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22 Cards in this Set
- Front
- Back
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When is a NG tube needed?
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- nutrition for those unable to feed by mouth
- ease of administering medications (i.e. scope) - diagnostic purposes (gastric washings) - gastric decompression and drainage |
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How often are plastic NG tubes changed?
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- Polyvinyl chloride (PVC) plastic tubes are changed at least every 3 days due to degeneration when exposed to gastric contents and high pH
- MAXIMUM is 1 week if there are associated risks i.e. intubation, loss of gag reflex, etc - reinsert in alternating nares |
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How often are polyurethane tubes (silastic) changed?
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- every 4 weeks
- or PRN if irritation around nare - reinsert in alternating nares |
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How do you check placement?
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- Need to use at least TWO ways each time tube is used or at least q8h if continuous feeding, NPO, or grastric drainage/decompression
- Xray: GOLD STANDARD but risks, inconvenient, costly - pH of aspirate - auscultation (pop): LEAST reliable - no research to differentiate respiratory from GI placement |
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What are some possible NG insert contraindications?
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- congenital anomalies (choanal atresia, tracheoesophageal fistula, esophageal strictures), non-intact palates, fractures, recent sinus surgery, etc
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Risks for aspiration of feedings
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decreased LOC, neurological disease, poor/non-existant gag reflex, supine positioning, GERD, vomiting
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When are silastic polyurethane tubes chosen?
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long-term feeding
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When are polyvinyl chloride (PVC) plastic tubes chosen?
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short-term for drainage/decompression and feeding
- stiffer, doesn't collapse and has several intake holes |
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How do you choose the appropriate sized NG tube?
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Smallest possible to prevent swallowing difficulties, prevent blockage of nare, and decreased possibility of GERD episodes
Larger tubes required to facilitate effective gastric drainage |
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NG tapes replacement
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Every 48 hrs or more if dirty/wet
Use duoderm underneath if sensitive skin |
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Supplies for NG insert
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Appropriate size NG tube
3ml and 10ml syringe Water-soluble lubricant or sterile water Duoderm/hypafix Measuring tape Stethoscope Permanent marker pH paper gloves |
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STEPS
1) Wash hands and assemble equipment (cut tapes) |
STEPS
2) Measure tube from exit holes and mark with permanent marker - NG tube: nose, earlobe, midpoint between xyphoid process and belly button - OG tube: same but from lips |
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STEPS
3) Place base tape on patient and wrap/restrain |
STEPS
4) Gloves; lubricate tip of tube (water-activated lubricant on silastics); - older children encourage to swallow/drink - avoid petroleum-based due to risk of aspiration |
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STEPS
5) Insert with guide style secured inside - stop if respiratory distress |
STEPS
6) Check placement |
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STEPS
7) Activate lubricant by flushing with 2-10ml sterile water and remove stylet - never reinsert guidewire into tube while in patient |
STEPS
8) secure with tape, measure length from tip of nare to end of tube |
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pH placement check (method, pH range and aspirate colours)
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- cap ports, push 10ml air and withdraw for gastric contents
- childrens' pH <4, neonates <5, acid-suppressing meds/recently or continuously fed <6 - aspirate colour: colourless, white, tan-green, blood-tinged, brown, clear, cloudy, curdled |
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What colours would the aspirate be if in duodenum?
What pH would they show? |
yellow, clear
>6 |
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What colours would the aspirate be if in lungs? What pH would they show?
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clear, yellow serous, blood-tinged
>6 |
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ph/aspirate troubleshooting
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- inject another 5-10ml air and retry
- advance tube another 1cm - place patient on left side and wait few minutes for tip to fall below fluid level, retry - verify with another nurse - consider xray |
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Auscultation (pop) check
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- stethoscope over LUQ abdoment
- inject 3ml air using 10ml syringe - listen for pop - withdraw same aount of air as was instilled - discard syringe - least reliable because referred sounds may be heard in stomach if in resp, intestines or esophagus |
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Auscultation/pop check troubleshooting
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- inject more air
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Documentation
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type, size, location, external length, pop/pH, patient tolerance during/after, date of next change
flowsheet and progress notes |
