NG Tube Nursing Care Plans Diagnosis and Interventions
NG Tube NCLEX Review and Nursing Care Plans
A nasogastric (NG) tube is a flexible rubber or plastic tube inserted via the nose, esophagus, and stomach.
The purpose of the NG tube is to transport or eliminate substances from the stomach. When an individual cannot swallow solid foods, an NG tube’s primary purpose is to provide nutrition. In some cases, it can also be used to administer drugs.
The most prevalent causes for utilizing an NG tube are as follows:
- Nutrient and medicine administration
- Taking liquids or air out of the stomach
- Adding contrast to the stomach in preparation for X-rays
- Bowel protection after surgical operations or during bowel rest
Nasogastric Tube Feeding
A patient on NG tube feeding typically has a condition or injury that prohibits them from eating a regular diet by mouth, but their GI tract is still functioning well.
They can receive nutrients and keep their GI tract beneficial by being fed through an NG tube. NG tube feeding may be utilized to complement or replace their caloric intake.
NG tube feeding is frequently used as a temporary alternative while a patient recuperates from an illness, injury, or surgery. Most patients who get NG tube feedings resume regular eating habits.
However, in some cases, such as for persons with mobility abnormalities or children with physical limitations, NG tube feeding is utilized as a long-term option.
In some situations, NG tube nutrition can be used to extend the life of a severely ill individual or an older adult who cannot meet their nutritional needs. The ethics of employing NG tube feeding to extend life must be considered in each case.
Types of Nasogastric Tube
The healthcare provider will decide on the type and length of the nasogastric (NG) tube that will better fit the patient’s needs, including lavage, aspiration, enteral therapy, or stomach decompression. The Levin, Salem sump, and Moss tubes are the various types.
- Levin Tube. The Levin tube is a synthetic rubber or plastic tube with a single lumen and lengths ranging from 42″ to 50″ (106.5 to 127cm). It contains openings at the tip and down the side. The Levin tube is generally used for long-term stomach drainage and gavage feeding. The utilization of the Levin tube is also beneficial in making diagnoses. Moreover, its advantages include the ability to be administered either intranasal or oral, as well as the fact that it is strong enough to be passed into an unconscious person while remaining flexible enough to avoid harm. The main risk of passing this tube is that it will enter the trachea rather than the esophagus.
- Salem sump tube. The Salem sump tube is a clear plastic double-lumen tube (one for suction and drainage and one for ventilation) with a blue sump port (pigtail) that permits atmospheric oxygen to pass the patient’s stomach. As a result, the tube floats freely without adhering to or damaging the gastric mucosa. Furthermore, it is commonly utilized for constant suction. The existence of a venting lumen, which reduces the likelihood of tube obstruction, is an advantage of this tube.
- Moss tube. The Moss tube is a triple-lumen, nasogastric feeding-decompression tube that utilizes a gastric balloon to completely block the cardio esophageal junction while simultaneously performing esophageal aspiration and intragastric feeding.
Nasogastric Tube Management and Patient Care
- The patient’s mouth should be cleaned with a damp towel, a toothbrush, and floss at least once a day, .
- Every day, clean the area where the NG tube enters the nose. Use a cotton bud that has been dampened with warm water.
- Replace the nose tape every other day or if it becomes loose.
- Make sure the nose tape is always secure.
- If the feeding tube slips out, do not reinsert it without prompt medical attention.
- To avoid clogging the feeding tube, rinse it with water after feeding or medication.
- If the tubing becomes clogged, take these steps:
– Insert the syringe into the NG tube and withdraw the plunger.
– Fill the NG tube halfway with warm drinking water.
- If the caregiver cannot clear the tube, seek medical attention immediately. Not missing any liquid food, water, or prescribed medication is necessary for patients with NG tubes.
Indications of Nasogastric Tube Insertion
The following are some diagnostic indications for NG tube insertion:
- NG tube is beneficial in evaluating upper gastrointestinal (GI) bleeding, such as the prevalence and volume of GI bleeding.
- NG tube is indicated for gastric fluid content aspiration.
- One of the indications of an NG tube is the evaluation of the esophagus and stomach through a chest radiograph.
