Nasogastric Tube Contraindications Quiz and Flashcards

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Questions and Answers

When is it recommended to re-confirm the correct tube position after NGT insertion?

After episodes of vomiting or coughing; Unexplained respiratory distress; Excessive tube length externally; Excessive salivation or gagging noted

What are the steps involved in the removal of a NGT?

Check placement with pH testing; 2. Flush the tube with water; 3. Insert a bolus of air; 4. Instruct patient to hold breath when withdrawing the tube

What is the purpose of inserting a bolus of air before withdrawing the NGT?

To free the tube from the stomach lining

What should the patient do when the NGT is being withdrawn to prevent aspiration?

Hold their breath to ensure the glottis closes Signup and view all the answers

What is the purpose of flushing the NGT with water before removal?

To prevent gastric content from draining back into the esophagus Signup and view all the answers

What is the recommended method for determining the correct placement of a nasogastric tube?

Aspiration of gastric contents with pH testing as well as X-ray confirmation Signup and view all the answers

Why is it important to re-confirm the correct positioning of a nasogastric tube after episodes of vomiting or coughing?

To ensure the tube is still in the correct place and has not moved Signup and view all the answers

What is the purpose of flushing the nasogastric tube with water before removal?

To prevent gastric content from draining back into the esophagus Signup and view all the answers

When withdrawing a nasogastric tube, why is it important for the patient to hold their breath?

To ensure the glottis closes and prevents aspiration Signup and view all the answers

What is a percutaneous endoscopic gastrostomy (PEG) used for?

It is used for feeding or drainage purposes Signup and view all the answers

Why is excessive salivation or gagging noted as a reason to re-confirm the correct position of a nasogastric tube?

These symptoms may indicate a problem with the tube placement Signup and view all the answers

What is the purpose of inserting a bolus of air before withdrawing a nasogastric tube?

To free the tube from the stomach lining Signup and view all the answers

Why is X-ray confirmation recommended for determining the placement of a nasogastric tube?

It provides a more effective confirmation of tube placement Signup and view all the answers

What surgical procedure involves inserting a tube through the abdomen wall into the stomach?

Gastrostomy Signup and view all the answers

How does holding the breath during nasogastric tube removal prevent aspiration?

It ensures the glottis closes, preventing the passage of material into the airway Signup and view all the answers

Study Notes

Nasogastric Tubes (NGTs)

Nasogastric tubes are used prior to an endoscopy for patients with bleeding peptic ulcers, with orogastric tubes as a possible alternative.

Contraindications for NGTs

Severe mid-face trauma
Recent nasal surgery
Base of skull fracture
Nasopharyngeal obstruction
Deviated septum

Types of NGTs

Short-Term NGTs

Made of PVC
Single lumen with wider bore
Various sizes with color-coded connectors
Varied lengths
Left in situ for 24 hours to 7 days
Used for enteral feeds and/or aspiration of gastric secretions
Examples: Ryles tubes, Levin tube

Long-Term NGTs

Made of polyurethane
Very flexible
Radiopaque
May have a stylet to guide insertion (removed after insertion)
Can be left in situ for 4 to 6 weeks
Weighted polyurethane feeding tube
Designed for nasogastric and nasoduodenal feeding

Salem Sump NGTs

Dual lumen
Smaller blue lumen: Vent attaches, allowing room air in, preventing distal end from adhering to the stomach
Larger clear lumen: Gastric suctioning, decompression, irrigation, and delivery of medication
Not for feeding

Safety Measures

Before NGT Insertion

Measure the length of the NGT by placing the distal end at the nose tip, extending the tube to the ear lobe, and then to the xyphoid process (NEX: Nose Earlobe Xyphoid)

During NGT Insertion

Patient positioning: Tilting the head in slight extension or forward can facilitate insertion of the tube
Unconscious patient
Left lateral position
Head turned to downward side
Gag and cough reflexes absent or suppressed
NG tube easily misplaced (lung)
Inability to swallow

After NGT Insertion

Measure tube length after initial insertion, prior to feed or medication, and at least once per shift
Radiological imaging (chest X-ray) is the gold standard for confirming NGT placement after insertion
Aspiration of gastric contents with pH testing as well as X-ray confirmation is more effective for determining tube placement

When to Re-Confirm Correct Tube Position

After episodes of vomiting or coughing
Unexplained respiratory distress
If excessive tube length noted externally (compared to length previously documented)
If excessive salivation or gagging is noted

Removal of a NGT

Check placement – pH
Flush the tube with 20mls of water
Insert a bolus of air to free tube from stomach lining
Instruct patient to hold their breath to ensure that the glottis closes, preventing aspiration

Percutaneous Endoscopic Gastrostomy (PEG)

Surgical procedure for inserting a tube through the abdomen wall and into the stomach, used for feeding or drainage

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Description

Test your knowledge on the contraindications for nasogastric tubes before an endoscopy for a patient with a bleeding peptic ulcer. Learn about when not to use NG tubes based on various medical conditions and injuries.

Contraindications for Nasogastric Tubes Quiz