NASOGASTRIC TUBE INSERTION AND NASOGASTRIC FEEDING

Basant Kumar Karn Asst. Professor Dept. of Pediatric Nursing College of Nursing BPKIHS

y Nasogastric intubation is a medical process

involving the insertion of a plastic tube (Nasogastric tube, NG tube) through the nose, past the throat, and down into the stomach. y Nasogastric (NG) tube is a small tube that goes into the stomach through the nose. y Breast milk, formula, or liquid food is given through the tube directly into the stomach, giving your child extra calories.2 B K Karn, Dept. of Pediatric Nursing, CON, BPKIHS. 11/28/2010 9:13 PM

y Nasogastric Tubes: Nose to stomach y Orogastri Tubes: Mouth to Stomach y Gastrostomy tube y Nasointeric Tubes: Nose to intestine y Jejunostomy Tubes: Directly to the

jejunum3 B K Karn, Dept. of Pediatric Nursing, CON, BPKIHS. 11/28/2010 9:13 PM

y To decompress the stomach and proximal small

intestine. y To evacuate blood, secretions and ingested drugs or toxins. y To control bleeding from gastric and oesophageal therapies. y To instill medications, fluids , or feedings y To obtain samples of gastric contents y To administer lavage or irrigation4 B K Karn, Dept. of Pediatric Nursing, CON, BPKIHS. 11/28/2010 9:13 PM

Nasogastric tube Non-sterile gloves Emesis basin Adhesive Tape

Cup of water with straw 5 ml syringe PH tape NS or water

Topical anesthetic agent Tissues Paper or Towels

Water soluble lubricant Stethoscope

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B K Karn, Dept. of Pediatric Nursing, CON, BPKIHS.

11/28/2010 9:13 PM

y Trauma of head, maxillary facial injury or anterior fossa

skull fracture, epistaxis. y Caution should be used when inserting the tube in a patient with a potential cervical spine injury; the patient head should be manually immobilized for this procedure. If the patient has oesophageal varices, there is a risk of inadvertent esophageal rupture and hemorrhage as result of tube placement. y The smallest possible tube appropriate to the intervention or task should be used, because smaller tubes place less stress on the oesophageal sphinter.6 B K Karn, Dept. of Pediatric Nursing, CON, BPKIHS. 11/28/2010 9:13 PM

y Explain

the procedure as age and developmentally appropriate to both child and family. y Wash hands. y Collect necessary equipments and supplies for tube placement.hen discuss again. y Take the child to the procedure room. y Sometime parents may not cooperate7 B K Karn, Dept. of Pediatric Nursing, CON, BPKIHS. 11/28/2010 9:13 PM

yPosition the childInfants or toddlers may be restrained in a supine position

either with mummy restraint or using a second person to securely hold the child. The infant or toddler may be placed in a sitting position for placement if a second care provider can effectively hold the child and keep him calm during procedure. If the child is in supine position, arrange towels or pillows under the shoulders to slightly extend the head. Older children may be placed in a sitting position with the head slightly extended.8 B K Karn, Dept. of Pediatric Nursing, CON, BPKIHS. 11/28/2010 9:13 PM

Determine length of tube to be insertedy Determine the length of NG

tube to be inserted. Measure the tube for appropriate length of inserting from the childs nose to the bottom of the earlobe and then to the end of the Xiphoid process. y Mark the length with marker.9 B K Karn, Dept. of Pediatric Nursing, CON, BPKIHS. 11/28/2010 9:13 PM

y Place emesis basin and tissues within easy

access. y Place towel over childs gown. y Don non-sterile gloves. y Softening tube or using lubricant is optional. y Gently insert tube into nostril or mouth aiming down and back. y When NG tube reaches the pharynx and the child gags, ask child to swallow as rapidly as continuously as possible.10 B K Karn, Dept. of Pediatric Nursing, CON, BPKIHS. 11/28/2010 9:13 PM

y If there appears obstruction, do not use force. Try

rolling the NG tube gently. If still unable to pass the tube remove it and try the other nostril. y Dont pass the tube beyond the original mark until further assessment is made. Remove the tube at once if there are signs of distress, coughing, gasping or cyanosis. y Allow child to rest and resume insertion. y Continue to pass the tube until marked position is at tip of the nostril.11 B K Karn, Dept. of Pediatric Nursing, CON, BPKIHS. 11/28/2010 9:13 PM

y Listening for popping sounding with stethoscope

over childs stomach while 2-5 ml of air in a syringe is injected in the tube. Aspirate injected air from stomach. y Aspirate for stomach contents with a syringe and test acidity by pH tape. y Submerge the open end of the tube in water and observe for bubbles synchronizing with expiration.12 B K Karn, Dept. of Pediatric Nursing, CON, BPKIHS. 11/28/2010 9:13 PM

y Anchor the tube to childs face with tape so that it

doesnt interfere with the childs vision, cause pressure or irritate the nasal mucosa. y Attach or clamp the primary lumen, as prescribed (e.g. to suction, gravity drainage or feeding) y Remove gloves and wash hands y Replace the articles. y Thank parents and praise child for cooperation. y Morally boost up the child and ensure the child is not going to remove the tube, if so restrain the child.13 B K Karn, Dept. of Pediatric Nursing, CON, BPKIHS. 11/28/2010 9:13 PM

yInfants and children can be fed

simply and safely by a tube passed into the stomach through either the nares or the mouth which is known as Nasogastric feeding or gavage feeding.14 B K Karn, Dept. of Pediatric Nursing, CON, BPKIHS. 11/28/2010 9:13 PM

y Premature babies y Babies