CONTRAINDICATIONS: Nasogastric tubes are contraindicated or used with extreme caution in people with particular predispositions to injury from tube placement.  These may include:Patients with sustained head trauma, maxillofacial injury, or anterior fossa skull fracture. Inserting a NG tube blindly through the nose has potential of passing through the criboform plate, thus causing intracranial penetration of the brain.Patients with a history of esophageal stricture, esophageal varices, alkali ingestion at risk for esophageal penetration.Comatose patients have the potential of vomiting during a NG insertion procedure, thus require protection of the airway prior to placing a NG tube.

NASOGASTRIC TUBE FEEDING Purpose To feed the patient with fluid diet via a nasogastric tube Requisites Tray containing Ryles tube ,Kidney tray Measured volume of water Prescribed feed - Ensure/Glucerna 50ml syringe / 20ml syringe Blue litmus paper A Stethoscope Protective materials - White towel

Procedure Action Place the patient in semi to high fowler’s position or a lateral if patient cannot be propped up. Rationale To prevent gastric discomfort or regurgitation of feed. Remove spigot from the nasogastric tube Action Aspirate stomach contents gently with 50ml syringe and with test with blue litmus paper. Rationale To conform the position of the tube and note the residual amount. If the tube is in the stomach the blue litmus paper change red. Action Observe the nature of aspirate for color, volume and presence of blood. Rationale To exclude the malabsorption of previous feed and review feeding regime if necessary. Action Attach funnel / Syringe to the tube and hold it to the side, at the level of the patient’s forehead. Rationale

If the syringe is held too high, it increases the pressure at which the fluid enters the stomach. Action Fill the funnel/ syringe with the prescribed feed, allowing it to flow in by gravity. Action Do not allow the funnel to become empty. Rationale To prevent gastric distention during feeding. Action Observe the nature of aspirate for color, volume and presence of blood. Rationale To exclude the mal absorption of previous feed and review feeding regime if necessary. Action Observe the patient during feed. Rationale To detect any adverse reaction to the feeding. Action Conclude feed with water. Rationale To keep the lumen of tube feeding. Action Disconnect the apparatus and spigot the tube. Rationale To prevent backflow and leakage. Action Record the type and amount of feed and water given. Gastric lavageIs the aspiration of stomach contents and washing out of the stomach by means of a large bore gastric tube

Contraindicated1. After acid or alkali ingestion2. Seizure3. After ingestion of hydrocarbon or petroleumdistillates4. Dangerous after ingestion of strongcorrosive agent

Purpose:1. For urgent removal of ingested substance to decrease systemic absorption2. To empty the stomach after endoscopic procedure3. To diagnose gastric hemorrhage and to rest hemorrhage.

Equipmento Large bore levin tube or large bore ewald tube

o Large irrigating syringe with adaptero Large plastic funnel with a adapter to fit tubeo Water soluble lubricanto Tap water or appropriate antidote [ milk, salinesolution, sodium bicarbonate solution, fruit juice,activated charcoal]o Container for aspirateo Suction apparatuso Container for specimeno StethoscopeRemove dentures and inspect oral cavity for looseTeeth -> This will prevent aspiration of