Transcript Nasogastric Intubation

Nasogastric Intubation
Medical NCO Course
GI Tract
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Oral cavity
Pharynx
Esophagus
Stomach
• Small Intestine
• Large Intestine
• Accessory
Structures
Gastrointestinal System
• Provides body with:
– Water
– Electrolytes
– Other nutrients used by cells
Gastrointestinal System
• Function
– Breaks down ingested food
– Propels food through the GI tract
– Absorbs nutrients across wall of lumen
of GI tract
– Absorbs water and salts
– Eliminates waste
Oral Cavity
• Chemical Digestion
– Salivary glands produce saliva
– Contains digestive enzyme
• Salivary amylase
• Begins chemical breakdown of
carbohydrates
Oral Cavity
• Mechanical Digestion
– Mastication facilitates swallowing and
processing of food
– Food swallowed by voluntary and involuntary
mechanisms
– Pharynx elevates to receive food from mouth
Oral Cavity
• Mechanical digestion
– Esophageal sphincter relaxes, opening
esophagus
– Food is pushed into esophagus
– Epiglottis closes airway to prevent aspiration
Medical NCO Course
The Gastrointestinal System
The Oral Cavity
• Chemical digestion
• Mechanical digestion
Esophagus
• Peristaltic waves
Esophagus
• Muscular canal (24 cm long)
• Extends from pharynx to stomach
• Begins below cricoid cartilage
• Descends to sphincter of stomach
Esophagus:
•Muscular canal
•About 24 cm
long
•Extends from
pharynx to
stomach
Esophagus
• Composition
• Lined with mucous membrane
• Peristaltic waves push food into
stomach
Stomach
Structure
• Layered muscular
tube
• Lined with mucous
membranes
• Contains gastric
glands
Stomach
• Function
– Storage and mixing chamber
– Secretes HCl, intrinsic factor, gastrin,
pepsinogen
– Produces chyme
– Moves chyme into duodenum
Small
Intestine
• Begins at pyloric
sphincter
• Coils through
abdominal cavity
• Opens into large
intestine
Small Intestine
• 10 ft divided into 3 segments
– Duodenum
– Jejunum
– Ileum
• Mixing and propulsion of chyme
• Absorption of fluid and nutrients
Small Intestine
• Peristaltic contractions
– Chyme moves through ileocecal valve
• Chyme enters cecum
• Cecum distends
– Sphincter closes
– Prevents contents from returning to ileum
Large Intestine
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1.2m (5ft) long
6.2cm (2.2in) in diameter
Extends from ileum to anus
Attached to abdominal cavity by
mesocolon
Large Intestine
• Divided into four
principal regions
– Cecum
– Colon
– Rectum
– Anal canal
Large Intestine
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Absorbs water
Absorbs salts
Bacteria acts on undigested material
Converts chyme into feces
Liver
Liver
• Largest gland in
body
• Upper right
quadrant
• Vascular organ
with 2 sources of
blood supply
– Hepatic artery
– Portal vein
Hepatic
Artery
Portal vein
Liver
Plays major role in:
• Iron metabolism
• Plasma-protein
production
• Detoxification
Liver
• Secretes bile
– 600 – 1000 ml each day
– Dilutes stomach acid (no digestive enzymes)
– Emulsifies fats
• Bile salts
– Reabsorbed in ileum
– Carried back to liver in blood
– Also lost in feces
Liver
• Metabolism
– Helps maintain blood glucose levels
– Involved in fat and protein metabolism
– Stores vitamins and minerals
• Toxin Breakdown
– Breaks down metabolism by-products
– Can be toxic if accumulate in the body
Liver
• Blood Protein Production
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Albumin
Fibrinogen
Globulin
Clotting factors
Gallbladder
• Pear shaped sac
• 7-10 cm long (3-4”)
• Located on
posterior surface of
liver
• Hangs from
anterior/inferior
margin of liver
Gallbladder
• Secretes and
stores bile
produced by the
liver
Pancreas
• Gland
• 12-15 cm (5-6 in)
long
• 2.2 cm (1 in) thick
• Posterior to the
stomach
• Connected to
duodenum by 2 ducts
Pancreas
• Exocrine gland
– Secretes pancreatic juice
• Endocrine gland
– Secretes hormones (insulin) into blood
– Cells need insulin to process glucose
Pancreas
• Pancreatic juice
– Most important digestive juice
– Contains digestive enzymes, sodium
