Introduction of a flexible probe into the gastric cavity or small intestine through the nostrils for nutritional, therapeutic or diagnostic purposes.
Objectives:
– Administer nutrition as an alternative route to oral feeding. – Administer medication when oral route is not possible. – Prevent aspiration in patients with altered level of consciousness. – Perform gastric lavage in case of intoxication. – Remove gastric contents for diagnostic and therapeutic purposes.
Equipment:
– Towels. – Glass with water. – Stethoscope.
– Tray. – Suction, draining, or feeding equipment.
Material:
– Sterile nasogastric tube suitable according to the reason for probing (Levin, Salem, etc.). – Water soluble lubricant. – Pipette. – Non-sterile disposable gloves. – Waste bag. – Sterile gauze. – Anti-allergic plaster. – Collection bag – 1 Syringe of 50 c.c. – Nasogastric tube stopper. – Tongue depressor. – Nursing records.
Nasogastric catheterization procedure:
– Perform hand washing. – Prepare the material. – Preserve the patient’s privacy. – Inform the patient. – Ask for the patient’s and family’s cooperation. – Place the patient in Fowler position with the head upright. – Put on non-sterile gloves. – Examine oral mucosa and nostrils. Ask the patient to blow his/her nose. – Choose the nostril with the highest permeability. – Remove dentures. – Place towel or cloth over the patient’s chest. – Check that the probe has no defects and is permeable. – Approximately measure the length of the probe from the tip of the nose to the earlobe and the xiphoid appendage. Mark the distance with a marker pen (usually between 45 cm and 55 cm). – Lubricate well the distal end of the probe about 15-20 cm with gauze and water-soluble lubricant. – With the head hyperextended (backwards), introduce the probe through the nostril towards the back of the throat. On reaching the nasopharynx after passing the turbinates (there is a small resistance here), ask the patient to bend the head forward. This maneuver may cause nausea.
– Facilitate the procedure by asking the patient to take small sips of water, if this is not possible, insist on the need to breathe through the mouth and swallow during the technique. – If any resistance is encountered, the patient coughs, chokes or presents cyanosis, interrupt the maneuver and remove the probe. – Check the correct placement of the probe: Aspirate with 50 ml syringe to obtain gastric contents.2. Introduce 20-30 ml of air with the syringe through the tube and auscultate in the epigastrium (upper left abdominal quadrant) to hear the air entry. The absence of noise indicates poor placement. – Fix the probe to the nose without impeding the patient’s mobility and visibility and avoiding nostril decubitus. If the patient has oily skin, clean first with alcohol and let it dry. – Connect to the end of the tube the drainage system, feeding equipment or clamp the tube with the clamp or place the tube cap, according to medical prescription. – Leave the patient in a comfortable position. – Collect the material. – Remove gloves. – Wash hands. – Record in the nursing documentation the procedure, reason, date and time, incidences, and patient’s response.
Observations:
– In premature and neonates measure the distance from the nasal bridge to the lower end of the sternum. To check the placement of the tube, introduce 2-5 cc of air. – If during the procedure the patient has nausea and vomiting and the tube does not advance, there may be a kink or the tube may be bent in the mouth or throat. Inspect the mouth with the aid of a depressor, and if necessary, remove the tube.
Nasointestinal catheterization procedure:
Insert the nasointestinal tube following the same procedure as the nasogastric tube except:
1. Place the patient in right lateral decubitus, once the tube is inserted to facilitate passage into the duodenum. 2. Leave the guidewire in place until radiological confirmation of the correct placement of the tube.
– Check that the intestinal fluid content is less than 30 ml or nonexistent (if there is more, it may be due to a displacement of the tube into the stomach).
NIS observations:
Never attempt to reinsert the removed guidewire while the feeding tube remains in place (may perforate the GI tract).
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