- One of the purposes of the NG tube is administering radiographic contrast to the gastrointestinal tract.
- Another indication of NG tube is the analysis of gastric lavage cytology samples for detection of the presence (GL1) or absence (GL0) of cancer cells in a study of patients with gastric cancer; GL1 was firmly related to poor overall survival and progression-free survival.
The following are some therapeutic indications for NG intubation:
- One of the indications of the NG tube is gastric decompression which includes managing a decompressed state following endotracheal intubation, most commonly through the oropharynx.
- NG tube is also beneficial for symptom relief and bowel rest in the presence of small-bowel obstruction.
- Another indication is the aspiration of gastric contents following recent hazardous substance intake.
- Medication administration
- Feeding of the patient
- Irrigation of the bowels
- NG tube can be retained following caustic consumption to establish a tract in the esophagus that can subsequently be used for balloon dilatation.
Contraindications of Nasogastric Tube
- Absolute Contraindications against NG Tube Insertion
- High risk of aspiration
- Stasis of the stomach.
- Gastroesophageal reflux disease
- Upper gastrointestinal constriction.
- Nasal injuries or surgery
- Skull fractures
- Extensive maxillofacial trauma
- Obstruction of the nasopharynx or esophagus
- Significant risk of esophageal perforation and esophageal anomalies such as recent caustic ingestions, diverticula, or stricture
- Relative Contraindications against NG Tube Insertion
- Coagulation disorders that go untreated
- Esophageal varices (typically treated with a Sengstaken-Blakemore tube, but an NG tube can be used for lower-grade varices) or strictures
- Recent esophageal varices banding
- Anastomosis between the esophagus and stomach –
- Consumption of alkaline
Complications of NG Tube Insertion
The following are the nasogastric tube insertion complications:
- Sinusitis. The existence of an NG tube in the nostrils for an extended duration may induce ciliary epithelial damage and infection, which can lead to sinusitis.
- Pulmonary aspiration. Because of the relative proximity of the larynx to the esophagus, the nasogastric tube may penetrate the larynx and trachea. This could result in pulmonary aspiration. The tube becomes stuck in the airway, causing acute discomfort and coughing.
- Esophagus or gastric bleeding. Traumatic damage to the GI mucosa after NG tube insertion might result in GI hemorrhage, especially in patients suffering from coagulopathy.
- Discomfort. While the NG tube is being pushed down the nostril and into the stomach, a conscious patient may experience discomfort, resulting in vomiting or gagging. In this instance, a suction should constantly be available and ready to utilize.
- Incorrect placement of NG tube. Unwanted events, such as incorrectly inserting an NG tube into the lungs, will allow food and drugs to pass, potentially killing the patient.
- Trauma to the nasopharynx, with or without bleeding
- Mediastinal or intracranial penetration (very rare)
Medical Supplies Used in Nasogastric Tube Insertion
Before initiating the NG tube insertion, all necessary medical apparatus or supplies should be prepared, assembled, and ready at the bedside. The following equipment are essential:
- Gloves, a face shield, and a protective gown
- Decompression nasogastric tubes, such as a Levin tube (single-lumen) or Salem sump tube (double-lumen such that second-lumen vents to atmosphere)
- A long, thin intestinal feeding tube (gastroenteric tube) for long-term enteral feeding if small intestine feeding is expected (use with a stiffening wire or stylet)
- Topical anesthetic spray
- Vasoconstrictor spray
- Straw and a cup of water
- A 60-mL syringe with a catheter tip
- Emesis basin
- Blue pad or towel
- Medical tape
- The suction (wall or mobile device)
Procedure of Nasogastric Tube Insertion
- Put on the protective gown, gloves, and face mask.
- Check the stability of each nostril by closing one and requesting the patient to breathe through the other.
- Ask the patient which gives the best airflow.
- Examine the interior of the nose for any visible blockages.
- To keep the patient’s chest clean, lay a towel or blue pad over it.
- Spray local anesthetic in the nostril and the pharynx at least 5 minutes preceding tube placement. If time allows, administer 4 mL of 10% lidocaine via nebulizer or insert 5 mL of 2% lidocaine gel into the nasal passages.
