The Nasogastric Tube Placement in Nursing

Explanation of the Concept

The specific concept involves the insertion and maintenance of nasogastric tubes for patients with gastrointestinal diseases. A Nasogastric (NG) tube is a flexible, hollow tube passed from the nasopharynx into the stomach (Cooper & Gosnell, 2022). The tube removes toxic substances, fluids, and gas from the stomach, diagnosing gastrointestinal problems, obtaining secretions, or administering nutrients and fluids into the stomach. In addition, an NG tube can be used to prevent abdominal distention and vomiting, thereby allowing the digestive tract to heal and rest. Some of the commonly known NG tubes that physicians use depending on the suitability of the patient are jejunal, button tubes, and percutaneous endoscopic gastrostomy.

Depending on the function of the NG tube, the procedure can be referred to as tube feeding if it is used for delivering liquid nutrition. Therefore, NG tubes have become part of care procedures in alleviating intestinal obstruction and supporting nutritional support. The procedure can be used for any patient population requiring nutritional or decompression support (“Kids health information: Nasogastric tubes,” n.d.). The tube can also be used during the X-rays process when adding contrast to the stomach to assist in differentiating structures for better views. An NG tube can be used for persons irrespective of age (Cooper & Gosnell, 2022). In addition, the tube can be used among children experiencing difficulties in swallowing, inflammation, digestive problems, and medical conditions. The NG tube placement serves different purposes and can be used for gastric gavage, gastric lavage, and gastric decompression.

Gastric Gavage

Gastric gavage refers to supplying nutritional substances via a feeding tube directly to the stomach. The process entails attaching an NG tube to a feeding pump or feeding the patient by allowing the nutrients or fluids to flow using a syringe or gravity. Ensure the patient feeds through the NG tube to keep their head elevated at 30 degrees to avoid gastric reflux or aspiration. Start tube feeding slowly and increase gradually or dilute and strengthen gradually to avert dumping syndrome associated with too rapid infusion of concentrated feedings. Damping syndrome has similar symptoms to shock and is very distressing to the patient when it occurs. The feeding can be supplemented with additional water, which the health caregiver gives through the tube.

Water is given during feeding to assist in meeting the fluid requirements of the patients, assist in dilution of the tube feedings, and maintain the tube’s patent. However, before anything is introduced into an NG tube, it is essential to verify tube placement to prevent contents from entering the lungs. X-ray is used as absolute means of verification for NG tube placement (Nasogastric intubation, 2022). Another means of testing the placement involves aspirating gastric contents either by observing the aspirated contents for consistency and color of the fluid or testing the aspirated gastric juices for pH. The pH of normal gastric juice contents is less than 4. The caregiver continuously monitors residual feedings in the stomach of the patients’ receiving nutrients. Any increase is reported as a sign of a problem like aspiration or gastric reflux.

Gastric Lavage

The NG tube is used primarily for delivering nutrients or fluids during nursing assessment for gastrointestinal disease. In this process, a feeding pump is attached to allow a steady flow of the fluids by gravity. When administering, patients must sit with their heads raised 30 degrees to prevent gastric reflux or aspiration. The use of gastric lavage allows for the stopping of gastrointestinal bleeding, and it is done in case of poisoning. Through this process, the stomach is provided with room temperature solutions, after which it is suctioned out. Precaution is taken not to use iced solutions to avoid causing hypothermia, increased bleeding, and impaired platelet production. The solution used is administered until there is an improvement in results, and every time the solution is removed from the stomach, it has to be measured, evaluated, and documented.

Gastric Decompression

Gastric decompression is done mainly to remove the fluids and air building up during slowed gastrointestinal motility. The method can be used after surgery to prevent vomiting, nausea, and distention development. During decompression, the NG tube is coupled to an intermittent gastric suction device, and with the help of the nurse measure, the content is routine. Lavin and Salem sump tubes are the most common tubes applied for decompression. When administering the NG tube, patients present numerous issues, and maintaining their comfort is often challenging (“Nasogastric tube (NG tube),” n.d.). The tube irritates nasal mucosa and can result in trauma. To lessen this discomfort involves securing the tube on the nose and gown to restrict unwanted movement. Excessive secretions around the nostrils and nares are also removed, and the tube is lubricated with water-soluble that prevents the crusting of secretions.

Patient Problems/Nursing Diagnoses

1. Risk for aspiration related to the insertion of NG tube, which is secondary to dysphagia.
2. Deficient knowledge is mainly related to home management and care of NG tube management which is secondary to stroke. It is evidenced by inadequate understanding regarding the condition, limited ability to manage NG tubes appropriately, and the existence of severe complications which are preventable (Ignatavicius et al., 2020).
3. The risk for imbalanced nutrition associated with feeding through the NG tube is secondary to gastrectomy.
4. Risk for fluid volume deficiency related to feeding through NG tube secondary to critical Crohn’s disease.
5. Risk for infection related to the insertion of NG tube and feeding secondary to gastrointestinal cancer.

