NGT INSERTION

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NGT INSERTION- basically an insertion of a nasogastric tube to the nasoesophageal tract to the stomach

Purpose:
- to provide nutrition and medication - gavage
- to gain access to the stomach and its contents- lavage
- to decompress the stomach

Contraindications:
- basal skull fracture
- esophageal strictures
- fistulae
- nasal fractures/ nose bleeds
- patients who have recent esophageal surgery
- esophageal varices

Getting started:
- check doctor's order
- introduce yourself to the patient and explain the procedure
- get consent and let her/him sign the consent form. Remember to make a full clinical assessment of the patient prior to carrying out the procedure.

Materials needed:
- sterile gloves
- hypoallergenic tape
- 5O ml asepto syringe
- stethoscope
- water-soluble lubricant
- nasogastric tubing

Patient's position:
- sit the patient in a semi-recumbent position
- examine the nasal passages for any deformity/obstruction in order to determine the best side for insertion

Determine the length to be inserted:
-Place the tip of the tube against the epigastrium

Measure length to be inserted:
- passing the tube behind the ear, over the top of the ear and to the tip of the nostril

Mark the NGT:
- mark the NGT with an indelible marker

Lubricate the NGT:
- lubricate the tip of nasogastric tube with a water based lubricant or just water depending on local policy

Lubricate the nasal meatus:
- apply gel or water to the nasal meatus that you have selected to insert the nasogastric tube in

Insertion of the NGT:
- insert the nasogastric tube into the nasal meatus
- advance forward in a calm manner

Things to remember:
- if obstruction is encountered, withdraw slightly then advance the tube at a slightly- different angle. Gentle rotation of the tube can be helpful.
- if the patient can cooperate, instruct him that when the tip of the tube is felt in the throat; he should swallow, tilting the chin downward slightly at the same time. Swallowing enhances the passage of tube into the esophagus.
- never force the NGT. Withdraw the tube immediately if the patient demonstrates any signs of respiratory distress.

Continuing insertion:
- continue to pass the tube until you reach the part with the marking
- secure the nasogastric tube with tape to the cheek.Then proceed to checking of placement.

Checking the placement using "swoosh" method
- the swoosh method is done with the use of syringe. You push a small volume of air down the NGT while listening for the bubbling sound in the epigastric area by a stethoscope.

Checking the placement of NGT using pH paper:
- another method for checking the placement of a nasogastric tube is by aspirating a sample with a 5O ml catheter tip syringe. Test the pH of the aspirate with appropriate pH paper. Gastric contents should have a pH below 4.

Checking the placement of the NGT always take place :
- after initial insertion
- before administering each feed
- before giving medication via the NGT
- following any episode of vomiting or coughing
- if you suspect the nasogastric tube has moved like loose tape or the tube appears longer

Caution:
- if there is any query or doubt about the position of the NGT no feeding or administration of medication should take place

Checking placement using X-ray:
- the most accurate method for confirming the correct placement of NGT is radiography. An x-ray is not required routinely to confirm correct placement. If it is not possible to use swoosh method or to obtain an aspirate or if the pH of the gastric content is above 4 an x-ray is required. If you are unable to see the NGT tip clearly below the diaphragm, do not allow the NGT to be used until the x-ray has been reviewed by an experienced doctor.

Secure the NGT:
- anchor the tube securely to the nose and cheek keeping it out of the patient's field of vision
- correctly dispose of clinical waste and wash your hands

Documentation:
-date and time of procedure
- indication for insertion
- type of tube used
- distance tube inserted if appropriate
- the nature of the aspirate
- method used to check location of the tube insertion
- any procedural comments