Procedure for Irrigating A Nasogastric Tube

OBJECTIVE: To ensure the patency of the nasogastric tube.

INDICATION: Stomach contents fail to flow through tube.

CONTRAINDICATION: Some tubes are maintained by airflow, not normal saline solution.

NURSING ALERT: Connect proper end (main lumen) of double lumen tube to suction. The short lumen is an airway, not a suction-drainage tube. With double-lumen tube, if main lumen is probably blocked, clear the main lumen, then inject up to 60 cc of air through the short lumen above the level of the stomach where the end of the main lumen is located.

EQUIPMENT:
1. Nasogastric tube connected to continuous or intermittent suction.
2. Irrigation or Toomey syringe and container for irrigating solution.
3. Normal saline for irrigation.
4. Disposable pad or bath towel
5. Disposable gloves (optional)
6. Stethoscope
7. Clamp

ACTION
1. Check physician’s order for irrigation. Explain procedure to client.
Rationale: Clarifies schedule and irrigating solution. An explanation encourages client cooperation and reduces apprehension.

2. Gather necessary equipment. Check expiration dates on irrigating saline and irrigation set.
Rationale: Provides for organized approached to task. Agency policy dictates safe interval for reuse of equipment.

3. Wash your hands.
Rationale: Handwashing deters the spread of microorganisms.

4. Assist client to semi-Fowler’s position unless this is contraindicated.
Rationale: Minimizes risk of aspiration.

5. Check placement of NG tube;
a. Attach Asepto or Toomey syringe to the end of tube and aspirate gastric contents.
Rationale: The tube is in the stomach if its contents can be aspirated.
b. Place 10mL-50ml of air in syringe and inject into the tube. Simultaneously, auscultate over the epigastric area with a stethoscope.
Rationale: A whoosing sound can be heard when the air enters the stomach through the tube.
c. Ask client to speak.
Rationale: If tube is misplaced in trachea, client will not be able to speak.

6. Clamp suction tubing near connection site. Disconnect NG tube from suction apparatus and lay on disposasble pad or towel.
Rationale: Protects client from leakage of NG drainage.

7. Pour irrigating solution into container. Draw up 30 ml of saline (or amount ordered by physician) into syringe.
Rationale: Delivers measured amount of irrigant through NG tube. Saline compensates for electrolytes lost through NG drainage.

8 Place tip of syringe in NG tube. Hold syringe upright and gently insert the irrigant (or allow solution to flow in by gravity if agency or physician indicates). Do not force solution into NG tube.
Rationale: Position of syringe prevents entry of air into stomach. Gentle insertion of saline (or gravity insertion) is less traumatic to gastric mucosa.

9 If unable to irrigate tube, reposition client and attempt irrigation again. Check with physician if repeated attempts to irrigate tube fail.
Rationale: Tube may be positioned against gastric mucosa making it difficult to irrigate.

10. Withdraw or aspirate fluid into syringe. If no return, inject 20 ml of air and aspirate again.
Rationale: Inject of air may reposition the end of tube.

11. Reconnect NG tube to suction. Observe movement of solution or drainage.
Rationale: Determine patency of NG tube and correct operation of suction apparatus.

12. Measure and record amount and description of irrigant and return solution.
Rationale: Irrigant placed in NG tube is considered intake: solution returned is recorded as output.

13. Rinse equipment if it will be reused.
Rationale: Promotes cleanliness and prepares equipment for next irrigation.

14. Wash your hands
Rationale: Handwashing deters the spread of microorganisms.

15. Record irrigation procedure, description of drainage and client’s response.
Rationale: Facilitates documentation of procedure and provides for comprehensive care.


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