#9 NGT PP: quizlet imports

* What is the purpose of using an NGT for enteral feeding?

Giving nutrition (liquid food or formula) directly into the stomach through the NGT.

* How is medication administered using an NGT?

Giving prescribed medications through the NGT when the patient can't take pills by mouth.

* What is suctioning in the context of NGT use?

Removing stomach contents or air using suction through the NGT.

* Why is NGT suctioning used?

To relieve pressure from a distended (bloated) stomach and to prevent vomiting and aspiration in patients with bowel obstruction or post-surgery.

* What is the purpose of laboratory analysis using an NGT?

Taking a sample of gastric contents (stomach fluid) through the NGT.

* Why is laboratory analysis through an NGT performed?

To check pH, blood, infection, or other diagnostic purposes.

* What is lavage in relation to NGT use?

Washing out the stomach with fluid through the NGT.

* What is the internal application of pressure using an NGT?

Using a specialized NGT (like a Sengstaken-Blakemore tube) to apply pressure inside the stomach or esophagus.

* Why is internal application of pressure through an NGT used?

To control bleeding, especially from esophageal varices (enlarged veins that can rupture).

* What is an indication for using a nasogastric tube (NGT) post-operatively?

To decompress the stomach after abdominal surgery.

* How does an NGT help after surgery?

It prevents vomiting or aspiration if bowel function is slow to return.

* What is one function of an NGT in post-operative care?

It helps remove air and gastric secretions that can cause discomfort or pressure on surgical sites.

* What condition is indicated for NGT use when peristalsis is impaired?

Ileus or bowel obstruction.

* How does an NGT help with impaired peristalsis?

It removes gas and fluid buildup to relieve nausea, vomiting, and distention.

* What is an indication for NGT use in cases of abdominal distention?

To decompress the stomach when there's excessive gas or fluid accumulation.

* What does an NGT prevent in cases of abdominal distention?

Further discomfort, vomiting, or aspiration.

* Why is an NGT used in critically ill patients?

It provides a route for nutrition (enteral feeding) when patients cannot eat by mouth.

* What is another use of an NGT in critically ill patients?

Allows medication administration directly into the stomach.

* How does an NGT help prevent aspiration in unconscious or ventilated patients?

It is used for suctioning to keep the stomach empty.

* Indications for an NGT 

1. Post-operative (after surgery)

Used to decompress the stomach after abdominal surgery.

Prevents vomiting or aspiration if bowel function is slow to return.

Helps remove air and gastric secretions that can cause discomfort or pressure on surgical sites.

2. Impaired peristalsis

When the normal movement of the intestines (peristalsis) slows or stops (e.g., ileus or bowel obstruction).

NGT helps remove gas and fluid buildup to relieve nausea, vomiting, and distention.

3. Abdominal distention

Used to decompress the stomach when there’s excessive gas or fluid accumulation.

Prevents further discomfort, vomiting, or aspiration.

4. Critically ill patients

Provides a route for nutrition (enteral feeding) when patients cannot eat by mouth.

Allows medication administration directly into the stomach.

Used for suctioning to keep the stomach empty and prevent aspiration in unconscious or ventilated patients.

Use of an NGT 

1. Enteral Feeding

Giving nutrition (liquid food or formula) directly into the stomach through the NGT.

2. Administering Medication

Giving prescribed medications through the NGT when the patient can’t take pills by mouth.

3. Suctioning

Removing stomach contents or air using suction through the NGT.

Why it’s used:

To relieve pressure from a distended (bloated) stomach.

To prevent vomiting and aspiration in patients with bowel obstruction or post-surgery.

4. Laboratory Analysis

Taking a sample of gastric contents (stomach fluid) through the NGT.

Why it’s used: To check pH, blood, infection, or other diagnostic purposes.

5. Lavage

Washing out the stomach with fluid through the NGT.

6. Internal Application of Pressure

Using a specialized NGT (like a Sengstaken-Blakemore tube) to apply pressure inside the stomach or esophagus.

Why it’s used: 

To control bleeding, especially from esophageal varices (enlarged veins that can rupture).

