Procedure for Monitoring A Nasogastric Tube

OBJECTIVES:
a.    To check the intactness of the tube into the stomach.
b.    To monitor the flowrate of feeding.

CHARTING:
a.    Intactness of the tube
b.    Check amount, color, consistency and odor of drainage from Nasogastric tube.
c.    Patient’s activities and reaction.

ACTION
1. Confirm physician’s order for NG tube, type of suction, and direction for irrigation.
Rationale:   Ensures correct implementation of physician’s order.

2. Observe drainage from NG tube. Check amount, color, consistency, and odor. Hematest drainage to confirm presence of blood in drainage.
Rationale: Normal color of gastric drainage is light yellow to green in color due to the presence of bile. Bloody drainage may be expected after gastric surgery but must be monitored closely. Presence of coffee-ground type drainage may be indicate bleeding.

3. Inspect suction apparatus. Check that setting is correct for type of suction (continuous or intermittent), range of suction (low,medium,high) and that movement of drainage through tubing is present.
Rationale: Ensures correct implementation of physician’ order. Ensures that suction is present and correctly adjusted. Loose connections or a kind or blockage in tube may interfere with suction.

4. Assess placement of NG tube.
Rationale: NG tube may be displaced into trachea through movement or manipulation.

5. Assess comfort of client. Check for presence of nausea and vomiting, feeling of fullness, or pain.
Rationale: May indicate incorrect operation of NG suction or blockage in tube.

6. Assess client’s abdomen for distention and auscultate for presence of bowel sounds.
Rationale: Abdominal distention may be related to the accumulation of gas or internal bleeding. Presence of bowel sounds indicates the return of peristalsis.

7. Assess mobility of client and respiratory status.
Rationale: Turning from side to side in bed and ambulation when permitted encourage the return of peristalsis and facilitate drainage. Presence of NG tube may discourage client from coughing and deep breathing necessary for adequate respiratory exchange.

8 Observe condition of client’s nostrils and oral cavity.
Rationale: Nostrils need cleansing and lubrication with water-soluble lubricant and tape must be changed when necessary to minimize irritation from NG tube. Frequent mouth care (at 2-hr intervals) improves comfort and maintains moisture in oral mucosa.

9 Monitor overall safety of client with NG tube.
Rationale: NG tube that is secured to client’s nose with tape and pinned to gown allows easier movement. Call bell within reach allows client ready access to nursing assistance. Any kinks or obstruction interferes with patency of NG tube. A semi-Fowler’s position facilitates drainage and minimizes any risk or aspiration.

10. Monitor NG tube and suction apparatus at least every 2 hours. Irrigate at interval ordered by physician.
Rationale: Promotes safe operation of system. Any change in client’s condition or type of drainage necessitates more frequent observation and notification of physician.

11. Record and measure NG irrigations and drainage on intake/output chart according to schedule and agency protocol. Documents description of drainage and client’s response on chart.
Rationale: Irrigations are recorded as intake. Drainage from NG tube is measured as output every 8 hour. If drainage is copious, more frequent emptying of collection container will be necessary. Documentation provides accurate record of client’s response to NG drainage.

12. Replenish supplies and maintain equipment according to agency policy and manufacturer’s recommendations.
Rationale: Ensures availability of necessary supplies. Provides for safe operation of equipment and efficient drainage of client’s gastric contents.


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