nasogastric tube [NGT] insertion,feeding and removal.

Nasogastric tube insertion"NGT"

Preparation:

1. check physician's order and client care plan for insertion NGT.
2. determine size of tube.
3. prepare equipment.
4. discuss procedure with client.
5. provide privacy.
6. raise bed to appropriate working height.

Procedure:

1. wash hands.
2. face patient,stand on left side of bed if you are right handed"on right side if left handed".
3. lower side rails on working side of bed.
4. position client at 45 degree angle or higher with head elevated.
5. Don clean gloves.
6. examine nostrils,and select the most patent nostril.
7. measure from tip of nose to earlobe to xiphoid process of sternum.
8. pinch the tube.
9. lubricate first 4 inches "10 cm" of tube with water-soluble lubricant.
10. insert tube through nostril to back of throat.
11. suggest client to swallow to assist tube insertion.
12. instruct the client to flex head toward chest.
13. continue advancing tube until taped mark.
14. check position of tube.
15. aspirate the injected air. 
16. pinch the tube.
17. remove gloves.
18. tape tube securely to nose.
19. position client for comfort.
20. lower bed,and raise side rails.
21. dispose equipment.
22. wash your hands.

Giving intermittent nasogastric feeding

Preparation:

1. check physician's order and client care plan for appropriate formula "type,calories,or amount or both ,and frequency".
2. send request for prescribed formula is available.
3. check expiration date on formula.
4. warm formula to room temperature.
5. prepare feeding equipment.

Procedure:

1. check client's identification.
2. explain procedure and purpose to the patient.
3. keep patient privacy.
4. wash hands.
5. Don gloves.
6. face patient,stand on right side of patient if you are right handed"on left side if left handed".
7. raise bed to appropriate working height.
8. lower side rails on working side of bed.
9. assess abdominal distention,and auscultate bowel sound.
10. place client in high fowler's position.
11. check placement of NGT.
12. place absorbent towel at working area on bed.
13. aspirates all gastric contents.
14. measure the volume of residual.
15. check color and character of residual.
16. return aspirated residual to stomach.
17. clamp or pinch the end of the feeding tube.
18. remove plunger from barrel of syringe.
19. attach barrel of syringe to the proximal end of the feeding tube tightly.
20. flush tube before feeding with 30 ml of sterile water.
21. pinch the end of the feeding tube.
22. fill syringe with formula until grades only.
23. unclamp the feeding tube and hold syringe no more than 18 inches "45 cm" above insertion site.
24. pinch the tube before syringe runs dry and refill the syringe with formula.
25. follow tube feeding with sterile water "30 ml" or in ordered amount.
26. clamp end of the tube.
27.  keep client in high-fowler's position for 30-60 minutes after feeding.
28. with gloved hands wash,rinse and dry equipment after feeding. 
29. return equipment to client bedside.
30. provide oral and nasal hygiene.
31. remove gloves.
32. wash handes.
33. lower bed and raise side rails.

Post procedure;

document all relevant information.

Removing of nasogastric tube"NGT"

Preparation;

1. check order and client care plan for removing NGT.
2. discuss procedure with client.
3. provide privacy.
4. raise bed to appropriate working height.

Procedure;

1. wash hands.
2. face patient,stand on left side of bed if you are right-handed"on right side if left-handed".
3. lower side rails on working side of bed.
4. place client in high fowler's position.
5. place paper towel over client's chest.
6. loosen tape securing tube.
7. Don gloves.
8. clamp or plug tube.
9. take paper towel in non-dominant hand and place under chin.
10. pinch tube near nostril and remove with a continuous steady pull.
11. hold tube in paper towel.
12. dispose tube and gloves in rash.
13. Don other clean gloves.
14. clean client face especially nares.
15. offer oral hygiene.
16. remove gloves.
17. assist client to a comfortable position.
18. lower bed and raise side rails.

wash hands.

Watch this video  for more explanation

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