What is a nasogastric tube

a pliable tube that is inserted through the client's nasopharynx into the stomach

Has a hollow lumen that allows for removal of gastric secretions & introduction of solutions into the stomach

Small or large bore

* Maintenance of an NGT

Irrigate tube as required/ordered

• Verify placement

• Maintain patency

• Assess abdominal distention

• Auscultate for bowel sounds

• Auscultate breath sounds

* Care of the client with NGT

Maintaining comfort

Assess nares & mucosa

Change soiled tape

•Frequently lubricate nares

•Frequent mouth care

Frequent assessments (abdominal/respiratory)

* Complications of NGT

Abdominal distention

vomiting

absence of drainage

Throat Irritation

Chronic inflammation

erosion of nasal mucosa

Fluid volume deficit

Pulmonary aspiration (stomach contents enter lungs, due to misplacement of the tube into the trachea, vomiting, or improper positioning during feeding)

* Aspiration immediate response with an NGT

• Coughing

• Dyspnea (troubled breathing)

• Cyanosis

• Crackles/wheezes

• Decreased O2 sat

• Increased RR

Delayed Response

• Fever

• Development of pneumonia

* Unexpected Outcomes with Enteral Feeds

Increased gastric residual (>200-500 mL) (Indicates the stomach is not emptying properly.

• Diarrhea (rapid infusion)

• N/V (vomit and nausea)

• Clogged tube

• Fluid overload

• Dehydration

What is the first step in NGT insertion?

Patient Assessment

What should be checked in the nares, oral cavity, and abdomen during NGT insertion?

Assess for previous nasal fractures or surgeries, nasal polyps, or other blockages.

What position should the patient be in for NGT insertion?

High Fowler's position (sitting upright)

How do you measure the length of the NGT to be inserted?

Measure the length and mark the appropriate length on the tube with tape or a marker.

What should be prepared in advance to anchor the NGT upon insertion?

Tape

What equipment should be prepared if indicated for the NGT procedure?

Suction equipment

How should the NGT be prepared before insertion?

Curve the tip and apply lubrication (if not pre-lubricated) or dip in water.

What is the recommended neck position for NGT insertion?

The patient's neck should be extended back against the pillow.

What should you do if the patient begins to gag during NGT insertion?

Pause the advancement of the tube and retract it a few centimeters.

What should the patient do once the tube is past the nasopharynx?

Flex their head forward and sip water to facilitate insertion into the stomach.

What should you observe for when checking tube placement?

Signs of distress such as cyanosis, coughing, or gasping for air.

What should you do if you observe signs of distress in a patient with a tube?

Remove the tube immediately.

How can you confirm tube placement through patient communication?

Ask the patient to talk, if able.

What physical check can indicate improper tube placement?

Check if the tube has coiled at the back of the throat.

What is the purpose of gently aspirating back in the syringe during tube placement checks?

To obtain gastric contents and observe the color of the aspirate.

What is the normal gastric pH range for aspirate?

0-4

What is the normal duodenal pH range for aspirate?

>4 to 7

What is the normal respiratory pH range for aspirate?

>6

How can acid-inhibiting agents affect pH testing of aspirate?

The pH range may be between 4-6.

What factors can alter the pH of aspirate?

Medications or feedings.

What should you do to secure the tube during the procedure?

Anchor the tube securely to the nose and secure it to the gown.

What is the purpose of X-ray confirmation in the procedure?

To verify placement of the tube.

What should be done to mark the tube for future checks?

Ensure that the tube has a mark or tape at the nose to check for migration over time.

How should the NGT be connected?

Connect the NGT appropriately, whether for intermittent or continuous drainage or enteral feeding.

What should be provided to the patient post-procedure?

Provide comfort and mouth care to the patient.

What details should be documented during the NGT insertion process?

Document tube size, drainage amount, color of the aspirate, pH of the aspirate, and patient's tolerance and response to the procedure.

Documenting Insertion of an NGT tube includes

Tube size

Drainage amount

Color of the aspirate

pH of the aspirate

Patient's tolerance and response to the procedure.

Equipment/Supplies Needed for inserting NGT

Water soluble lubricant

NG tube

Stethoscope

Tape

Tongue depressor/blade

Flashlight (if needed)

Non-sterile gloves

60 mL catheter tip syringe

Safety pin (if permitted)

'Blue' pad or towel

K-basin

Marker or measuring tape

Cup of water with straw

Saline for irrigation

Appropriate suction

Working suction available

pH test strip

Patient Assessment Steps: inserting NGT

Assess nares

Assess oral cavity

assess abdomen for obstructions, previous surgeries, or abnormalities

Assess gag reflex and ability to swallow

Position patient in high Fowler's for insertion

Measure tube length:

(nose → earlobe → mid-umbilicus) and mark tube

inserting NGT: Preparation for Insertion

Prepare tape in advance to anchor the tube upon insertion.

