NRSG 302 Week 1

What is an NG tube

A flexible tube inserted from the nostril into the stomach or upper part of the small intestine

What is the benefit of weighted NG tubes

Added portion of weight keeps the tube down in the GI tract

What size NG is used in pediatrics

5-12 Fr

What size NG is used in adults

12-18 Fr

Indications for an NG

Gain access to GI tract, decompress stomach (air, toxins, GI contents), lavage, enteral feeding, instilling medications

Contraindications for NG tube

Facial, head, neck or throat trauma

No gag reflex

Hard bore NG tube

Salem sump

Large tube, double lumen with a main tube and air vent lumen

Used for charcoal pumping, large emesis etc.

Used to take fluid out

What is the purpose of the air vent lumen in salem sump NGs

Allows air in to stop vacuum sealing and prevent sticking to and damaging the stomach wall tissue

Soft bore NG tube

Levin

Single lumen, softer, more flexible, often used with anti-reflux vibe, have stylet to help insertion, change monthly, most common for enteral feeding in IH

Used to put fluid in

Anti-reflux valve

Prevents gastric reflux or leakage through the vent lumen of a double-lumen nasogastric tube

Allows air into vent, valve prevents flow of fluids through the tube when stomach pressure exceeds atmospheric pressure

Complications of enteral feeding

Refeeding syndrome, aspiration, metabolic problems, over-hydration, hypo/hypernatremia, tube dislodgement, infection, GI side effects

Refeeding syndrome

Occurs in previously malnourished patients who are given high carb loads

Causes large increase in circulating insulin, causing rapid fall in phosphate, potassium and magnesium and increased ECF

Increased O2 consumption and increased CVS/resp workload

How to check placement of NG

X-ray or aspiration of contents and checking pH (only if removal only)

Safety for pts with NGs

Semi-fowlers only, no oral intake unless ordered, check position of NG prior to med admin, elevate HOB 30-60 mins after enteral feeding, provide oral care, tape in place + pin to gown to prevent irritation and accidental removal

Potential complications of NG tube

Aspiration, abdominal pain, discomfort, nausea, tissue trauma, compromised patency of tube, dehydration

What to assess prior to NG insertion

Previous nasal surgery, nasal septal deviation, gag reflex, patency of nares, patient cooperation

Assessing NG

Suction if prescribed, amount/quality of gastric content, check equipment, ensure length, assess for SE, irrigation of tubing as ordered, check measurement

How to measure NG tube insertion

Nose to ear to xyphoid + 15 cm

Inserting an NG

Assess nares, measure, prepare items and pt, insert, get them to swallow, check back of throat, finish insert, check placement, complete assessment, initiate ordered care.

Purpose of surgical wound drain

Used to remove drainage from a wound bed to prevent infection and fluid that would delay wound healing

Open vs closed drain system

Open = penrose, soft + flexible tube to maintain opening and allow passive drainage

Closed = active suction, fluid is collected in reservoir

Emptying a drain

Gradually reduce pressure, empty contents, maintain sterility of port, cleanse with alcohol, recharge and close port, secure device, note drainage characteristics, document

Drain removal

Empty drain and leave uncharged, remove dressing, cleanse wound, remove suture if needed, stabilize skin with 4x4, remove, apply pressure, cover with sterile dressing, assess 30 mins later, document

Penrose shortening

Set up sterile field, add scissors + safety pin + suture blade, pull out as per order, insert new safety pin, cut and discard, apply dressing