Nasogastric Tube Insertion and Removal.
Hi. I'm Sarah and today we are going to
do the skill of nasal gastric tube
insertion and removal. So to get started,
we're going to go to the computer here.
We're going to look up our physician
order and our patient information.
Okay so we have our patient.
Morgan Brown MR number 255205. He has
no known allergies, his date of birth is
August 4th 1970. Now let's look down here.
I see that he's NPO and I see there's an
order here from today at 15:18 to insert
nasogastric tube now and to insert it to
low intermittent suction. So now I'm
going to go gather my supplies. We need a
pulse ox, a drape or towel, a stethoscope
a cup with some water, and a straw.
Lubricating spray if this were an actual
patient we'd be using lubricating gel but
for mannequin purposes we're using the
spray. Oral hygiene sponges, some tape,
litmus paper, safety pin with a rubber
band, emesis basin cannister with a
piston of course RNG 2. Now that I have
all my supplies I'm going to go to the
patient's room. The other thing that we
will need are facial tissues our Kleenex
but those are already in the patient's
room. Hi Morgan.
it's Sarah your nurse. I'm here to insert
a nasal gastric tube into your stomach.
The doctor just ordered this. So can you
verify your name and date of birth for
me? Okay Morgan Brown 8 for 70 and I'm
just gonna verify that that's what we
have here. We're going to look up the
order again. Now Morgan we're going to put
this tube in your stomach today.
It's usually used to relieve either a
bowel obstruction or extra air from your
belly. I see that let's see here's
the order to insert nasal gastric tube
and then I'm to connect it to suction
which is on the wall behind you and
you're not to be having anything by
mouth and you have no known allergies so
that's good. So typically this type of
tube is inserted into a patient that
either has a bowel obstruction, they're
not able to move through things through
their GI system properly may have too
much air trapping in their abdomen
that's making them uncomfortable, they
may be experiencing nausea, vomiting so
by putting this tube in it's going to
help relieve that air and gastric
contents if necessary. So Morgan I will
walk you through everything that I do.
Today I will admit it's not going to be
a very comfortable procedure so I'm
going to put your head up right now the
highest position.
Okay and then bring you up to a more
comfortable level for myself so I'm not
doing a lot of bending. Okay. Now I'm
going to perform my necessary assessment.
So of course I want to listen to the
Okay Morgan, it does sound pretty quiet
in your belly there and you do feel a
little distended and your tummy's not as
soft as it should be so I think it's a
good idea that we go ahead and insert
this tube Okay. So to give you guys an
idea of what we're doing today, we are
going to put this tube into his stomach.
We want to make sure that we're going
down the right pipe. That's always
important so when I say the right pipe
you want to make sure you're going down
into the esophagus because this tube is
going to drop down right into his
stomach. So it's gonna enter through the
nose, then we're going to keep advancing
it to the back of the throat which is
the nasal pharynx area, then we're going
to continue to pass it down into the
stomach and then that's where we will, if
the doctor has ordered to, hook it up to
suction which in this case they do.
So I just wanted to give you guys a visual of what we'll be doing today. All right.
let's get this started.
So I'm going to put this pulse X on your
finger just to monitor your oxygenation.
I also want to ask if you have any
deviated septum. I want to make sure that
you have no nose bleeding here so I did
bring a pen light with me. So I'm going
to check out Morgan's nasal passages,
make sure there's no face little trauma
or anything. Usually you know want to try
just kind of investigate look for the
best nair to go down. I am left-handed so
I am the left side of the bed. If you
were right-handed you'd be on the right
side of the bed. I'm also going to just
double-check everything in his mouth.
Looks okay. Okay I'm going to put this
blue drape across his chest. Like I said
before, you can also use a towel. This is
just to prevent from making a mess.
I'm going to get my area all set up.
Morgan if at any point you're having any
issues I want you to put your hand up to
let me know we'll use as a signal that
you need me to stop. Okay. I'm going to
have you hold this cup that
I have poured a little bit of water in
there. At one point I'm going to need you
to actually drink from this but not take
any sips quite yet just in case if you
need to spit up or anything.
I'll prepare my tape. I'm gonna wanna
split it here.
Okay. All right. Should have everything I
All right. So here I have my tube. It is a
14 French Salem sump and g2. Now I'm
going to just show you a few things
about this tube. Okay. So this piece right
Very crucial to hooking up to suction so
you don't want to lose this piece.