Prepare suction equipment if indicated for the procedure.

Prepare the tube by curving the tip and applying lubrication (if the tube is not pre-lubricated) or dip in water.

inserting NGT: Insertion Technique

Neck Position:

With the patient's neck extended back against the pillow, gently insert the tube to the nasopharynx.

Gag Reflex Management:

If the patient begins to gag, pause the advancement of the tube and retract it a few centimeters to allow the patient to rest.

Continued Insertion:

Once past the nasopharynx, instruct the patient to flex their head forward and sip water to facilitate the insertion and placement of the tube into the stomach (to the mark on the tube).

Checking Tube Placement: inserting NGT

Observe the patient for signs of distress such as cyanosis, coughing, or gasping for air

remove the tube immediately if observed.

Ask the patient to talk, if able, to confirm placement.

Check if the tube has coiled at the back of the throat.

Gently aspirate back in the syringe to obtain gastric contents, observing the colour of the aspirate.

Obtain the pH of the aspirate:

Gastric pH: 0-4

Duodenal pH: >4 to 7

Respiratory pH: >6

Note: If the patient is receiving acid-inhibiting agents, the pH range may be between 4-6.

Finalizing the Procedure: inserting NGT TUBE

Anchor the tube securely to the nose and secure it to the gown.

Ensure that an X-ray confirmation is received to verify placement.

Ensure that the tube has a mark or tape at the nose to check for migration over time.

Connect the NGT appropriately, whether for intermittent or continuous drainage or enteral feeding.

Provide comfort and mouth care to the patient post-procedure.

Documenting Insertion:

Tube size

Drainage amount

Color of the aspirate

pH of the aspirate

Patient’s tolerance and response to the procedure.

Peer Critique - NGT Removal STEPS

Verifies physician's order for NGT removal

Explains the procedure to the patient

Turns off suction and disconnects NGT from suction or drainage bag

Places the patient in a semi to high Fowler's position

Ensures working suction equipment is readily available

Removes tape from the nose and pins from the gown (if pins are used)

Instructs the patient to take and hold a deep breath

If the patient is unable to hold their breath, the tube is removed on expiration

Clamps or kinks the tubing and withdraws tubing steadily, smoothly, and quickly while the patient holds their breath

Measures the amount and character of drainage from the suction canister (if applicable) and records it on the Input/Output (I/O) sheet

Provides mouth and nasal care

Documents NGT removal

the amount and character of the drainage

the patient's tolerance/response

When removing a NGT tube- what position should the pt be in?

High fowlers

What should the pt do while you are removing the NGT

end of inspiration when holding there breath

What should be assessed to determine nutritional status before feedings?

Baseline weight

Lab values: albumin, transferrin, prealbumin

What physiological or metabolic issues should be assessed before starting feedings?

Fluid volume excess or deficit

Electrolyte imbalances

Metabolic abnormalities (e.g., hyperglycemia)

What orders must be verified before administering enteral feedings?

Formula type

Feeding rate, route, and frequency

Lab tests and bedside assessments (e.g., fingerstick glucose)

Tube feedings and assessments must have a physician order

How do you assess GI readiness for feeding?

Auscultate bowel sounds before feeding

Absence of bowel sounds may indicate decreased digestive or absorptive capacity

What steps are necessary to prepare formula for enteral feeding?

Check expiration date and container integrity

Bring formula to room temperature (prevents cramping/discomfort)

Perform hand hygiene and apply gloves

Shake formula container well

Fill feeding container and tubing, opening stopcock to remove air

Purpose: prevents air in GI tract and maintains sterile pathway

How do you prepare an enteral feeding for administration?

Connect tubing to container or use ready-to-hang container.

Critical Point: Tube feedings are infused using feeding pumps; do not use IV pumps.

For intermittent feedings: have syringe ready.

Ensure formula is at room temperature to prevent gastric cramping.

* How do you verify nasoenteric tube placement?

Aspirate and check colour:

Intestinal aspirate: bile-stained, yellow

Gastric aspirate: usually not bile-stained

Consider pH testing:

Gastric pH 1–5.5 reliably indicates stomach placement

Lower pH = stronger evidence for gastric vs. respiratory placement

Check length of tube from naris to tip; ensure original mark is unchanged

CO₂ detectors may help differentiate gastric vs. pulmonary placement (not used alone)

Abdominal radiograph if placement is in doubt

How do you check and interpret gastric residual volume (GRV)?

Draw 30 mL of air with syringe, connect to tube, flush tube with air.