- Assess the appropriate insertion depth—about the distance between the earlobe and the angle of the mandible, plus 6 inches; record which of the black lines on the tube corresponds to this distance.
- Lubricate the nasogastric tube end.
- Insert the tube tip gently into the nose and slide it along the bottom of the nasal passage. Aim backward and then downwards to stay underneath the nasal turbinate.
- As the tube goes inside the posterior nasopharynx, expect to feel some resistance from the patient.
- Ask the patient to drink sips of water with a straw while moving the tube forward.
- The tube will be swallowed by the patient, allowing it to enter the esophagus. During swallows, continue to advance the tube to the predetermined depth using the black lines on the tube as a guide.
- The doctor can determine adequate tube placement by asking the patient to talk. If the patient cannot talk, has a husky voice, is aggressively gagging, or is in respiratory distress, the tube is most likely in the trachea and should be removed as soon as possible.
- Administer 20 to 30 mL of air and use a stethoscope to listen underneath the left subcostal region. The sound of a rush of air aids in determining the tube’s position in the stomach.
- Aspirate the contents of the stomach to ensure placement.
- A chest x-ray may be required to verify the tube’s position in the stomach. A chest x-ray is strongly suggested if the tube will be used to infuse any chemicals, such as radiopaque contrast media or liquid feedings.
- Fit the tube over the patient’s nose.
- Attach the wide half of a 4- to 5-inch strip of adhesive tape that has been folded vertically for half its length to the patient’s nose.
- Wrap the tape tails in different directions around the NG tube.
- Set the nasogastric tube to low suction (intermittent suction if possible).
Nursing Considerations for Patients with Nasogastric Tube
- Provide oral and skin care for the patient. Apply mouthwash and lubrication to the patient’s lips and nostrils. Lubricate the catheter till it contacts the nostrils using a water-soluble lubricant, as the client’s nose may become itchy and dry.
- Check the patient’s NG tube placement. Always aspirate a tiny amount of gastric contents to ensure that the NG tube is in the stomach. The best technique to confirm placement is via an X-ray study.
- Put on gloves. Always use gloves when initiating an NG since the possibility of coming into touch with the patient’s blood or bodily fluids increases, especially with inexperienced practitioners.
- Provide the patient with eye and face protection. If the danger of vomiting is considerable, face and eye protection should be considered. The trauma protocol requires all team members to wear gloves, protective goggles, and gowns.
NG Tube Nursing Diagnosis
NG Tube Nursing Care Plan 1
Nursing Diagnosis: Deficient Knowledge related to NG tube management and care at home secondary to stroke as evidenced by a lack of understanding about the condition, inability to manage NG tube well, and presence of severe complications that could be prevented at first.
- The patient will be able to learn the proper way to manage an NG tube.
- The patient will be able to recognize if severe complications start to manifest, and they could be prevented from worsening.
- The patient will appreciate the advantages and will be able to manage the disadvantages of NG tube feeding.
|NG Tube Nursing Interventions||Rationale|
|Ensure that the patient’s food in the NG feeding tube is appropriate for stroke patients.||Food used for NG Tube feeding is often of a liquid consistency. The precise food or medication and the frequency of feeding are based on the patient’s condition. The doctor or dietitian will advise the healthcare staff on which meals to eat and which to avoid. The patient and family can pick ready-made liquid formulas and prepare the food themselves. Warm the food to a temperature agreeable for the patient before administration.|
|Instruct the patient and his or her family member about the proper procedures of NG tube feeding.||Administering food through an NG tube may sound complicated, but caregivers and family members can learn to execute it properly with good practice and training. Ensure to feed the patient with the prescribed amount and timetable, and follow the instructions provided by health care providers: Place the patient in a feeding position.Examine the tube positioningIf the patient is ready to be fed, check his or her stomach content.Pump the food and medication via the tube at an optimum rate using a syringe.After feeding, flush the tube with water.|
|Educate the patient and his or her family regarding proper NG tube management and care.||Flushing the tube before and after each feed keeps it clear of clogs and infections. After medicine administration, an extra flush should be provided to ensure that the whole amount is delivered. Warm water can be used for flushing the NG tube.|
|Ensure that the patient’s NG tube is in an appropriate position to avoid complications. Educate them not to remove or reinsert the NG tube without the doctor’s advice and supervision.||Patients who need long-term NG tube feeding are typically bedridden. Caregivers must ensure that the tube is not pulled out during this process. Furthermore, some individuals may unintentionally remove the NG tube while sleeping. Caregivers and patients should never attempt to reinsert the NG tube at home in such instances. Alternatively, consult a doctor for further instructions.|
|Educate the patient and caregivers about proper hygiene to avoid complications such as diarrhea.||Bacterial growth develops in enteral feeding environments. Thus, cleanliness is critical to avoid food contamination and infection, both of which can result in diarrhea. Before handling the tube, liquid food, or medication, caregivers should properly wash their hands. Using an aseptic towel to wipe the skin around the nose before and after each feeding is also critical. During feeding, caregivers should also wear masks.|
NG Tube Nursing Care Plan 2
Nursing Diagnosis: Risk for Aspiration related to NG tube insertion secondary to dysphagia.
