a nurse is preparing to remove an ng tube for a client who had a partial colectomy This is a topic that many people are looking for. savegooglewave.com is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, savegooglewave.com would like to introduce to you Nasogastric Tube Insertion and Removal. Following along are instructions in the video below:
Im sarah and today. We are going to do the skill of nasal gastric gastric tube insertion and removal so to get started. Were going to go to computer here.
Were 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 lets look down here.
I see that hes npo. And i see theres an order here from today at 15 18 to insert nasogastric tube. Now and to insert it to low intermittent suction.
So now im 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. Wed be using lubricating gel but for mannequin purposes were 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. Im going to go to the patients room. The other thing that we will need are facial tissues.
Our kleenex. But those are already in the patients room hi morgan. Its sarah your nurse.
Im 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 im just gonna verify that thats what we have here were going to look up the order.
Again now morgan. Were going to put this tube in your stomach. Today.
Its usually used to relieve either a bowel obstruction or extra air from your belly. I see that lets see heres the order to insert nasal gastric tube. And then im to connect it to suction.
Which is on the wall behind you and youre not to be having anything by mouth. And you have no known allergies so thats good so typically this type of tube is inserted into a patient that either has a bowel obstruction. Theyre not able to move through things through their gi system.
Properly may have too much air trapping in their abdomen. Thats making them uncomfortable. They may be experiencing nausea vomiting so by putting this tube in its 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.
Its not going to be a very comfortable procedure so im 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 im not doing a lot of bending. Okay.
Now im going to perform my necessary assessment. So of course. I want to listen to the abdomen.
Okay morgan. It does sound pretty quiet in your belly. There and you do feel a little distended and your tummys not as soft as it should be so i think.
Its a good idea that we go ahead and insert this tube okay so to give you guys an idea of what were doing today. We are going to put this tube into his stomach. We want to make sure that were going down the right pipe.
Thats always important so when i say the right pipe. You want to make sure youre going down into the esophagus because this tube is going to drop down right into his stomach. So its gonna enter through the nose.
Then were going to keep advancing it to the back of the throat. Which is the nasal pharynx area. Then were going to continue to pass it down into the stomach and then thats 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 well be doing today all right morgan lets get this started. So. Im 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 im going to check out morgans nasal.
Passages. Make sure. Theres 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 youd be on the right side of the bed.
Im also going to just double check everything in his mouth. Looks. Okay okay.
Im 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. Im going to get my area all set up morgan if at any point youre having any issues. I want you to put your hand up to let me know well use as a signal that you need me to stop.
Okay. Im going to have you hold this cup that i have poured a little bit of water in there at one point. Im 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 ill prepare my tape im gonna wanna split it here okay all right should have everything i need all right so here. I have my tube.
It is a 14 french salem sump and g2 now. Im going to just show you a few things about this tube okay. So this piece right here very crucial to hooking up to suction.
So you dont want to lose this piece otherwise. Im 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 im going to do now. Whats important to so we know how far this needs to go into more again. Were going to measure from the tip of the nose to the earlobe then down to the xiphoid process.
Okay then i want to look. Im going to mark this with a tape. So i know that once im going that i know how far to go and when to stop because were not going to insert this whole tube into him its really long.
Im going to curl the end of the tube with my fingers. Now remember anything gi is not sterile so if you notice im just you know im using clean gloves all right now im going to spray this with the lube okay all right morgan here we go now im going to have you tilt your head back were going to insert the tube have you tilt your head back to the pillow. Im putting the tube back until i hit you want to make sure to that its 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 youre going to tilt your head forward. Im going to have you take some sips of water while i can in you to advance the tube okay you doing okay all right youre doing a nice job. Here morgan a little bit more to go okay.
Ive hit to where my marking is im just gonna i just want to put my tape just there so we dont slide out quite yeahcause. I do need to check that this is in the right spot. So now im going to take this connector piece out dont lose it im going to draw up 30 milliliters of air.
Its going to check placement stick. The piston into the tube and take my stethoscope and im going to listen over the stomach. Im listening for a gurgling sound.
Thats how or whooshing sound. Okay good. I heard the woosh that means were in the right spot now im gonna pull back some gastric juices okay and im going to take that and im gonna put that on my litmus paper here the acidity for a for gastric juices is between usually a three to four so thats you can see thats the color here.
So it looks like that im in the right spot. So thats 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 wasnt a comfortable procedure.
We dont want to have to put this in more than once all right good all right now. Im going to take that my safety pin with my rubber band just slip knot. And this is just so it doesnt 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 doesnt cause any bleeding or irritation of the gastric lining.
We dont 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.
Whats your lips. And then i will be back in a little while to check on you okay there you go all right were gonna keep your head up because thats better for everything to work properly not my area. Im gonna put your head down it looks like you have your call light youre laying comfortably.
Im going to go to the nurses station. Now and im going to document everything that i did morgan call. If you need anything okay okay.
Now im back at the nurses station. Im going to document what we just completed so im going to login all right morgan brown. All right then im going to go over here to flow sheets.
Were going to do interventions lines toots drains okay so we put in a gastric tube. So im going to add that needle gastric tube insertion purpose for decompression. 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 im going to cement this up in a comment.
Im going to put that it was placed at 15 54 for insertion all right submit and were all set so now my documentation is complete so that concludes our skill of nasogastric tube insertion hi. Im back again. We are now going to do nasal gastric tube removal so im going to check my patients chart for an order.
Okay you need morgan brown. Hes our patient today okay. So ive morgan brown.
Mr. Number 23213. I see as no known allergies.
Date of birth august 4th. 1970. Admitted with acute pended situs and morgan.
Wheres your order. Okay. I see we have an order here to remove his nasogastric tube.
Today so thats fantastic. Were going to go ahead and do that now im 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 im ready to go to my patients room hi morgan. Its 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 im going to look in your chart here okay all right and i see you have no known allergies so thats good and i see we have an order here to remove the ng tube. Today so thats great so im going to grab my gloves.
Im gonna get everything all set up all right all right. Were going to turn off this suction turn off the suction turn this back off okay morgan. Im 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.
Ill let you eat or drink. Something today much better than the other day nice and soft and i hear some noises in there. So its 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 were going to pull up we got our 30 milliliters of air first. Were 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 were double checking that this is in the spot.
Where it is supposed to be heres my litmus paper. Okay again it turns the right color about an yellowish oranges color. Means that thats positive the correct.
Ph which is about 35. To 4 for gastric. Im going to drop now 30 milliliters of water and were going to flush this too because when we remove it we dont want anything spraying out at us.
Okay. Im do the safety pin here with our rubber band okay. Im 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. Ill release the tape okay now morgan. Im going to have you take a deep breath.
And im 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. Lets 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 well let the doctor.
Know we got this tube out maybe later on today. You can eat or drink. Something that because it means your stomachs working on its own again is there anything else i can get you right now.
Im 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 dont have that tube in your nose.
Anymore all right a lot more comfortable all right morgan. Ill be back in a little while to check on you call. If you need anything in the meantime.
Im going to go document at the nurses station. Now okay now im back at the nurses station. Were going to document what we just did so we took out the tube.
Im gonna log back in im gonna find morgan brown all right im 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 doesnt 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 im 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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