NGT ▪ Local anesthetic spray
Introduction NASOGASTRIC TUBE KEY POINTS
Patients in the Emergency room, Acute care and in ▪ Nasogastric Tube: Levin Tube
the Community settings often have a Nasogastric tube
1. GA- Vage (Feeding)
insertion to assists in an emergency situation, in a
Decompression
recovery from surgeries, medical conditions, or
diagnostic procedures. 2. 2. LA- Vage (Cleansing)
We Nurses, must comprehend how these devices 3. To administer Medications (Non-Enteri-
work, their purpose, function, insertion, removal and coated)
how to prevent complications from these procedure.
I. Insertion
Nasogastric Tube Placement
1. PXN: HF (12-18in)
Indications
“Bladder is more sterile than the stomach”
Decompression of stomach (e.g. obstruction
or perforation) NASOGASTRIC TUBE KEY POINTS
Reduce incidence and risk of vomiting 2. Sterile Gloves
Monitor and evaluate upper gastrointestinal
bleeding 3. Lubrication : Water-based solution
Prolonged ileus 4. Upon insertion, hyper-extend the neck of the
Administration of medication or oral contrast patient
in a patient unable to swallow
Detection of transdiaphragmatic stomach 5. Upon reaching the oropharynx, flex and tilt
herniation forward.
Contraindications 6. Instruct: Deep Breathing Exercises
▪ Midface injury, basilar skull fracture, or 7. Instruct: Offer sips of Water
coagulopathy (Orogastric placement may be a 8. Check for patency
better option)
▪ History of gastric bypass or lap banding NASOGASTRIC TUBE KEY POINTS
▪ Esophageal structures or alkali injury Checking for Patency: MOST COMMON: ASAX
Complications 1. Auscultation Whooshing Gurgling
▪ Bleeding 2. Submersion With Bubbles Without Bubbles
▪ Pneumothorax
▪ Aspiration 3. Aspiration of GI Fluid Blue Red
▪ Intracranial placement
(Litmus Paper)
▪ Vomiting/retching
▪ Pulmonary placement 4. Chest-Xray
▪ Sinusitis
Tape the bridge of the Nose: Correct Taping (Not
Equipment too tight)
▪ Nasogastric tube (fine bore) NASOGASTRIC TUBE KEY POINTS
▪ Disposable gloves
II. Feeding
▪ Lubricant and gauze
▪ Disposable bowl 1. PXN: SF
▪ Paper Towels
▪ Large Syringe 2. Check for patency: Auscultate
▪ Dressing 3. Aspirate for residual volume:
▪ A glass of water for the patient (if swallow is
deemed safe). Volume:
Color: METHODS:
Indication: • TOTAL PARENTERAL NUTRITION
*More than 100ml: Withhold feeding • PARTIAL PARENTERAL NUTRITION
4. Instill: 30 to 60 ml of Water for Flushing PURPOSE:
NASOGASTRIC TUBE KEY POINTS • To provide nutrients required for normal
metabolism, tissue maintenance, repair and
5. Distance (Gravity): 12 inches
energy demands.
<12: SLOW
• To bypass the GI for patients who are unable
>12: FAST to take food orally.
*Dumping Syndrome • To rest the GI tract
6. Before clamping the tube, retain some water INDICATION:
in the catheter
• Patient who cannot tolerate enteral nutrition
7. PXN: SF 30mins to prevent aspiration because of:
Change the Catheter: Every 3 to 5 days • Paralytic ileus
PARENTERAL NUTRITION • Intestinal obstruction
CENTRAL LINES VS PERIPHERAL LINES • Acute pancreatitis
A central line (or central venous catheter) is • Inflammatory bowel disease
like an intravenous (IV) line. But it is much
• Gastrointestinal fistula
longer than a regular IV and goes all the way
up to a vein near the heart or just inside the • Severe diarrhea
heart.
• Persistent vomiting
• Malabsorption
• Patient at risk for malnutrition
• Gross under weight
• Metastatic cancer
• Hypermetabolic state (w/c enteral feeding is
not possible)
• Severe burns
• NPO for more than 5 days
• ARF
• Multiple fracture
• Tumor in the GIT
• GI Sepsis
METHODS OF PARENTERAL NUTRITION
Total parenteral Nutrition (TPN)
• Infusion of nutrients directly into a vein who
are unable to eat or digest food through the
GI tract, who refuses to eat, or who have
inadequate oral intake
• CENTRAL -YELLOW
OTHER TYPES:
• TOTAL NUTRIENT ADMIXTURE
• V AND M, GLUCOSE, AMINO ACIDS, LIPIDS
• 20% MORE DEXTROSE
• CENTRAL LINE
• MORE THAN 7 DAYS
• PERIPHERAL PARENTERAL NUTRITION
• 12.5% OR LESS DEXTROSE
• PERIPHERAL
• GLUCOSE
• AMINO ACIDS
• VITAMINS AND MINERALS
• CHO + CHON
• PERIPHERAL -WHITE
• LIPIDS
• FATS
ADMINISTRATION SET WITH LUER LOCK SYSTEM
b. After using the container, discard.
5. Complications:
• Hyperglycemia
• Systemic Infection (Sepsis)
6. Monitor
A. Capillary Blood Glucose (CBG)
Normal: 80-120mg/dl
B. Fever
C. Input and Output
D. Weight (Every other day)
NURSING CARE PLANS
1. Imbalanced Nutrition: Less Than Body
Requirements
2. Risk for Deficient Fluid Volume
3. Risk for Deficient Fluid Volume
SUMMARY:
• Purpose: To provide nourishment
-Nursing Considerations
-Bloodstream
1. Route: IV
2. Site: Subclavian Vein
3. Common Contents: V.A.M.G.
4. Storage:
a. Before: Refrigerator (Prior to Administration,
leave at room temp for 30 mins.)