As a risk nursing diagnosis, Risk for Aspiration is absolutely irrelevant to any signs and symptoms since it has not yet developed in the patient, and safety precautions will be initiated instead.
- The patient will not suffer from aspiration since the healthcare staff knows how to manage it.
- The healthcare team will be able to recognize the signs and symptoms of aspiration quickly.
|NG Tube Nursing Interventions||Rationale|
|If the doctor prescribes it, add a few drops of blue or green food coloring to the patient’s tube feeding to determine aspiration quickly. In addition, look for glucose in tracheobronchial secretions to rule out enteral feeding aspiration.||Colored fluids that are suctioned or coughed from the respiratory tract indicate aspiration.|
|Raise the patient’s head on the bed to 30 to 45 degrees during NG tube feeding and for another 30 to 45 minutes afterward if feeding is inconsistent. Before lowering the head of the bed, turn off the feeding. Patients receiving continuous NG tube feedings should be placed in an upright position.||Upright positioning decreases aspiration by reducing reflux of stomach contents.|
|Instruct the patient to consult a speech pathologist if necessary.||A speech pathologist can perform a dysphagia analysis to assess the necessity for videofluoroscopy or a modified barium swallow and develop particular procedures to avoid aspiration in patients with impaired swallowing.|
|Obtain detailed information concerning hospital management from the discharging institution for patients at high risk of aspiration.||Continuity of treatment can reduce unneeded stress for the patient and family while facilitating successful home management.|
|Create emergency and contingency plans for patient care.||A fundamental purpose of home care nursing is to ensure the clinical safety of patients throughout consultations.|
|Educate the patient and his or her family on the importance of appropriate position during NG tube feeding or even administration of medications.||Upright positioning reduces the likelihood of aspiration.|
|Educate the patient on the clinical manifestations of aspiration.||Information aids in accurately assessing high-risk circumstances and deciding when to request an additional evaluation.|
|Portray suctioning techniques to the patients to avoid secretions from accumulating in the mouth cavity.||Respiratory aspiration necessitates immediate treatment to keep the airway open and facilitate good breathing and oxygen supply.|
|Refer the patient to a home care nurse, rehabilitation expert, or occupational therapist as needed.||Consultants may be necessary to ensure satisfactory outcomes.|
NG Tube Nursing Care Plan 3
Risk for Imbalanced Nutrition
Nursing Diagnosis: Risk for Imbalanced Nutrition related to NG tube feeding secondary to gastrectomy.
- The patient will show no evidence of malnutrition.
- The patient will maintain a stable weight or exhibit gradual weight gain toward the objective of normalization of laboratory values.
