Chapter 10: Tubes and Devices
10.3 Nasogastric Tubes
Critical Thinking Exercises: Questions, Answers, and Sources / References
- You are inserting a nasogastric tube and the patient begins to cough and turn red in the face. Explain your next steps.
Answer: It is common for the patient to feel discomfort, and this may be expressed with light coughing and gagging. More aggressive coughing and gagging may indicate that the tube has entered the airway, in which case you should STOP and wait for a few seconds for the coughing to stop. If it doesn’t stop, withdraw the NG tube
Source: Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical skills and nursing techniques (9th ed.). St Louis, MO: Elsevier-Mosby.
2. Your patient has a nasogastric tube and is requesting water because her throat feels dry. Describe your next actions.
Answer: Do not give the patient anything to eat or drink without knowing that the patient has passed a swallowing assessment. Determine if drinking water is contraindicated. If water is allowed and the patient is on fluid balance assessment, ensure accurate volumes are recorded.
Source: Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical skills and nursing techniques (9th ed.). St Louis, MO: Elsevier-Mosby.
3. Your patient calls you to say they’ve accidentally pulled out the NG. Explain your next steps.
Answer: If the NG tube falls out of the patient, it is not an emergency. But be sure to assess your patient. Consider how are the patient’s airway, breathing, circulation, consciousness, safety status? Know the rationale for the nasogastric tube and the patient’s current status to determine if immediate reinsertion is appropriate. Otherwise consult the prescriber for further orders.
Source: Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical skills and nursing techniques (9th ed.). St Louis, MO: Elsevier-Mosby.
- Describe 3 ways to confirm placement of an NG tube used for feeding.
Answer:
a. Depending on the kind of tube, aspiration may or may not be permitted (weighted tubes should not be aspirated due to risk of clogging it). If aspiration is permitted, aspirate gastric contents and check pH. Secretions from the stomach should be acidic.
b. Compare external length with previous measurement
c. XRAY (Gold Standard)
Note: air injected into the stomach through the NG tube is not an accurate measure of placement.
Source: Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical skills and nursing techniques (9th ed.). St Louis, MO: Elsevier-Mosby.
2. You note the patient’s NG secretions to be coffee ground. Explain your next steps.
Answer: coffee ground NG secretions are not normal. They suggest irritation of the gastric mucosa and slight bleeding. Consult with the prescriber for an acid reducing agent (ie. proton pump inhibitor). Gastric irritation can lead to ulcers which are uncomfortable, can perforate and cause sepsis.
Source: Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical skills and nursing techniques (9th ed.). St Louis, MO: Elsevier-Mosby.
Lilley, L., Rainforth Collins, S., Snyder, J., Collins, S. & Swart, B. (2016). Pharmacology for Canadian health care practice (3rd Canadian ed.). Toronto, ON: Elsevier.