Nasogastric tube placement: Difference between revisions
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== Indications | ==Indications== | ||
*Aspiration of stomach contents (poor sens and spec for UGI bleed) | |||
*Vomiting likely to be dangerous or recurrent | |||
**Bowel obstruction | |||
**Paralytic ileus | |||
**Acute gastric dilatation | |||
*Stomach decompression prior to surgery or peritoneal lavage | |||
== Contraindications == | ==Contraindications== | ||
*Facial fx involving cribriform plate | |||
== Relative Contraindications == | ==Relative Contraindications== | ||
*Severe Coagulopathy | |||
*Gastric bypass and lap band procedures | |||
*Esophageal strictures | |||
*History of alkali ingestion | |||
== Equipment Needed | ==Equipment Needed== | ||
*PPE including gown for practitioner and pt | |||
*NG Tube- typically a 16F or 18F Sump | |||
*Syringe/Bulb- 50-60cc | |||
*Tape | |||
*Emesis basin | |||
*Towels | |||
*Cup of water with straw | |||
== Procedure | ==Procedure== | ||
# | #Consent by informing patient of risk, benefits, and alternatives | ||
#Position pt upright | #Position pt upright | ||
#Place towel over | #Place towel over patient's gown and emesis basin in lap | ||
#Estimate length of insertion | #Estimate length of insertion | ||
## | #*A standard of 56cm is reasonable<ref>Phillips DE, Sherman IW, Asgarali S, and Williams RS. How far to pass a nasogastric tube? Particular reference to the distance from the anterior nares to the upper oesophagus. J R Coll Surg Edinb. 1994; 39(5):295-296.</ref>) | ||
#*Alternatively measure from tip of nose to earlobe to xyphoid and then add 15cm | |||
#Check nares for obstruction and pass through the most widely patent nare | #Check nares for obstruction and pass through the most widely patent nare | ||
#Provide relief from discomfort | #Provide relief from discomfort | ||
# | #*Topical vasoconstrictors to both nares | ||
# | #**Oxymetazoline or phenylephrine | ||
# | #*Topical Anesthetics (5 min prior to procedure) | ||
# | #**Benzocaine, tetracaine, nebulized lidocaine (4 or 10%), lidocaine jelly | ||
# | #**Anesthetize OP, as well, to prevent gagging | ||
# | #*Antiemetics | ||
# | #**Zofran and reglan 15 min prior may reduce gagging and nausea | ||
#Insert tube along floor of nose under inferior turbinate | #Insert tube along floor of nose under inferior turbinate | ||
#Pause when NGT is in OP | #Pause when NGT is in OP | ||
#Flex | #Flex neck to decrease chance of tracheal passage | ||
#Advance into esophagus | #Advance into esophagus | ||
# | #*Sipping water may aid in esphageal passage | ||
# | #*Withdraw to OP promptly if excessive coughing, gagging, choking or voice change | ||
#Once NGT is in esophagus, rapidly insert rest of tube to premeasured length | #Once NGT is in esophagus, rapidly insert rest of tube to premeasured length | ||
#Confirm placement | #Confirm placement | ||
# | #*Insufflate air while listening over stomach | ||
##Obtain | #**One study shows this discovers only 6% of malplacement<ref>Neumann MJ, Meyer CT, Dutton JL, et al. Hold that x-ray: aspirate pH and auscultation prove enteral tube placement. J Clin Gastroenterol. 1995; 20(4):293-295.</ref> | ||
# | #**Should not be primary confirmation technique<ref>Christensen M. Bedside methods of determining nasogastric tube placement: a literature review. Nurs Crit Care. 2001; 6(4):192-199.</ref> | ||
#*Obtain Abd xray | |||
#*Check pH of aspirate | |||
#**pH<5.5 in 99% of cases and has sen of 0.78 and spec of 0.86 at or below this level<ref>Boeykens K, Steeman E, Duysburgh I. Reliability of pH measurement and the auscultatory method to confirm the position of a nasogastric tube. Int J Nurs Stud. 2014; 51(11):1427-1433.</ref> | |||
