Nasogastric Tubes
1. Levin Tube – single lumen
a. Suctioning gastric contents
b. Administering tube feedings
2. Salem Sump Tube – double lumen (smaller blue lumen vents the tube & prevents suction on the gastric mucosa, maintains intermittent suction regardless of suction source)
a. Suctioning gastric contents
b. Maintaining gastric decompression
Key Points
1. Prior to insertion, position the client in High-Fowler’s position if possible.
2. Use a water-soluble lubricant to facilitate insertion
3. Measure the tube from the tip of the client’s nose to the earlobe and from the nose to the xiphoid process to determine the approximate amount of tube to insert to reach the stomach
4. Flex the client’s head slightly forward; this will decrease the chance of entry into the trachea
5. Insert the tube through the nose into the nasopharyngel area; ask the client to swallow, and as the swallow occurs, progress the tube past the area of the trachea and into the esophagus and stomach. Withdraw tube immediately if client experiences respiratory distress
6. Secure the tube to the nose; do not allow the tube to exert pressure on the upper inner portion of the nares
7. Validating placement of tube.
o Aspirate gastric contents via a syringe to the end of the tube
o Measure ph of aspirate fluid
o Place the stethoscope over the gastric area and inject a small amount of air through the NGT. A characteristic sound of air entering the stomach from the tube should be heard
8. Characteristics of nasogastric drainage:
o Normally is greenish-yellowish, with strands of mucous
o Coffee-ground drainage – old blood that has been broken down in the stomach
o Bright red blood – bleeding from the esophagus, the stomach or swallowed from the lungs
o Foul-smelling (fecal odor) – occurs with reverse peristalsis in bowel obstruction; increase in amount of drainage with obstruction
Intestinal Tubes
· Provide intestinal decompression proximal to a bowel obstruction. Prevent/decrease intestinal distention. Placement of a tube containing a mercury weight and allowing normal peristalsis to propel tube through the stomach into the intestine to the point of obstruction where decompression will occur
1. Types of Intestinal Tubes
a. Cantor and Harris Tubes
i. Approximately 6-10 feet long
ii. Single lumen
iii. Mercury placed in rubber bag prior to tube insertion
b. Miller-Abbot Tubes
i. Approximately 10 feet long
ii. Double lumen
iii. One lumen utilized for aspiration of intestinal contents
iv. Second lumen utilized to instill mercury into the rubber bag after the tube has been inserted into the stomach
2. Nursing Implications
a. Maintain client on strict NPO
b. Initial insertion usually done by physician and progression of the tube may be monitored via an X-ray
c. After the tube has been placed in the stomach, position client on the right side to facilitae passage through the pyloric valve
d. Advance the tube 2 to 4 inches at regular intervals as indicated by the physician
e. Encourage activity, to facilitate movement of the tube through the intestine
f. Evaluate the type of gastric secretions being aspirated
g. Do not tape or secure the tube until it has reached the desired position
h. Tubes may attached to suction and left in place for several days
i. Offer the client frequent oral hygiene, if possible offer hard candy or gum to reduce thirst
j. Removal of the tube depends on the relief of the intestinal obstruction
k. May be removed by gradual pulling back (4-6 inches per hour) and eventual removal via the nose or mouth
l. May be allowed to progress through the intestines and expelled via the rectum.
How to Insert a Nasogastric (NG) Tube
· Check physician’s order.
· Check client’s identaband and if able have client state name.
· Discuss procedure to client.
· Provide privacy.
· Gather equipment.
· Position client at 45 degree angle or higher with head elevated.
· Wash hands and don clean gloves.
· Provide regular oral and nasal hygiene.
· Remove gloves and wash hands.
· Position client for comfort.
· Document procedure.