bicarbonate and alkaline substances
– Neutralizes HCl in juices entering small
intestine
Nasogastric Intubation
NG Tube Indications
• Aspirate stomach
contents
– Diagnostic or
therapeutic
• Assessment of GI
bleeding
• Determine gastric
acid content
NG Tube Indications
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Treat paralytic ileus
Treat intestinal obstruction
Recurrent vomiting likely
Trauma
Overdose
NG Tube Contraindications
• Esophageal strictures
• Alkali ingestion, caustic ingestions,
esophageal burns
• Comatose patients
NG Tube Contraindications
• Trauma patients with:
– Cervical or intracranial bleeding
– Increased intracranial pressure
• Recent surgery of the following
types:
– Oropharyngeal
– Nasal
– Gastric
Inserting NG Tube
• Explain procedure
• Position patient
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High Fowler if alert
Drape
Emesis basin
Water and straw
Inserting NG Tube
• Unconscious patient
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Left lateral position
Head turned to downward side
Gag and cough reflexes absent or suppressed
NG tube easily misplaced (lung)
Inability to swallow
Inserting NG Tube
• Check nares for
patency
• Select appropriate
tube size
• Determine length
of insertion
– Tip of nose, to ear, to
xiphoid process
– Mark tube
S C10077/EC10077/E-3
1010-98
Inserting NG Tube
• Lubricate tube
– Lubricant must be water-soluble
– May use topical anesthetic if available (ie,
lidocaine)
• Coil tube to shape it into curve
• Have patient hold water and straw
to mouth
Inserting NG Tube
• Insert tube
– Along floor of
nose
– Straight back
– Advance until
resistance felt
(nasopharynx)
Inserting NG Tube
Ask patient to
swallow sips of
water and flex
neck slightly.
As patient swallows,
advance tube into
and down
esophagus.
S C10077/EC10077/E-6
1010-98
Inserting NG Tube
• When tube is in the esophagus:
– Advance rapidly to the pre-marked distance
Excessive choking, gagging, coughing,
change in voice or condensation inside the
tube indicates possibility of placement in
trachea. The tube should be withdrawn.
Confirm NG Tube
Placement
• X-ray
– Most reliable if tube is radiopaque
– Requires order from physician
• Injecting air
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60 cc catheter syringe
Place stethoscope over LUQ of abdomen
Inject air into lumen of tube, NOT blue pigtail
Listen for “swoosh” sound
Confirm NG Tube Placement
• Aspirate stomach contents
– 60 cc catheter tip syringe
– Pull back to check for gastric aspirate
– Possibility for fluid to be from lungs or
pleural space
Confirm NG Tube Placement
• Test pH of gastric aspirate
– 60 cc catheter-tip syringe and pH paper
– pH < 4 = 95% chance that tip is in
stomach
– pH > 6 = may be in lung or pleural space;
could be in stomach if patient takes
antacids or some medications
Confirm NG Tube Placement
• Non-radiopaque methods
– Possibility of error
– Use more than one method
– Passage into lungs frequent; especially in
comatose or demented patients
– Aspiration of gastric contents more reliable
• Especially if tested with pH paper
Securing the Tube
• Secure to patient’s
nose
– Tape to nose and coil
around tube
– Avoid pressure to nares
– Secure to patient’s
clothing near shoulder
area
– Blue pigtail must be
above level of patient’s
stomach
Complications
Excessive coughing, motion, gagging may
aggravate the following:
• Neck injuries
– Increased risk for C-spine injuries
• Penetrating neck wounds
– May increase hemorrhage
• Tube misplacement
– Pulmonary
– Intracranial
Removing NG Tube
• Disconnect from drainage container and
suction (if applicable)
• Attach syringe-tip catheter to lumen of
tube
• Flush tube with 20cc of air
– Empties contents from tube to prevent
aspiration into lungs
Removing NG Tube
• Remove tape from patient’s nose
• Unpin tube from gown
• Have patient take deep breath and hold
while tube is removed
• Pull tube with quick and steady motion
• Discard appropriately
• Provide or instruct patient on oral and
nasal care