Pull back evenly to aspirate gastric contents.

GRV indicates delayed gastric emptying.

Continue feeding if GRV ≤ 500 mL and no signs of intolerance.

Withhold feedings if GRV > 500 mL in 6 hours (critical care patients).

Pediatric patients have lower GRV thresholds.

One elevated GRV does not automatically stop feeding; monitor for intolerance.

What should be done with aspirated contents and how do you maintain tube patency?

Return aspirated contents to stomach if agency policy allows.

Flush tubing with 30–50 mL of room-temperature water to maintain patency and prevent clogging.

Critical Point for Small-Bore Tubes:

Soft small-bore tubes may collapse when checking GRV → falsely low readings.

Tube location matters; small bowel placement produces ongoing secretions.

What should you do before starting an enteral feeding?

Label feeding tube bag with: formula type, rate, time, and date.

Post nutrition label clearly.

Document tube assessment, formula infusing, and infusion rate.

How is intermittent feeding via syringe performed?

Pinch proximal end of feeding tube.

Remove plunger and attach syringe barrel to tube.

Fill syringe with measured formula and release tube.

Hold syringe high enough for gradual emptying by gravity.

Refill and repeat until prescribed amount delivered.

Purpose: Gradual infusion reduces abdominal discomfort, vomiting, or diarrhea.

How do you administer intermittent feedings via feeding bag?

Hang bag on IV pole.

Fill with prescribed formula; allow to empty gradually over at least 30 minutes.

Critical: Use feeding pumps for continuous feeding; IV pumps must not be used.

Slow infusion reduces complications.

How do you prepare for continuous-drip feeding?

Prime and hang feeding bag and tubing.

Connect distal tubing to proximal end of feeding tube.

Connect tubing through infusion pump; set prescribed rate.

Do not hang more than 4-hour supply (prevents spoilage/infection).

Gradually advance feeding rate to reduce abdominal discomfort and intolerance.

What should you consider when verifying tube placement during continuous feeding?

Continuous feeding can alter gastric pH → pH testing may be less reliable.

Always confirm placement using multiple verification methods.

Why and how should you flush the feeding tube?

Flush after intermittent feeding or at end of continuous feeding with 10–30 mL of room-temperature water.

Repeat every 4–6 hours if needed.

Purpose: Maintains tube patency, prevents clogging, provides water for fluid/electrolyte balance.

What should be done if feedings are held (e.g., for tests/procedures)?

Cap or clamp proximal end of tube → prevents air entry and contamination.

Rinse bag and tubing when interrupted or every 8 hours → reduces bacterial growth.

Change bag/tubing every 24 hours.

What monitoring is essential for patient safety and tolerance during enteral feeding?

Measure gastric residual every 8-12 hours.

Monitor fingerstick blood glucose every 6 hours until max rate maintained 24 hours.

Monitor intake/output every 8 hours; compute 24-hour totals.

Weigh patient daily until max rate maintained; then 3x/week.

Observe respiratory status → ↑ RR may indicate aspiration.

Monitor labs (albumin, transferrin, prealbumin) for nutritional improvement.

What should you do if gastric residual exceeds 200-500 mL (per agency policy)

Withhold feeding and notify physician if residual volume exceeds policy limits

If residual volume is less than 300 mL, return aspirated contents to patient via feeding tube

If residual volume is 300 mL or more, discard aspirate

Maintain patient in semi-Fowler's position, or elevate head of bed to 30 to 45 degrees

Perform physical assessment to detect signs of intolerance or complications

Assess glycemic control to ensure safe metabolic status

How do you measure and manage gastric residual volume for enteral feeding?

Draw 30 mL of air in a syringe.

Connect the syringe to the end of the feeding tube and flush tube with air.

Pull back evenly to aspirate gastric contents.

Measure the volume of aspirated contents.

Compare the GRV to agency policy limits (commonly 200–500 mL).

If residual is within safe limits: return aspirate to the stomach if allowed.

If residual exceeds policy limits: withhold feeding and notify the physician.

Flush the tube with 30–50 mL of room-temperature water to maintain patency.

Repeat assessment at intervals per agency policy (usually every 4–6 hours).

How should a nurse respond if a patient develops diarrhea (3x or more episodes in 24 hours) during enteral feeding?

Notify physician.

Confer with dietitian.

Institute skin-care measures.

Diarrhea could relate to the speed and method of administration and the type of enteral nutrition formula

Look for other causes of the diarrhea (e.g., antibiotics; consider change in antibiotics only for patients receiving antibiotics).

