Tubal insertion into the stomach is sometimes necessary in order to either diagnose or treat some existing digestive tract malfunctions. The usual tube inserted to have an access into the stomach is the Nasogastric Tube (NGT) commonly termed as Nasogastric Tube Insertion Procedure or simply put as NGT insertion.
Indications of NGT Insertion
- To drain gastric contents like in case of poisoning.
- Gastric decompression like in case of internal bleeding
- For diagnostic procedures where gastric contents will become the specimen
- Therapeutic with the NGT serving as passageway for foods or medicines in case a patient is unable to swallow
Be careful to read instructions as the purpose of inserting nasogastric tube whether it is for feeding or for drainage. The purpose of the insertion determines too the type of tube to be used.
The types of NG Tubes are as follows:
Nasogastric tubes has varying sizes measured in French (8, 10, 12, 14, 16 and 18 Fr).
Nasogastric Tube Insertion Procedure
It is very important that the procedure must be done by a trained medical practitioner like doctors or nurses.
1.Wash hands and prepare materials to be used in the nasogastric tube insertion.
2.Assemble all materials at the bedside. Identify patient and explain the procedure to the client to gain cooperation. Check hospital policy for informed consent if there is a need for it.
3. Assist client to assume an upright position facing forward or side lying for patients who cannot withstand an upright position. Don sterile gloves afterwards.
4. Open the catheter kit (or have someone to assist you), with dominant hand holding the tip of the tube while the non dominant hand holds the other end of the tube. Estimate the length to be inserted by measuring from the tip of the nose to the earlobe then to the xiphisternum.
5. Lubricate the tip of the NGT using a water based jelly then start the gentle insertion of the tube in one nasal opening. Should there be any resistance felt, withdraw the tube and try it on the other nasal passage.
6. Instruct the client to inform you when he already feels the tube at the back of his throat or open their mouth (in case an anaesthetic spray was used beforehand) to check for the end of the tube as you insert. Once the tube is already at the level of the throat, instruct the client to swallow or let him have a sip of water while you are advancing the tube.
7. Check for passage of gastric content, otherwise, test for the placement of the tube using a stethoscope, listen for borborygmus at the epigastric area as you introduce air into the tube with the use of an asepto syringe. Sometimes, an xray may also be indicated to confirm tube placement.
8. Secure the tube using an adhesive tape or a securing device. Depending upon the purpose of the NGT insertion, it may be attached to a drainage bag if it is for decompression (medically termed as lavage)or it is not attached to any receptacle if it is intended for feeding and medications (termed medically as gavage). If it is for gavage, make sure the the opening of the tube is closed by invaginating a certain portion of the tube to prevent gas entry into the stomach as this may cause gastric discomfort to the patient.
9. Remove gloves, properly dispose off used materials.
10. Document the procedure.
11. Wash hands
Nasogastric tube insertion procedure for nurses is not seldom done except for those who are trained and experienced. This is a nursing skill that needs in depth training so as to be skillful and knowlegeable in executing it. It does not only entail skills but also the proper attitude in doing it since the procedure in itself entails caution and gentleness for the welfare of the patient.