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Cleansweep RN

Gastric intubation via the nasal passage is a common procedure that provides access to the stomach for diagnostic and therapeutic purposes. A nasogastric (NG) tube is used for the procedure. The placement of an NG tube can be uncomfortable for the patient if the patient is not adequately prepared with anesthesia to the nasal passages and specific instructions on how to cooperate with the operator during the procedure. The main use of a nasogastric tube is for feeding and for administering drugs and other oral agents. For drugs and for minimal quantities of liquid, a syringe is used for injection into the tube. For continuous feeding, a gravity based system is employed, with the solution placed higher than the patient's stomach. If accrued supervision is required for the feeding, the tube is often connected to an electronic pump which can control and measure the patient's intake and signal any interruption in the feeding.

Nasogastric aspiration (suction) is the process of draining the stomach's contents via the tube. Nasogastric aspiration is mainly used to remove gastric secretions and swallowed air in patients with gastrointestinal obstructions. Nasogastric aspiration can also be used in poisoning situations when a potentially toxic liquid has been ingested, for preparation before surgery under anesthesia, and to extract samples of gastric liquid for analysis.

Indications:

Diagnostic
1. Evaluation of upper gastrointestinal (GI) bleed (ie, presence, volume)
2. Aspiration of gastric fluid content
3. Identification of the esophagus and stomach on a chest radiograph
4. Administration of radiographic contrast to the GI tract

Therapeutic
1. Gastric decompression, including maintenance of a decompressed state after endotracheal intubation, often via the oropharynx
2. Relief of symptoms and bowel rest in the setting of small-bowel obstruction
3. Aspiration of gastric content from recent ingestion of toxic material
4. Administration of medication
5. Feeding
6. Bowel irrigation

Contraindications:

Absolute contraindications
1. Severe midface trauma
2. Recent nasal surgery

Relative contraindications
1. Coagulation abnormality
2. Esophageal varices or stricture
3. Recent banding or cautery of esophageal varices
4. Alkaline ingestion

Materials:

1.Nasogastric tube
a. Adult - 16-18F
b. Pediatric - In pediatric patients, the correct tube size varies with the patient’s age.

2. lidocaine 2%
3. Oral analgesic spray (Benzocaine spray)
4. Oral syringe, 12 mL
5. Glass of water with a straw
6. Water-based lubricant
7. Toomey syringe, 60 mL
8. Tape
9. Emesis basin or plastic bag
10. Wall suction, set to low intermittent suction
11. Suction tubing and container

Complications:
1. Patient discomfort
2. Generous lubrication, the use of topical anesthetic, and a gentle technique may reduce the patient’s level of discomfort.
3.Throat irritation may be reduced with administration of anesthetic lozenges prior to the procedure.
4. Epistaxis may be prevented by generously lubricating the tube tip and using a gentle technique.
5. Respiratory tree intubation
6. Esophageal perforation



2 Responses
  1. Anonymous Says:

    Recently I had a bowel obstruction. Despite having had a recent surgery on a bleeding ulcer and gastric bypass surgery 3 years ago and a broken nose 1 year ago, I was forced to have this tube inserted. The pain rivaled childbirth and I have had (3) 10 lb. babies without anesth.
    After removing the tube it took hours for my nose to stop bleeding. Not a little blood, but pouring blood. Next time I plan on just dying.
    Since then I have lost most of my sense of smell and taste. Could there be any relationship?
    Thank you, Nancy donlon5@pacbell.net



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