What are the interventions for nausea or vomiting during enteral feeding?

Notify physician.

Check patency of tube.

Aspirate for residual, keeping in mind that GRV remains the most common factor in defining feed intolerance, despite the lack of evidence to support this

Auscultate for bowel sounds.

What should patients or primary caregivers know about verifying feeding tube placement in the community?

Teach how to determine correct tube placement using pH strips.

Explain normal pH ranges:

Gastric: 0–4 (usually <5.5)

Intestinal: >4–7

Respiratory: >6 (alert for misplacement)

Emphasize that pH testing should be done before each feeding or medication administration to ensure safety.

What signs of pulmonary aspiration should patients or caregivers be aware of?

Coughing during or after feeding

Dyspnea (difficulty breathing)

Cyanosis (bluish discoloration of lips or skin)

Crackles or wheezes in lungs

Increased respiratory rate

Teach caregiver to stop feeding and seek immediate help if these signs appear.

What signs of delayed gastric emptying should be taught to patients or caregivers?

Abdominal distention or bloating

Nausea or vomiting

High gastric residual volumes (if measuring at home per agency instructions)

Feeling of fullness or discomfort during or after feeding

Advise caregiver to contact physician if these symptoms persist or worsen.

What feeding tube complications should patients or caregivers monitor for?

Tube clogging or inability to aspirate contents

Tube displacement or migration

Diarrhea or gastrointestinal intolerance

Signs of infection at tube insertion site

Unusual aspirate color or odor

Advise to call the physician promptly if any of these issues occur.

Delegation Considerations: Administering Enteral Feedings via Gastrostomy or Jejunostomy Tube

Can be delegated to an unregulated care provider (UCP) after nurse verifies tube placement.

UCP should not test tube position or administer the first feeding.

Patient must be upright in chair or bed.

UCP instructed to infuse slowly and report any difficulty or patient discomfort.

What GI assessments are needed before feeding?

Auscultate bowel sounds

Absence may indicate decreased or absent peristalsis, increased risk of aspiration or abdominal distention

Assess gastrostomy/jejunostomy site for breakdown, irritation, drainage

Infection, tube pressure, or gastric secretions can cause skin breakdown

What patient factors indicate the need for gastrostomy or jejunostomy feedings?

Impaired swallowing

Decreased level of consciousness

Surgical procedures involving upper alimentary tract

Need for long-term enteral nutrition

How is tube placement verified? (gastrostomy or jejunostomy)

Aspirate gastric or intestinal secretions

Observe appearance and check pH:

Gastric: pH 1–4 (fasting), higher with continuous feeding

Jejunal: <10 mL, intestinal fluid

Return aspirate unless volume exceeds specified limits

How is the feeding container and formula prepared (gastrostomy or jejunostomy)

Formula at room temperature (cold can cause gastric cramping)

Shake formula well

Fill container and tubing to remove air

Elevate head of bed 45°

Verify tube placement

Steps for syringe (bolus) feedings via gastrostomy or jejunostomy?

Pinch proximal end of tube (prevents air entry/leakage)

Remove plunger, attach syringe barrel, fill with formula

Release tube and elevate syringe, allowing formula to empty gradually by gravity

Refill and repeat until prescribed amount delivered

Key steps for continuous drip feedings?

Designed to deliver prescribed hourly rate

Reduces risk of diarrhea and abdominal discomfort

Verify tube placement every 4 hours

Monitor gastric residual volumes (GRVs): critical care patients every 4 hours, non-critical patients decrease after 48 hours

Begin infusion at prescribed rate, advance gradually

How is tube patency maintained? (gastrostomy or jejunostomy)

Administer water as ordered with or between feedings

Flush tube with 30 mL water every 4-6 hours and before/after medications

Maintains tube patency, prevents clogging, provides free water

How should intermittent feedings be managed?

Cap or clamp proximal end when not feeding

Rinse container and tubing after feedings

Change container and tubing every 24 hours

Steps for stoma care in patients:

Assess skin around tube daily

Clean with normal saline until healed; apply precut gauze secured with tape

After healing, clean daily with warm water and mild soap; leave site open to air

Report drainage, redness, swelling, or tube displacement

What is a gastrostomy tube?

A gastrostomy tube is a medical device used to provide nutrition to patients who cannot eat by mouth.

What is the procedure for checking gastric secretions with a gastrostomy tube?

Attach a syringe and aspirate gastric secretions.