Nasogastric Intubation

WHAT YOU SHOULD KNOW:

• Nasogastric (na-zo-GAS-trik) intubation (in-too-BA-shun) is a procedure to insert a nasogastric (NG) tube into your nose down into your stomach. An NG tube is a long, thin, bendable plastic or rubber tube with holes at both ends. Depending on the type of NG tube, it may help remove air or excess fluids out of the stomach. It may also be used as a way to bring food to your stomach. Medicines and other substances, such as activated charcoal or dye, may also be given through an NG tube. Use of this tube should only be temporary (short time).
  
  
• You may need an NG tube if your stomach gets too full or if you throw up a lot after surgery. An NG tube may also be useful in food poisoning or drug overdose. Sometimes, an NG tube is placed to get samples of fluid from the stomach for testing. This is done particularly if caregivers want to check for bleeding.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

Having a nasogastric intubation may carry certain risks. There may be bleeding, infection, or injury to the parts where the tube will pass through. The tube may enter the wrong place, such as the lungs, and cause breathing problems. If part of the skull (head) is broken, the tube may enter the brain. Medicines, including anesthesia, that are used during the procedure may cause an allergy. Over time, the NG tube may move which may lead to lung problems or indigestion. Patients with a head injury, nose or esophagus problems, or problems swallowing are at a higher risk for problems. You may not have an NG tube if you just had an injury to your upper jaw or face. Patients who cannot cooperate or are not conscious may also not have an NG tube. Talk with your caregiver if you are worried or have questions about your procedure, medicine, or care.

WHILE YOU ARE HERE:

Before your procedure:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Local anesthesia: This is medicine to make you more comfortable during your procedure or surgery. It is a shot of medicine put into the skin. It is used to numb the area and dull your pain. You may still feel pressure or pushing during the procedure or surgery after you get this medicine.

During your procedure:

• You are asked to sit up with your neck bent forward. Your caregiver will choose which nostril (opening of the nose) will be better to put the NG tube into. You may be given medicine to numb the area where the NG tube will pass. Medicine to make your blood vessels in the nose get smaller and prevent bleeding may also be given. Your caregiver will measure the length of the tube needed to reach your stomach. This area may then be marked using tape. Sterile (clean) jelly or water is placed around the end of the tube to help it slide down. A nasendoscope (a long thin tube passed through the nose and down into the esophagus) may be used as guide.
  
  
• With your head straight up, neck slightly tilted forward, and facing forward, the NG tube is gently put into your nostril. The tube will pass through your nostril, throat, esophagus, and into your stomach. You may cough or feel like throwing up as the tube reaches your throat. Swallowing may help the tube slide down easily and avoid going into your lungs. Caregivers may ask you to take sips of water and to tilt your head forward. Tell your caregiver right away if you cannot breathe.
  
  
• Your caregiver pushes down the tube until the taped mark reaches the nostril. Certain steps are done to check if the tube is in its proper place. Air may be blown in the tube while the sound it makes in the stomach is checked. Some fluids may be taken and tested for its acidity and content. An x-ray of the abdomen (stomach) may also be done. To keep the tube in place, it will be taped to your nose. The part of the tube that is hanging down will be pinned to your hospital gown.

After your procedure:

• Monitoring:
  
  
  • Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.
    
    
  • NG tube: Different devices may be attached to the NG tube. This will depend on the purpose of the tube insertion. If your stomach needs to be emptied, a suction (vacuum) may be connected to it. If the tube is mainly a way to feed the patient or give medicines, a feeding pump may be used. While the tube is inserted, caregivers will check on the tube regularly to make sure it stays in the proper place. This may be done by sucking fluid out of the tube and testing for its content or acidity. If the tube seems to be blocked, it may have to be flushed with saline (salt-water solution) or blown with air. Tape used to secure the NG tube may have to be checked everyday or whenever it becomes soaked.
    
    
  • Skin and abdomen: Your skin in the area of tube insertion will be checked often to make sure it is not causing sores or problems. Caregivers will look for redness, swelling, drainage, or bleeding at the site of insertion. Your abdomen (stomach) will also be checked often to make sure that it is not getting hard or bloated.
    
    
  • Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
  
  
• Removing the NG tube: Taking out the NG tube may be easier than putting it in. However, you may still experience the same uncomfortable feeling while the tube is being taken out. This includes feeling like you want to vomit (throw up). Your caregiver may do the following steps in taking out the NG tube:
  
  
  • Your caregiver will turn off and disconnect any device that is attached to the NG tube. This may include the suction machine or feeding pump.
    
    
  • You will be asked to sit up and a towel will be put over your chest.
    
    
  • Tapes or other materials used to secure the tube will be taken away. The tube will also be removed from the hospital gown.
    
    
  • With gloves on, your caregiver will gently and quickly pull out the tube from your nose. The tube is then wrapped in a towel and disposed off properly.
    
    
  • The area where the NG tube was placed will be cleaned. Mouth and nasal care may also be given.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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