#Secure to patients nose with tape | #Secure to patients nose with tape | ||
#Attach to desired suction, not to exceed 120 mmHg | #Attach to desired suction, not to exceed 120 mmHg | ||
== Complications | ==Complications == | ||
*Pulmonary placement | |||
*Intracranial placement | |||
*Increased cervical and cranial pressures with gagging/vomiting | |||
*Epistaxis | |||
*Invagination of stomach lumen into eyes of ngt | |||
== | ==See Also== | ||
*[[Upper GI bleed]] | |||
*[[Small bowel obstruction]] | |||
==Reference== | |||
<references\> | |||
[[Category:Procedures]] [[Category:GI]] | [[Category:Procedures]] [[Category:GI]] | ||
Revision as of 01:59, 30 December 2015
Indications
- Aspiration of stomach contents (poor sens and spec for UGI bleed)
- Vomiting likely to be dangerous or recurrent
- Bowel obstruction
- Paralytic ileus
- Acute gastric dilatation
- Stomach decompression prior to surgery or peritoneal lavage
Contraindications
- Facial fx involving cribriform plate
Relative Contraindications
- Severe Coagulopathy
- Gastric bypass and lap band procedures
- Esophageal strictures
- History of alkali ingestion
Equipment Needed
- PPE including gown for practitioner and pt
- NG Tube- typically a 16F or 18F Sump
- Syringe/Bulb- 50-60cc
- Tape
- Emesis basin
- Towels
- Cup of water with straw
Procedure
- Consent by informing patient of risk, benefits, and alternatives
- Position pt upright
- Place towel over patient's gown and emesis basin in lap
- Estimate length of insertion
- A standard of 56cm is reasonable[1])
- Alternatively measure from tip of nose to earlobe to xyphoid and then add 15cm
- Check nares for obstruction and pass through the most widely patent nare
- Provide relief from discomfort
- Topical vasoconstrictors to both nares
- Oxymetazoline or phenylephrine
- Topical Anesthetics (5 min prior to procedure)
- Benzocaine, tetracaine, nebulized lidocaine (4 or 10%), lidocaine jelly
- Anesthetize OP, as well, to prevent gagging
- Antiemetics
- Zofran and reglan 15 min prior may reduce gagging and nausea
- Topical vasoconstrictors to both nares
- Insert tube along floor of nose under inferior turbinate
- Pause when NGT is in OP
- Flex neck to decrease chance of tracheal passage
- Advance into esophagus
- Sipping water may aid in esphageal passage
- Withdraw to OP promptly if excessive coughing, gagging, choking or voice change
- Once NGT is in esophagus, rapidly insert rest of tube to premeasured length
- Confirm placement
- Secure to patients nose with tape
- Attach to desired suction, not to exceed 120 mmHg
Complications
- Pulmonary placement
- Intracranial placement
- Increased cervical and cranial pressures with gagging/vomiting
- Epistaxis
- Invagination of stomach lumen into eyes of ngt
See Also
Reference
<references\>
- ↑ Phillips DE, Sherman IW, Asgarali S, and Williams RS. How far to pass a nasogastric tube? Particular reference to the distance from the anterior nares to the upper oesophagus. J R Coll Surg Edinb. 1994; 39(5):295-296.
- ↑ Neumann MJ, Meyer CT, Dutton JL, et al. Hold that x-ray: aspirate pH and auscultation prove enteral tube placement. J Clin Gastroenterol. 1995; 20(4):293-295.
- ↑ Christensen M. Bedside methods of determining nasogastric tube placement: a literature review. Nurs Crit Care. 2001; 6(4):192-199.
- ↑ Boeykens K, Steeman E, Duysburgh I. Reliability of pH measurement and the auscultatory method to confirm the position of a nasogastric tube. Int J Nurs Stud. 2014; 51(11):1427-1433.