Otherwise I'm not going to be able to
hook this tubing up to him to do what I
need it to do.
Okay now this right here is a one-way
valve. You never insert anything into
this blue tube. This is how air escapes
so always you want to just leave it open
like this. Now what I'm going to do now
what's important to so we know how far
this needs to go into more. Again we're
going to measure from the tip of the
nose to the earlobe then down to the
xiphoid process. Okay then I want to look,
I'm going to mark this with a tape so I
know that once I'm going that I know how
far to go and when to stop because we're
not going to insert this whole tube into
him it's really long. I'm going to curl
the end of the tube with my fingers now.
Remember anything GI is not sterile so
if you notice I'm just you know I'm
using clean gloves all right now I'm
going to spray this with the lube okay.
All right Morgan here we go now. I'm
going to have you tilt your head back.
We're going to insert the tube. Have you tilt your head back to the pillow.
I'm putting the tube back until I hit.
You want to make sure to that it's going
down the throat and not back through the
coming out through the mouth. Now once
you get to the back of the nasal pharynx,
Morgan you're going to tilt your head
forward. I'm going to have you take some
sips of water while I can
in you to advance the tube. Okay you
doing okay? All right. You're doing a nice
job here Morgan. A little bit more to
Okay I've hit to where my marking is. I'm
just gonna I just want to put my tape
just there so we don't slide out
quite. Yeah 'cause I do need to check that
this is in the right spot. So now I'm
going to take this connector piece out.
Don't lose it. I'm going to draw up 30
milliliters of air. It's going to check
placement stick the piston into the tube
and take my stethoscope and I'm
going to listen over the stomach. I'm
listening for a gurgling sound that's
how or whooshing sound. Okay. Good I heard the woosh that means we're in the right
spot. Now I'm gonna pull back some
gastric juices. Okay. And I'm going to
take that and I'm gonna put that on my
litmus paper here. The acidity for a for
gastric juices is between usually a
three to four so that's you can see
that's the color here so it looks like
that I'm in the right spot so that's
good. Morgan you did a great job. So now I
just want to tape this into place
that other piece out of your way there
buddy. Sorry I want this to secure
because wasn't a comfortable procedure.
We don't want to have to put this in
more than once.
All right. Good. All right. Now I'm going
to take that my safety pin with my
rubber band just slip knot and this is
just so it doesn't tug can pin it to his
gown you want to give enough slack so
the patient can at least turn their head.
okay now because the doctor did order
suction I need to put this piece back in,
hook it up to suction here. Okay now it
said low intermittent so over here on
the suction gauge the low part is this
green suction intermittent is we want to
you should have a continuous or
intermittent so we want to switch over
to intermittent you know turn the dial
want it to stay in between the green. Now
the purpose of that is so it doesn't
cause any bleeding or irritation of the
gastric lining. We don't want to suck
everything out of it or cause any
bleeding. So okay Morgan, thank you so
much. Would you like me to take
a little swab here I can wipe out your
mouth a little bit what's your lips and
then I will be back in a little while to
check on you. Okay. There you go. All right.
We're gonna keep your head up because
that's better
for everything to work properly.
Not my area I'm gonna put your head down.
It looks like you have your call light,
you're laying comfortably. I'm going to
go to the nurse's station now and I'm
going to document everything that I did.
Morgan call if you need anything okay.
Okay now I'm back at the nurse's station.
I'm going to document what we just
completed so I'm going to login.
All right. Morgan Brown. All right then
I'm going to go over here to flow sheets.
We're going to do interventions lines
toots drains. Okay. So we put in a gastric
tube. So I'm going to add that needle
gastric tube insertion purpose for
Very rarely will these tubes be used for
feeding just so you know. Okay left Nair.
It was a 14 French inserted by myself.
Remember to put Sarah born our end
placement checked yes surrounding skin
is intact within defined limits. Site
drainage comments, I had no drainage at
that point, dressing clean dry attacks, no
residual, no I had no I guess I had a
little bit of bile backflow and now I'm
going to cement this up in a comment. I'm
going to put that it was placed at 15:54
for insertion.
All right. Submit and we're all set so
now my documentation is complete so that
concludes our skill of nasogastric tube
insertion. Hi I'm back again. We are now
going to do nasal gastric tube removal.
