nasogastric intubation
Post on 19-Oct-2014
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Medical NCO Course
Nasogastric Intubation
GI Tract
• Oral cavity• Pharynx• Esophagus• Stomach
• Small Intestine• Large Intestine• Accessory
Structures
Gastrointestinal System• Provides body with:
– Water– Electrolytes– Other nutrients used by cells
Gastrointestinal System• Function
– Breaks down ingested food– Propels food through the GI tract– Absorbs nutrients across wall of lumen
of GI tract– Absorbs water and salts– Eliminates waste
Oral Cavity
• Chemical Digestion– Salivary glands produce saliva– Contains digestive enzyme
• Salivary amylase• Begins chemical breakdown of
carbohydrates
Oral Cavity
• Mechanical Digestion– Mastication facilitates swallowing and
processing of food– Food swallowed by voluntary and involuntary
mechanisms– Pharynx elevates to receive food from mouth
Oral Cavity
• Mechanical digestion– Esophageal sphincter relaxes, opening
esophagus– Food is pushed into esophagus– Epiglottis closes airway to prevent aspiration
Medical NCO Course
The Gastrointestinal System The Oral Cavity • Chemical digestion• Mechanical digestion
Esophagus • Peristaltic waves
Esophagus
• Muscular canal (24 cm long)
• Extends from pharynx to stomach
• Begins below cricoid cartilage
• Descends to sphincter of stomach
Esophagus:
•Muscular canal
•About 24 cm long
•Extends from pharynx to stomach
Esophagus
• Composition
• Lined with mucous membrane
• Peristaltic waves push food into
stomach
Stomach
Structure• Layered muscular
tube• Lined with mucous
membranes• Contains gastric
glands
Stomach
• Function– Storage and mixing chamber– Secretes HCl, intrinsic factor, gastrin,
pepsinogen– Produces chyme– Moves chyme into duodenum
Small Intestine
• Begins at pyloric sphincter
• Coils through abdominal cavity
• Opens into large intestine
Small Intestine
• 10 ft divided into 3 segments– Duodenum– Jejunum– Ileum
• Mixing and propulsion of chyme• Absorption of fluid and nutrients
Small Intestine
• Peristaltic contractions– Chyme moves through ileocecal valve
• Chyme enters cecum• Cecum distends
– Sphincter closes– Prevents contents from returning to ileum
Large Intestine
• 1.2m (5ft) long• 6.2cm (2.2in) in diameter• Extends from ileum to anus• Attached to abdominal cavity by
mesocolon
Large Intestine• Divided into four
principal regions– Cecum– Colon– Rectum– Anal canal
Large Intestine
• Absorbs water• Absorbs salts• Bacteria acts on undigested material• Converts chyme into feces
Liver• Largest gland in
body• Upper right
quadrant• Vascular organ
with 2 sources of blood supply– Hepatic artery– Portal vein
Liver
Portal vein
Hepatic Artery
Liver
Plays major role in:• Iron metabolism• Plasma-protein
production• Detoxification
Liver• Secretes bile
– 600 – 1000 ml each day– Dilutes stomach acid (no digestive enzymes)– Emulsifies fats
• Bile salts– Reabsorbed in ileum– Carried back to liver in blood– Also lost in feces
Liver
• Metabolism– Helps maintain blood glucose levels– Involved in fat and protein metabolism– Stores vitamins and minerals
• Toxin Breakdown– Breaks down metabolism by-products– Can be toxic if accumulate in the body
Liver
• Blood Protein Production– Albumin– Fibrinogen– Globulin– Clotting factors
Gallbladder
• Pear shaped sac• 7-10 cm long (3-4”)• Located on
posterior surface of liver
• Hangs from anterior/inferior margin of liver
Gallbladder
• Secretes and stores bile produced by the liver
Pancreas• Gland • 12-15 cm (5-6 in)
long• 2.2 cm (1 in) thick• Posterior to the
stomach• Connected to
duodenum by 2 ducts
Pancreas
• Exocrine gland– Secretes pancreatic juice
• Endocrine gland– Secretes hormones (insulin) into blood– Cells need insulin to process glucose
Pancreas
• Pancreatic juice– Most important digestive juice– Contains digestive enzymes, sodium
