Policy Manual sample

MDT Home Health Care Agency, Inc. 81 NASOGASTRIC TUBE PLACEMENT PURPOSE: A nasogastric tube (NG tube) may be indicated for medication and nutritional supplement delivery introduced into the stomach when normal ingestion is impaired Nasogastric intubation is accomplished in accordance with specific physician's orders including the size and frequency of tube change. Nursing assessment of the patient with an NG tube always includes an assessment of the lungs and bowel sounds and an assessment for complications. Any untoward signs such as the development of nasal erosion, sinusitis, esophagitis, irritation of gastric mucosa or other complications associated with long-term use should be reported to the physician so that corrective action may be initiated. Eyeglasses and dentures should always be removed prior to introducing the NG tube. RESPONSIBLE PERSONNEL : RNs with documented credentialing; LPN as by state Nurse Practice Acts/Advisory Opinions. EQUIPMENT: • Exam gloves • Water and straw • Water soluble lubricant • Tape • Nasogastric tube • Skin prep • Tissues SPECIAL CONSIDERATIONS: This procedure is stressful for the patient and the caregiver. Allow time for an explanation of the procedure, for questions and for a ventilation of feelings. If possible, obtain active assistance from the patient or caregiver. A signal that indicates distress or discomfort can be decided on prior to the actual insertion of the tube. The distance the tube is to be passed can be determined by measuring from the ear lobe to the bridge of the nose, and from the bridge of the nose to the bottom of the xyphoid process. Mark the total on the tube or note the cm marking. The choice of nostril in which the tube will be placed should be made based on an individual assessment. PROCEDURE: 1) Wash hands. Gather equipment. 2) Lubricate tube for 15 - 20 cm with water-soluble jelly. Put on gloves. 3) With patient in sitting or in a high Fowler's position, gently hyperextend the neck and pass the tube along the floor of the nostril into the posterior nasopharynx. The aim should be downward and backward. Slight pressure is sometimes needed to pass the tube into the nasopharynx. Do not force. Provide tissues or wipes in case the patient tears. Withdraw, lubricate and try other nostril if resistance is met. 4) When the tube reaches the oropharynx, the patient may gag. Allow him to rest. 5) Have the patient hold head in slightly downward position if possible. Offer sips of water through a straw if possible. Encourage continued swallowing and advance tube as the patient swallows. The tube can usually be advanced 2 - 4 inches with each swallow.