Nursing Assessments

1. Verify the NG tube, suction method, and irrigation instructions given by the doctor. This maintains precision in carrying out the doctor’s instructions.
2. Examine the NG tube drainage to assess the quality, including the sample’s quantity, color, composition, and odor. Test the drainage using a hematology kit to find out if there’s any blood in it. Gastric discharge typically appears to be a pale yellow to light green tint due to bile presence. Bloody leakage following gastric surgery is possible and should be constantly monitored. (Ignatavicius et al., 2020) Drainage that resembles coffee grounds could be a sign of internal hemorrhage.
3. Inspect vacuum cleaners to verify whether the correct settings have been made for the suction type, the suction range, and the presence of drainage movement through the tube. The action protects the integrity of the doctor’s instructions by ensuring their precise execution (Ackley et al., 2020). In addition, it verifies the presence and strength of suction. Inadequate suction may result from a loose connection or some form of obstruction in the tube.
4. Check the NG tube positioning because it can be accidentally pushed into the trachea if the patient moves or through manipulation.
5. Examine if the patient is experiencing pain, nausea, or fullness in their stomach. Lack of ease could indicate a clogged NG tube or improperly functioning NG suction.
6. Using auscultation, check the patient’s abdomen for distention and the absence of bowel sounds. Distention in the abdomen could be caused by gas buildup or internal hemorrhage. If there are rumblings in the stomach again, peristalsis has resumed.
7. Determine the client’s level of mobility and evaluate their breathing. Peristalsis can be restored and drainage facilitated by turning from side to side in bed and ambulating if allowed (Ignatavicius et al., 2020). In addition, NG tube may dissuade patients from engaging in deep breathing and coughing, which helps maintain a healthy respiratory exchange.
8. Check the client’s mouth and nose for any signs of infection. Cleaning and lubricating the nostrils with a water-soluble lubricant and changing the tape as needed can help reduce irritation from the NG tube. In addition, oral hygiene should be practiced every two hours to keep the oral mucosa supple and comfortable.
9. Continuously monitor and assess the well-being of your NG tube patient. An NG tube may be taped to the patient’s nose and attached to their robe to facilitate patient mobility. Nursing assistance is always a push away if a client has a call bell within easy reach. When an NG tube becomes obstructed or kinked, its ability to deliver oxygen is compromised (Ackley et al., 2020). The semi-Fowlers position helps with drainage and reduces the potential for aspiration.
10. Ensure that supplies are always adequate and that equipment is serviced as per manufacturer specifications and agency guidelines. The availability of resources ensures the proper functioning of machinery and the effective removal of stomach contents from patients.
11. Fill out an intake/output chart with NG irrigation and drainage measurements as required by the agency. Create a chart detailing the draining process and the client’s reaction. Intake includes irrigation, and output from the NG tube is monitored every 8 hours. When there is a lot of runoff, the trash can must be emptied more often. Therefore, the documentation of the client’s reaction to NG drainage is reliable.
12. Check the NG tube and suction equipment at least every two hours. Irrigate as prescribed by the physician to promote safe system functioning. Any change in the client’s condition or drainage demands increased monitoring and physician notification.

Specific, Realistic and Measurable Goals

Deficient Knowledge

1. The patient will acquire more knowledge about managing an NG tube.
2. The patient will be able to identify symptoms of severe complications at an early stage to prevent worsening.
3. The patient will gain awareness of the benefit and learn how to control the disadvantages associated with NG tube feeding.

Risk for Aspiration

The patient will be protected from the risk by healthcare staff who have adequate knowledge of its management by identifying the problem at an early stage.

Imbalanced Nutrition

1. The patient will display no malnutrition signs.
2. The patient will exhibit a slow weight gain or keep a stable weight in accordance with specific standards established to normalize laboratory values.

Deficient Fluid Volume

The patient will maintain a stable fluid volume and an appropriate balance between the output and input of fluids.

Infection

The patient will be knowledgeable concerning limiting and controlling the risk of infection associated with NG tube feeding.

Nursing Interventions

1. Ensure patients have the appropriate food in the NG tubing, especially those affected by stroke. Components of NG dietary food are often in a liquid form. The patient’s condition determines the specific food or medication to be given and the frequency (Gulanick & Myers, 2022). Care providers can receive guidance from a doctor or dietitian on what kinds of food to serve patients. The patient and their loved ones can select ready-made liquid formulations and prepare the food themselves. Food should be heated to a temperature the patient finds comfortable before being served.
2. Teach the patient and any close relatives how to use the NG tube correctly.
3. Provide patient and family members with information about NG tube care and management.
4. Check that the NG tube is in the right place to prevent any problems. Remind them that the NG tube must not be removed or reinserted unless instructed by the attending physician.
5. It is important to inquire about the hospital’s handling of patients at high risk of aspiration from other facilities where they were treated.
6. Create an alternative or contingency plan to treat all individuals with emergency needs appropriately.
7. Inform the doctor if there is any displacement of the NG tube
8. Record the quantity and features of the patient’s stomach discharge because persistent bleeding is indicative of complications
9. Check for skin breakdown, tachycardia, hypoglycemia, and a relatively high gravity in the patient’s urine as indicators of a fluid-volume deficit.
10. Ensure proper medication administration via the NG tube and appropriate preparation is done.
11. Inform family members about the risk for infection and strategies to avoid such factors
12. Examine urine production hourly and weigh the patient frequently to monitor any gain or losses per fluid volume retention strategies.

References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier

Cooper, K., & Gosnell, K. (2022). Foundations of nursing. Elsevier Health Sciences.

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medicalsurgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier

Kids health information: Nasogastric tubes. (n.d.). The Royal children’s hospital: The royal children’s hospital. Web.

Nasogastric intubation: Background, indications, contraindications. (2022). Diseases & Conditions – Medscape reference.

Nasogastric tube (NG tube). (n.d.). MedlinePlus – Health Information from the National Library of Medicine. Web.

Nasogastric tube. (n.d.). Nemours kids health – the Web’s most visited site about children’s health.