Principles of Care of NasoGastric Tube (Essay Sample)

Principles of Care of NasoGastric Tube
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Principles of Care of Nasogastric Tube
A nasogastric tube is a silicone or polyurethane long tube, which is passed via the nasal passages through the esophagus into the stomach. It is important that the health provider inserting this tube knows the correct procedure and principles that should be observed in the insertion process. This paper aims at exploring some of the principles of care of nasogastric tube.
Currently, nasogastric tubes are usually used to those patients undergoing esophageal or gastric operations for upper intestinal decompression, and decrease tension on alimentary anastomosis. The other group of patients nagged with nasogastric tubes are those with intestinal obstruction or with severe prolonged ileus, normally related to intra-abdominal sepasis. However, nasogastric decompression is appropriate on a selective basis for any patient in whom severe nausea, vomiting, or gastric distention develops (Garden, 2012).
Patients with nasogastric tubes need to have consistent oral care approximately every two to four hours; confirmation of the placement of the tube, and assessment of the consistency and amount of drainage from the tube. Although this tube is normally anchored with a tape or other devices, it can coil in the esophagus or at the back of the throat and as a result, hamper breathing. In addition, nasogastic (NG) tube can cause a pressure ulcer on the nares of unconscious patients. Thus, the condition of the skin around the tube is an important aspect of daily nursing assessment.
Special considerations during the insertion process
Ross-Hanson tape is a helpful device for calculating the correct tube length. The narrow end of the Ross-Hanson tape is placed at the tip of the patient's nose, and then it is extended to the patient's earlobe, and down to the tip of the xiphoid process. This distance is marked on the edge of the tape labeled "Nose to Ear to Xiphoid." The corresponding measurement on the opposite edge of the tape is the proper insertion length.
If the patient has a deviated septum or other nasal condition, which may hinder nasal insertion, nasogastric tube is advanced orally. The tube is slide over the tongue, then down to esophagus in a similar way to nasal insertion. When using the oral route, it is advisable to coil the end of the nasogastic tube around one's hand. This helps direct the tube in the right way downward without interfering with the pharynx.
If the patient is unconscious, his/her chin is tilted towards his/her chest to close the trachea. Then the tube is advanced between respirations to ensure that it does not enter trachea. While advancing the tube, the health expert should observe any signs that depict the tube has entered the trachea such as choking or breathing difficulties in a conscious patient, and cyanosis in an unconscious patient or a patient without a cough reflex. If these signs occur, the tube should be removed immediately, and then the patient is given some time to rest before restarting the insertion process. if the patient vomits after insertion of the NG tube, then this will depict that it is incorrectly inserted. It should be assessed immediately to determine the cause (Adam & Osborne, 2005).
Pain, swelling, and salivary dysfunction may signal parotitis, which occurs in dehydrated, debilitated patients. Intubation can cause nasal skin breakdown and discomfort and increased mucus secretions. Moreover, vigorous suction can result to significant bleeding and destroy the gastric mucosa.
Ensuring proper tube placement
* The health expert should use a tongue blade and penlight to examine the patient's mouth and throat for signs of a coiled section of tubing especially of an unconscious patient. Coiling indicates an obstruction.
* An emesis basin and facial tissues should be kept readily available for the patient.
* As the tube is been advanced, the doctor should watch for respiratory distress signs, which may mean the tube is in the bronchus and must be removed immediately.
* When the tape mark or the tube marking reaches the patient's nostrils, the advancement processes should be stopped.
* The health practitioner can then attach a catheter-tip or bulb syringe to the tube and try to aspirate stomach contents. If the stomach contents are not obtained, the patients should be positioned on her left side to move the contents into the stomach's greater curvature, and then aspirate again. Later on, the aspirate should be examined and a small amount placed on the PH test strip. Additionally, whenever confirming the tube placement, the tube should not be placed in a container of water.
* To reduce discomfort from the weight of the tube, a slipknot should be tied around the tube, with a rubber band, and then secure the rubber band to the patient's gown with a safety pin, or wrap another piece of tape around the end of the tube and leave a tab. Then fasten the tape tab to the patient's gown.
Complications associated with NG tube
Potential complications of prolonged intubation with an NG tube include skin erosion at the nostril, sinusitis, esophagitis, esophagastrocheal fistula, gastric ulceration, and pulmonary and oral infection. Additional complications that may result from suction include electrolyte imbalances and dehydration.
Monitoring patient comfort and condition
The patient should be provided with mouth care once per shift or as required. Depending on the patient's condition, the health care expert can use sponge-tipped swabs to clean his/her teeth or assist him/her to brush them with toothbrush and toothpaste. The patient's lips should be coated with petroleum jelly to prevent dryness from mouth breathing (Birpuri, 2012).