bicarbonate and alkaline substances– Neutralizes HCl in juices entering small
intestine
Nasogastric Intubation
NG Tube Indications• Aspirate stomach
contents– Diagnostic or
therapeutic
• Assessment of GI bleeding
• Determine gastric acid content
NG Tube Indications
• Treat paralytic ileus • Treat intestinal obstruction• Recurrent vomiting likely• Trauma• Overdose
NG Tube Contraindications
• Esophageal strictures• Alkali ingestion, caustic ingestions,
esophageal burns• Comatose patients
NG Tube Contraindications• Trauma patients with:
– Cervical or intracranial bleeding– Increased intracranial pressure
• Recent surgery of the following types:– Oropharyngeal– Nasal– Gastric
Inserting NG Tube
• Explain procedure• Position patient
– High Fowler if alert– Drape– Emesis basin– Water and straw
Inserting NG Tube
• Unconscious patient– Left lateral position – Head turned to downward side– Gag and cough reflexes absent or suppressed– NG tube easily misplaced (lung)– Inability to swallow
Inserting NG Tube• Check nares for
patency• Select appropriate
tube size• Determine length
of insertion– Tip of nose, to ear, to
xiphoid process– Mark tube
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Inserting NG Tube
• Lubricate tube – Lubricant must be water-soluble– May use topical anesthetic if available (ie,
lidocaine)
• Coil tube to shape it into curve• Have patient hold water and straw
to mouth
Inserting NG Tube
• Insert tube– Along floor of
nose– Straight back– Advance until
resistance felt (nasopharynx)
Inserting NG Tube
Ask patient to swallow sips of water and flex neck slightly.
As patient swallows, advance tube into and down esophagus.
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Inserting NG Tube
• When tube is in the esophagus:– Advance rapidly to the pre-marked distance
Excessive choking, gagging, coughing, change in voice or condensation inside the tube indicates possibility of placement in trachea. The tube should be withdrawn.
Confirm NG Tube Placement
• X-ray– Most reliable if tube is radiopaque– Requires order from physician
• Injecting air– 60 cc catheter syringe– Place stethoscope over LUQ of abdomen– Inject air into lumen of tube, NOT blue pigtail– Listen for “swoosh” sound
Confirm NG Tube Placement• Aspirate stomach contents
– 60 cc catheter tip syringe – Pull back to check for gastric aspirate– Possibility for fluid to be from lungs or
pleural space
Confirm NG Tube Placement
• Test pH of gastric aspirate– 60 cc catheter-tip syringe and pH paper– pH < 4 = 95% chance that tip is in
stomach– pH > 6 = may be in lung or pleural space;
could be in stomach if patient takes antacids or some medications
Confirm NG Tube Placement
• Non-radiopaque methods– Possibility of error– Use more than one method – Passage into lungs frequent; especially in
comatose or demented patients– Aspiration of gastric contents more reliable
• Especially if tested with pH paper
Securing the Tube• Secure to patient’s
nose– Tape to nose and coil
around tube– Avoid pressure to
nares– Secure to patient’s
clothing near shoulder area
– Blue pigtail must be above level of patient’s stomach
Complications Excessive coughing, motion, gagging may
aggravate the following:• Neck injuries
– Increased risk for C-spine injuries
• Penetrating neck wounds– May increase hemorrhage
• Tube misplacement– Pulmonary– Intracranial
Removing NG Tube• Disconnect from drainage container and
suction (if applicable)• Attach syringe-tip catheter to lumen of
tube• Flush tube with 20cc of air
– Empties contents from tube to prevent aspiration into lungs
Removing NG Tube• Remove tape from patient’s nose • Unpin tube from gown• Have patient take deep breath and hold
while tube is removed• Pull tube with quick and steady motion• Discard appropriately• Provide or instruct patient on oral and
nasal care