A nasogastric (NG) tube provides direct access to a patient's stomach. It can be used to empty the stomach, take samples and / or administer nutrients and drugs. Inserting it is a simple process, but it requires attention to minimize the risk of triggering inflammation.
Steps
Part 1 of 3: Prepare the Sondino
Step 1. Put on your gloves
Wash your hands and put on a pair of disposable medical gloves before proceeding.
Even if you use gloves, you still need to wash your hands with warm water and antibacterial soap to further reduce the risk of introducing germs into the tube
Step 2. Explain the procedure
Introduce yourself to the patient and describe the procedure. Make sure you have her consent before moving on.
Describing the procedure in detail before performing it allows you to gain his trust and reassure him at the same time
Step 3. Prepare the patient
For best results he should sit upright and keep his chin in contact with his chest. He must also have his face turned towards you.
- If she has trouble keeping her head up, you need someone to help support her. You could also use firm pillows to keep his head still.
- When you insert a NG tube into a child, you can make them lie flat on their back instead of sitting upright. Her face should be facing up and her chin should be slightly raised.
Step 4. Look at the nostrils
Quickly check your nostrils to make sure there are no impediments whatsoever.
- You will need to insert the tube into the one that appears looser.
- If necessary, use a small flashlight or similar light source to look inside the nostrils.
Step 5. Measure the NG tube
Measure the necessary length by stretching the tube outside the patient's body.
- Start at the septum, then run the tube over your face until it reaches your earlobe.
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From the earlobe it goes up to the xiphoid which is located between the end of the sternum and the navel. This point is located on the front of the body in a central position where the lower ribs meet.
- For a newborn, this point will be about a finger's width below the breastbone. For a child, consider the width of two fingers.
- This distance can vary more significantly for teenagers and adults according to height.
- Mark the correct size on the tube using a permanent marker.
Step 6. Anesthetize your throat
Spray a suitable anesthetic on the back of the patient's throat. Wait a few seconds for the spray to take effect.
Insertion can be uncomfortable, and using the spray can make things easier and reduce gagging. However, it is not strictly necessary
Step 7. Lubricate the NG tube
Coat the first 5-10 cm with a water-based lubricant.
Using a lubricant containing 2% lidocaine or a similar anesthetic can further reduce irritation and discomfort
Part 2 of 3: Insert the probe
Step 1. Insert the tube into your chosen nostril
Insert the lubricated end into the looser one and advance to the other end as you insert.
- The patient must continue to face you.
- Orient the tube downward and toward the ear on the same side as the nostril. Don't direct it up and towards the brain.
- Stop if you feel resistance. Pull out and try to insert into the other nostril. Never force the tube inwards.
Step 2. Check the back of the throat
If you have sprayed the anesthetic into the patient's throat, ask him to open his mouth and look at the other end of the tube.
- Opening the mouth may be too painful for someone who has not been treated with the anesthetic. If this is the case, simply ask them to report when the tube has reached the back of the throat.
- As soon as the tube has reached the top of the throat, push the patient's head so that the chin touches the chest. This helps direct it into the esophagus instead of the windpipe.
Step 3. Ask the patient to swallow
Give him a glass of water with a straw. Ask him to take small sips and swallow them while continuing to direct the tube down.
- If he is unable to drink water for any reason, you should still encourage him to swallow empty while continuing to push the tube down his throat.
- If it is a newborn, give him a pacifier to encourage him to suck and swallow during the process.
Step 4. Stop when you have reached the marker mark
Continue inserting the tube until the previous mark reaches the patient's nostril.
- If you encounter resistance in your throat, slowly rotate the tube as you advance it. This should help. If you still feel considerable resistance, pull it out and try again. Never force.
- Stop immediately and remove if you notice a change in the patient's respiratory condition. This could be choking, coughing or difficulty breathing. A change in breathing may indicate that the tube was inserted into the trachea by mistake.
- You must also remove it in the event that it should come out of the patient's mouth.
Part 3 of 3: Check the placement of the probe
Step 1. Inject air
Use a clean, dry syringe to insert air into the NG tube. Listen to the sound it makes with a stethoscope.
- Pull back on the syringe plunger to draw in 3ml of air, then insert the syringe into the accessible end of the tube.
- Place a stethoscope on the patient's stomach just below the ribs and towards the left side of the body.
- Press firmly on the plunger to push the air out. If the tube has been positioned correctly, you should hear a gurgling or crackling sound through the stethoscope.
- Remove it if you are in doubt that the placement is incorrect.
Step 2. Aspire
Use a syringe to draw gastric juices from the stomach through the tube, then check the contents with a pH litmus paper.
- Insert the tip of an empty syringe into the accessible end. Lift the plunger to aspirate 2ml of stomach contents.
- Use the paper to measure the pH by wetting it with the sample taken and compare the resulting color with those of the graduated scale. The pH should usually be between 1 and 5, 5.
- Remove the tube if the pH is too high or if you are in doubt that the placement is not correct.
Step 3. Secure the tube
Make sure it does not move from its position by attaching it to the patient's skin with a patch at least 2.5 cm wide.
- Stick a piece of the patch over your nose, then bandage the tube. Wrap it with more patch and stick it to one cheek.
- The tube must remain immobile when the patient moves his head.
Step 4. Observe the patient to see how comfortable he feels
Before you leave, make sure it's comfortable and quiet.
- Help him find a comfortable position to rest. Make sure the tube has no breaks or is bent.
- Once you've done this, you can take off your gloves and wash your hands. Throw them away in a sanitary waste bin and use warm water and antibacterial soap to wash yourself.
Step 5. Confirm tube placement with an X-ray
If the air and stomach contents test went well, the placement is most likely correct. However, it is still a good idea to take a chest X-ray to eliminate any doubts.
Do this before using it to administer food or drugs. The radiology technician should deliver the X-ray results promptly, and a doctor or nurse could confirm that the procedure was done correctly
Step 6. Use the NG tube as needed
At this point you should be able to use it to empty your stomach, administer food, and / or insert medications.
- A bile bag must be attached to the end of the tube if you need to drain digestive fluids for elimination. Alternatively, you could connect a vacuum machine. Set it along with pressure as required based on the patient's specific needs.
- If you need to use it for nutrition or medication, you may need to remove the guide wire inside before inserting anything. Run 1-2ml of water through the tube before carefully pulling the guide wire outward. Clean the wire, dry it and store it in a safe and sterile place for later use.
- Regardless of how you use it, you need to document its use accurately. Write down the reason for its insertion, the type and size and all other medical details related to its use.