So I'm going to check my patients chart
for an order. Okay. You need Morgan Brown, he's our patient today.
Okay so I've Morgan Brown MR number 23213. I see as no known
allergies, date of birth August 4th 1970,
admitted with acute pended situs, and
Morgan where's your order. Okay I see we
have an order here to remove his
nasogastric tube today. So that's
fantastic. We're going to go ahead and do
that now. I'm going to gather my supplies.
We want the canister with piston, our
litmus paper, a blue pad or towel, sealing
or you can use tap water from the sink
since the GI system is not sterile,
sponge for oral care, and then some
alcohol or adhesive remover, we want to
make sure that we have. And then facial
tissues or Kleenex which are already in
the room. Okay. Now I'm ready to go to my
patients room. Hi Morgan, it's Sarah your
nurse. Good news, we get to take that tube
out of your nose today. So again I just
want to verify everything so your name
and date of birth.
Morgan Brown August 4 1970. So I just
want to verify again, I'm going to look
in your chart here. Okay.
All right and I see you have no known
allergies so that's good and I see we
have an order here to remove the NG tube
today. So that's great so I'm going to
grab my gloves I'm gonna get everything
all set up.
All right.
All right we're going to turn off this
suction. Turn off the suction, turn this
back off. Okay Morgan. I'm gonna take a
quick listen to you again. That belly
should be making some noises by now for
ready to take that to about maybe the
doctor I'll let you eat or drink
something today.
Much better than the other day nice and
soft and I hear some noises in there so
it's great news. Okay so I just need to
check a few things. First put this blue
pad over you fill this up with my water
or I can pour my saline in here. I only
need 30 milliliters.
All right Morgan. I just want to take a
look at everything again. Check out your
nose and your mouth, make sure we have no issues going on here. Everything looks
good, okay.
All right. Drop my 30 milliliters.
Actually we're going to pull up. We got
our 30 milliliters of air first we're
gonna do the placement truck placement
first. So again I have to remove this
little plastic connector, connect to my
piston to the tube, have my stethoscope
over the stomach area. Okay a little bit
of air whoosh. I hear that whooshing
sound. Okay, now I can draw back some
gastric secretions. Again we just want to
we're double checking that this is in
the spot where it is supposed to be. Here's my
litmus paper. Okay. Again it turns the
right color about an yellowish oranges
color means that that's positive, the
correct pH which is about 3.5 to 4 for
gastric. I'm going to drop now 30
milliliters of water and we're going to
flush this too because when we remove it
we don't want anything spraying out at
us. Okay I'm do the safety pin here with
our rubber band. Okay I'm going to
remove the tape. If you need if the tape
is really stuck to his nose you could
use your alcohol adhesive remover. Looks
okay here I'll release the tape.
Okay now Morgan. I'm going to have you
take a deep breath and I'm going to go
ahead and pull this tube out. Alright.
Here we go.
All right good job. Fold that up.
Everything goes in the garbage.
Morgan you did a great job. Let's make
sure you got nothing on your face or
anything. Wipe you off here. Give you a
little wet your whistle a little bit
here. Okay and then we'll let the doctor
know we got this tube out. Maybe later on
today you can eat or drink something
that because it means your stomach's
working on its own again. Is there
anything else I can get you right now?
I'm going to put the bed down. Looks like
you have your call light, your side rails
are up, you can put your head down now a
little bit since you don't have that tube in
your nose anymore. All right. A lot more
comfortable. All right Morgan. I'll be
back in a little while to check on you.
Call if you need anything. In the
meantime I'm going to go document at the
nurse's station now.
Okay now I'm back at the nurse's station
We're going to document what we just did.
So we took out the tube, I'm gonna log
back in.
I'm gonna find Morgan Brown. All right.
I'm gonna go back to the flowsheet
interventions and lines d range where we
were the last time. So gastric tube type
nasogastric action this time is going to
be removal there we go. Not removed by
patient purpose then that doesn't apply
location was left near we had a 14
French, we did check placement,
surrounding skin was intact within
defined limits at the time dressing.
Status clean, dry, intact so drainage from
tube green removed by, I'm going to put
my name Sarah Born
RN and then reason for removal / MD
order. And you can put here patient
tolerated well.
Okay and then click Submit and that
completes our charting and our skill of
nasal gastric tube removal.

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