As nurses and student nurses, we oftentimes find patients during hospital duties with that narrow and long tube dangling from their noses. Yeah, we have come to know that is called a Nasogastric Tube or most well known with its abbreviation, NGT. Back in nursing school, when everybody starts going to hospitals for duties, a student often gets dismayed when he/she is assigned with a patient with NGT. For him/her, it means added burden both to the long 8-hour duty that is about to start and to their nosebleed inducing NCPs. Many speak about it, patients fear it. But what do we really know about the NGT? About its purposes and how it is inserted? Let’s find out.
NGT and its purposes
A nasogastric tube is an elastic plastic tube that goes through the patient’s mouth or nose into the stomach. With an inserted NGT comes gained access to the stomach and its contents. With this, we can be able to drain gastric contents, decompress the stomach, obtain a specimen of the gastric contents, or introduce a passage into the GI tract. By doing so, we can treat gastric immobility, and bowel obstruction. It is also used for drainage (or called lavage) in cases of drug over dosage or poisoning. In trauma settings, NG tubes can be used to assist in the prevention of vomiting and aspiration, it can also come in handy when it comes to the assessment of GI bleeding. Also, it can be used for enteral feeding initially or what we call as the gavage, which also includes giving of per orem medication such as tablets and syrups which the patient cannot swallow.
Before inserting an NGT, we must first get all the materials and equipment needed ready. This is to aid a less toxic and smoother insertion, without cramming and panicking. Below are the materials needed during an NGT insertion:
- Personal protective equipment
- NG/OG tube
- Catheter tip irrigation 60ml syringe
- Water-soluble lubricant, preferably 2% Xylocaine jelly
- Adhesive tape
- Low powered suction device OR Drainage bag
- Cup of water (if necessary)/ ice chips
- Emesis basin
- pH indicator strips
When you are sure that you have gathered all equipment, these steps are to be followed when inserting the tube:
- Don non-sterile gloves
- Explain the procedure to the patient and show equipment
- If possible, sit patient upright for optimal neck/stomach alignment
- Examine nostrils for deformity/obstructions to determine best side for insertion
- Measure tubing from bridge of nose to earlobe, then to the point halfway between the end of the sternum and the navel
- Mark measured length with a marker or note the distance
- Lubricate 2-4 inches of tube with lubricant (preferably 2% Xylocaine).
- Pass tube via either nare posteriorly, past the pharynx into the esophagus and then the stomach.
- Instruct the patient to swallow and advance the tube as the patient swallows. Swallowing of small sips of water may enhance passage of tube into esophagus.
- If resistance is met, rotate tube slowly with downward advancement toward closes ear. Do not force.
- Withdraw tube immediately if changes occur in patient’s respiratory status, if tube coils in mouth, if the patient begins to cough or turns pretty colors
- Advance tube until mark is reached
- Check for placement by attaching syringe to free end of the tube, aspirate sample of gastric contents. Do not inject an air bolus, as the best practice is to test the pH of the aspirated contents to ensure that the contents are acidic. The pH should be below 6. Obtain an x-ray to verify placement before instilling any feedings/medications or if you have concerns about the placement of the tube.
- Secure tube with tape or commercially prepared tube holder
- If for suction, remove syringe from free end of tube; connect to suction; set machine on type of suction and pressure as prescribed.
- Document the reason for the tube insertion, type & size of tube, the nature and amount of aspirate, the type of suction and pressure setting if for suction, the nature and amount of drainage, and the effectiveness of the intervention.
Things to look out for
Like any other nursing procedure, there are risks involved when it comes to performing the procedure. NGT insertion should not be done to patients with severe facial trauma such as cribriform plate disruption, since by doing so we expose the likelihood of inserting the tube intracranially. In this instance, an orogastric tube may be inserted instead of a nasogastric tube.
Complications are also possible in the form of aspiration and tissue trauma. Placement of the catheter can stimulate gagging or vomiting. With possibilities like these that may be fatal, suction should always be ready to use in the case of this happening.
Gloves must be worn while starting an NG; and if the risk of vomiting is high, the operator should consider face and eye protection as well as a gown to protect ourselves in cases wherein we potentially can come into contact with a patient’s blood and body fluids.
It has become mainstream to students to memorize concepts and procedures that they think of as something that will come out of the board exam that they tend to forget about them as soon as they finish answering the last question. But hey, if you’re thinking that way, then you’re heading to the wrong path. Learning about nursing procedures like NGT Insertion and the like is not just about memorizing its definition and steps, it’s all about understanding its purposes and rationale on why it should be done to a specific client. With that, you will not only learn and understand more about the procedure by heart, but you will also gain a sense of confidence and enlightenment when you perform the procedure later on.