NASOGASTRIC INSERTION – Purpose, Indications, Types of Tubes Used, Description of Ryle’s Tube, General Instructions, Preliminary Assessment, Preparation of Patient and Environment, Equipment, Procedure and Post-Procedure Care
Nasogastric insertion is defined as the passage of a tube through the node to the stomach.
Inserting a nasogastric tube or feeding tube into the stomach or duodenum allows a patient who cannot eat to receive nourishment.
PURPOSE
- To relieve abdominal distension
- To maintain gastric decompression after surgery
- To prevent nausea and vomiting after surgery
- To treat patients and mechanical obstruction and bleeding of the upper gastrointestinal tract
- To obtain a specimen of gastric contents for laboratory studies
- Administer medications and feeding directly into GI tract
- To relieve discomfort
INDICATIONS
Therapeutic
- To decompress the gastrointestinal tract, e.g. in paralytic ileus, intestinal obstruction and acute dilatation of stomach
- To keep the stomach empty to give local rest, e.g. in peritonitis, after intestinal anastomosis
- To prevent distension of abdomen, especially after repair of the incisional hernia
- After an esophagus operation, e.g. resection of growth excision of diverticulum, suturing of esophageal tear, correction of tracheoesophageal fistula
- Feeding: nasogastric tube feeding in unconscious and comatose patients to maintain nutrition and nasogastric hyperalimentation, especially in malnourished patients and low fecal fistula
- Gastric lavage: alcohol or non-corrosive poisoning or in hematemesis
- Prerequisite: before facial surgery. Also called in major faciomaxillary injury
Diagnostic
- Aspiration of gastric juice to know secretory activity and mobility of the stomach in chronic gastric ulcer, chronic duodenal cancer, pyloric obstruction, gastric carcinoma, and Zollinger-Ellison syndrome
- In abdominal trauma: if Ryle’s tube aspirate is blood stained, it indicates injury to the stomach and an emergency laparotomy is indicated
- To differentiate the bleeding above the pylorus from bleeding from below the pylorus. If blood is present in gastric samples but present in duodenal samples, then bleeding is from distal to pylorus
- Collection of duodenal contents to diagnose typhoid carriers and to demonstrate tuberculosis bacilli in children and recumbent patients who cannot expectorate
- To diagnose pseudopancreatic cyst: lateral view of the abdomen after Ryle’s tube is in the stomach, shows the tip near the abdominal wall due to compression of the stomach by cyst from behind
TYPES OF TUBES USED
- Ryle’s tube (Nasogastric tube): Old Ryle’s tube was a red rubber tube with one bead of metal at the tip. Now plastic Ryle’s tubes are in use they are made polyvinyl chloride
- Ewald tube: in an emergency, using this single-lumen tube with several openings at the distal allows you to aspirate large amounts of gastric contents quickly
- Levacuator tube: this tube has two lumens. Use the large lumen for evacuating gastric contents, the smaller for instilling an irritant
- Edlich tube: this single lumen tube has four openings near the closed distal tip. A funnel or syringe may be connected at the proximal end. Like the Ewald tube, the Edlich tube lets you withdraw large quantities of gastric contents quickly
DESCRIPTION OF RYLE’S TUBE
- They are made up of polyvinyl chloride
- Size caliber ranger from 10 to 20 F
- Length is 105-125 cm long
- Tip it is behind to avoid trauma
- There are three or four metal beads because:
Metal is radiopaque, so radiologically we can confirm the position of the tip
They facilitate the passage of the tube by action of the gravity and also facilitate swallowing due to their weight
There is multiple opening at different levels
- There are four marking in the tube:
40 cm from the tip to mark cardioesophageal junction
50 cm from the tip (tip in stomach)
60 cm from the tip (tip in pylorus)
65 cm from the tip (tip in the duodenum)
- Base: it is provided with one cork. Size of its lumen is just adequate to adopt the nozzle of the syringe
GENERAL INSTRUCTIONS
- Tube: the tip of the tube is lubricated with sterile paraffin or jelly (distal 10-15 cm of the tip is lubricated with water soluble lubricant)
- Nose: wider nostril is selected. Nostril is cleaned with pledget of cotton wool, moistened with savlon in water
- Patients: sitting position or, when the patient lying, the head should be flexed by one hand
- Sterilization
Gamma-rays irradiation
Ethylene oxide gas sterilization
Boiling (ideally, Ryle’s tube should be cleaned with water, it is not necessary to sterilize it)
PRELIMINARY ASSESSMENT
- Check the physicians order
- Check the progress notes and nursing care plan
- Check the level of consciousness and ability to follow directions
- Check the ability for self-care
- Check the articles available in patients unit
- Position the patient in supine
PREPARATION OF PATIENT AND ENVIRONMENT
- Explain the procedure to patient, if patient is conscious
- Explain the sequence of procedure and explain how patient can cooperate to you
- Provide privacy
- Provide safe and comfortable position
- Place Mackintosh and face towel across chest
- Allow the patient to adjust kidney tray according to his convenience
- Remove dentures if any
- Arrange articles near to bed
- Give a mouth wash and help him to clean teeth
- Clean the nostrils, if there is any secretion
EQUIPMENT
- Sterile gloves
- Aseptoc syringe
- Nasogastric tubes
- Water based lubricating jelly
- Cup of water or ice chips
- Bile bag or drainage bag
- Stethoscope
- Securing device or tape
- Specimen container
- Container
- Soap and water
PROCEDURE
- Explain the procedure to with the cooperation of patient
- Wash and dry hands
- Establish the distance that the tube is to be passed by measuring the distance on the tube from patient’s ear lobe to the bride of nose to the bottom of xiphisternum
- Lubricate 15-20 cm of the tube and jelly
- Insert the tube and slide it gently but firmly inwards and backward along the floor of nose to naso case of the patient who is under the effect of anesthesia pharynx
- Encourage the patient to swallow and breathe through mouth when tube reaches pharynx keeping chin down and head forward to assist the passage of tube
- Advance the tube until the length previously measured has been inserted and the mark has reached the external nares. If the patient shows any distress remove the tube immediately
- Ascertain whether the tube is in stomach by:
Aspirating the contents of stomach and a syringe
The aspirate should turn the litmus paper red
Place the steth over the epigastrium and inject 2-3 ml of air to the tube. It can be detected by whooshing sound
- Secure the tube to the patient nose with tape
POST-PROCEDURE CARE
- Ensure that patient is an comfortable as possible
- Clean and dispose of the equipment
- Wash hands
- Initiate and maintain intake output chart
- Record the time, date, and reaction of patient, etc. in nurse’s record as well as in the intake output chart
- Remove the tube when the aspiration is to be stopped