|NG Tube Nursing Interventions||Rationale|
|Maintain the patient’s NG tube’s patency. Inform the doctor if the NG tube gets displaced.||This method allows the GI tract to rest during the acute postoperative phase until normal function is restored. To avoid harm to the operational area, the physician or surgeon may have to adjust the tube.|
|Take note of the character and amount of the patient’s stomach discharge.||Gastric drainage will be bloody for the first 12 hours before clearing and turning greenish. Bleeding that persists, or returns implies complications. A decrease in output could indicate the return of the GI function.|
|Remind the patient to minimize his or her consumption of ice chips.||Ice causes nausea and can wash electrolytes out of the NG tube.|
|Provide regular oral hygiene, including petroleum jelly for lips.||This method avoids the irritation of the dry mouth and cracked lips due to fluid limitation and the NG tube.|
|Auscultate for the return of bowel sounds and the passage of flatus.||Peristalsis is predicted to return around the third postoperative day, indicating that oral intake can be resumed.|
|As tolerated, gradually switch from clear fluids to a bland meal with multiple small feedings.||To establish tolerance, the NG tube is typically clamped for predetermined durations of time when peristalsis restarts. After removing the NG tube, intake is gradually increased to avoid stomach discomfort and distension.|
NG Tube Nursing Care Plan 4
Risk for Deficient Fluid Volume
Nursing Diagnosis: Risk for Deficient Fluid Volume related to NG tube feeding secondary to severe Crohn’s disease.
Desired Outcome: The patient will be normovolemic if systolic blood pressure is 90 mm Hg or above, there is no orthostasis, heartbeat is 60 to 90 beats per minute, urine output is at least 30 milliliter per hour, and skin turgor is normal.
|NG Tube Nursing Interventions||Rationale|
|Examine the patient for clinical manifestations of deficient fluid volume: Skin integrityTachycardiaHypotensionUrine with a high specific gravity||Dry skin and low skin turgor come from decreased fluid content. The heart rate increases to compensate when there is a fluid volume shortage. A lack of fluid volume reduces circulatory volume and contributes to a drop in blood pressure. Urine becomes more diluted when fluid volume decreases.|
|Evaluate urine production every hour.||Consistently lower urine production than fluid intake indicates a fluid volume imbalance and the need for extra fluid to avoid dehydration.|
|Unless contraindicated, encourage the patient to have an increased fluid consumption.||Hydration is an essential aspect of living with a feeding tube that is sometimes overlooked because feeding tubes are primarily concerned with caloric intake. Patients with NG tube feeding tubes are more likely to become dehydrated.|
|As directed, keep an eye on the patient’s serum protein levels.||Protein levels are usually checked every 3 to 7 days; low serum protein levels might cause fluid leakage from intravascular regions due to low colloidal pressures.|
|Weigh the patient daily during the first week of NG tube feeding and then once a week afterward.||Daily weights are required to confirm whether or not nutritional objectives are being achieved. Weight loss can also determine fluid volume status. A daily weight reduction of more than half a pound could suggest a fluid volume deficiency.|
NG Tube Nursing Care Plan 5
Nursing Diagnosis: Risk for Infection related to NG tube insertion and feeding secondary to gastrointestinal cancer.
Desired Outcome: The patient and medical personnel will be informed about limiting the infection risk related to NG tube feeding.
|NG Tube Nursing Interventions||Rationale|
|Inform the patient, family members, and caregivers that only enteral syringes should be used, not intravenous syringes.||Some manufacturers provide enteral syringes with purple plungers or syringe barrels to distinguish them from intravenous syringes. To measure and give liquid medications, only use syringes labeled for enteral use; these cannot be attached to intravenous catheters or ports.|
|Ensure that the patient’s NG tube feeds are appropriately prepared and stored.||Pre-packaged, ready-to-use feeds should be utilized whenever possible instead of feeds that require decanting, reconstitution, or dilution to avoid contamination. On the other hand, feeds can be prepared ahead of time, refrigerated, and utilized within 24 hours. Lastly, hand hygiene with liquid soap and hot water or alcohol is vital before beginning feed preparation.|
|Ensure adequate feed administration.||Connect the administration system to the NG feeding tube with minimal handling and an aseptic procedure. Ready-to-use sterile feeds can be given with a maximum hang time of 24 hours, whereas reconstituted non-sterile meals can be given with a maximum hang time of 4 hours only.|
|Ensure that only trained healthcare staff will assist the patient in NG tube feeding.||Only personnel who have been trained and deemed competent should prepare or administer NG tube feeds. Moreover, further training is required when new processes or equipment are introduced.|
|Ensure that medications are appropriately administered through the NG tube.||Elixirs or syrups might stick to the tube and foster bacterial development. Hence aqueous solutions are preferred. Before and after administering medications, the tube must be thoroughly cleaned.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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