (Summary)
- Confirm tube position
- Sit patient upright
- Feed by gravity, not force
- Rinse tube after feeding
- Record intake
Administering Oral Medication via NG
Tube (Summary)
- Confirm tube placement
- Give medication by gravity
- Rinse tube
- Record administration
Removing NG Tube
- Explain procedure
- Sit patient upright
- Pinch tube and gently withdraw
- Dispose tube
- Rinse mouth
References
Nurses manual
https://www.youtube.com/watch?v=WZvIw0SnYrE
https://www.youtube.com/watch?v=ypFP_vW5cNg
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