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Under a Creative Commons license Open access The purpose of this review was to (1) identify areas of agreement and disagreement in guidelines/recommendations to distinguish between gastric and pulmonary placement of nasogastric tube and (2) summarize factors that affect choices made by clinicians regarding which method(s) to use in specific situations. Systematic searches were conducted in the PubMed, Scopus, and CINAHL Plus databases using a combination of keywords and
data-specific subject headings. Searches were limited to guidelines/recommendations from national level specialty groups and governmental sources published in the English language between January 1, 2015 and September 20, 2018. Fourteen guidelines that described methods to distinguish between gastric and pulmonary placement of nasogastric tubes were identified from a variety of geographic locations. Tube placement testing methods included in the review were: radiography, respiratory distress,
aspirate appearance, aspirate pH, auscultation, carbon dioxide detection and enteral access devices. All fourteen guidelines agreed that radiography is the most accurate testing method. Of the nonradiographic methods, pH testing was most favored; least favored was auscultation. Keywordsnasogastric tubes enteral nutrition tube placement determination practice guidelines intubation gastrointestinal Cited by (0)© 2019 The Authors. Published by Elsevier Inc. Chapter 10. Tubes and Attachments Using a Nasogastric TubeA nasogastric (NG) tube is a flexible plastic tube inserted through the nostrils, down the nasopharynx, and into the stomach or the upper portion of the small intestine. Placement of NG tubes is always confirmed with an X-ray prior to use (Perry, Potter, & Ostendorf, 2014). NG tubes are used to:
An NG tube used for feeding should be labelled. The tube is used to feed patients who may have swallowing difficulties or require additional nutritional supplements. These tubes are narrower and smaller bored than a Salem sump or Levine tube. An NG tube can also remove gastric content, either draining the stomach by gravity or by being connected to a suction pump. In these situations, the NG tube is used to prevent nausea, vomiting, or gastric distension, or to wash the stomach of toxins. The NG tube is fastened to the patient using a nose clip, and is taped and pinned to the patient’s gown to prevent accidental removal of the tube and to prevent the tube from slipping from the stomach area into the lungs. When working with people who have nasogastric tubes, remember the following care measures:
Checklist 78 outlines the steps for inserting a nasogastric tube. Checklist 78: Inserting a Nasogastric tube
Special considerations with NG tubes:
Video 10.1Removing an NG TubeAn NG tube should be removed if it is no longer required. The process of removal is usually very quick. Prior to removing an NG tube, verify physician orders. If the NG tube was ordered to remove gastric content, the physician’s order may state to “trial” clamping the tube for a number of hours to see if the patient tolerates its removal. During the trial, the patient should not experience any nausea, vomiting, or abdominal distension. To review how to remove an NG tube, refer to Checklist 79. Checklist 79: Removal of an NG Tube
What test should be performed to confirm the correct placement of a nasogastric feeding tube before the start of the feeding?Chest radiography is the gold standard for confirming appropriate placement of a nasogastric tube. If the feeding tube is blindly inserted, radiographic confirmation of correct placement is recommended before administration of medication or feeding.
Which evaluation indicates that placement of a nasogastric NG tube is correct?Auscultation is most often used at the bedside to check for appropriate placement of a nasogastric tube. Sound generated by air blown through the tube is used to determine tube placement in the gastrointestinal tract.
What should be checked before NGT feeding?Prior to accessing a NGT/OGT for any reason nursing staff members must ensure that the tube is located in the stomach. Coughing, vomiting and movement can move the tube out of the correct position. The position of the tube must be checked: Prior to each feed.
Which action taken by the nurse would be the most reliable confirmation of the correct position of a recently placed small bore feeding tube?Taking an abdominal x-ray is the best way to confirm the location of the tube, even if there is the aspiration of gastric contents as the tube may be placed past the pylorus where it will aspirate not just gastric secretions but also hepatobiliary secretions leading to persistently high output even when the patient's ...
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