Chest Tube Care and Monitoring TERMINAL LEARNING OBJECTIVE Given a scenario in a holding or ward setting, involving a patient

with a chest tube, identify procedures for chest tube care and monitoring IAW the Textbook of Basic ursing, !ippincott Introduction Trauma, disease, or surgery can interrupt the closed negative"pressure system of the lungs, causing the lung to collapse# Air or fluid may leak into the pleural cavity# A chest tube is inserted and a closed chest drainage system is attached to promote drainage of air and fluid# $hest tubes are used after chest surgery and chest trauma and for pnuemothorax or hemothorax to promote lung re"expansion Terms and definitions a# b# c# %neumothorax & collection of air in the pleura space 'emothorax & an accumulation of blood and fluid in the pleural cavity between the parietal and visceral pleurae, usually as the result of trauma $hest tubes & a catheter inserted through the thorax to remove air and fluids from the pleural space and to reestablish normal intrapleural and intrapulmonic pressures

Chest Tube !stems a# %leur"(vac chest drainage system )*+ ,ne"piece molded plastic unit that duplicates the three"chambered system )-+ $ost effective ).+ There must be bubbles flowing in the suction control portion of the unit to provide suction to the patient %leur"(vac /et 0p )*+ 1ill water seal chamber )-+ 1ill suction control chamber ).+ Attach tube to suction source )2+ Tape all the connections )3+ %rovide sterile tube for connection to patient %rocedure for %roper 0sage of the 'eimlich 4alve )*+ 'eimlich valve is a plastic, portable one"way valve used for chest drainage, draining into a vented bag )-+ (5uipment )a+ 'eimlich valve )b+ 6elly clamps " - )rubber"tipped+ )c+ 4ented drainage bag or ostomy bag )d+ ,stomy tape or rubber band )e+ /uction setup )if applicable+ )f+ $lean scissors ).+ %rocedure /teps )a+ Gather e5uipment and bring to patient area )b+ Wash hands

b#

c#

)c+ )2+

7on gloves# onsterile gloves are acceptable as long as sterile techni5ue is maintained while the connection is being made# 'eimlich 4alve To $hest Tube )a+ %lace rubber"tipped 6elly clamps in opposite directions on the proximal end of the chest tube as near to the patient as possible )b+ $onnect the chest tube to the blue end of the 'eimlich valve using sterile techni5ue ,nly the blue end of the 'eimlich valve can be connected to the chest tube# If the clear end is connected, the one"way valve will be in the wrong position and no drainage will take place# )c+ Tape the connection site at both ends of the valve using - inch cloth tape#

CA"TION8

CA"TION#

When two chest tubes are present, two 'eimlich valves must be used to ensure proper functioning of chest tubes# )d+ 9onitor and record character of drainage and patency of valve in nursing progress notes#

CA"TION#

9easure all drainage in a calibrated cylinder for accurate readings# )e+ :ecord drainage output on I ; , graphic every < hours# If conditions permit#

Care of $atients %ith chest tubes a# b# c# Assess patient for respiratory distress and chest pain, breath sounds over affected lung area, and stable vital signs ,bserve for increase respiratory distress ,bserve the following8 )*+ $hest tube dressing, ensure tubing is patent )-+ Tubing kinks, dependent loops or clots ).+ $hest drainage system, which should be upright and below level of tube insertion %rovide two shodded hemostats for each chest tube, attached to top of patient=s bed with adhesive tape# $hest tubes are only clamped under specific circumstances8 )*+ To assess air leak )-+ To 5uickly empty or change collection bottle or chamber> performed by soldier medic who has received training in procedure ).+ To change disposable systems> have new system ready to be connected before clamping tube so that transfer can be rapid and drainage system reestablished )2+ To change a broken water"seal bottle in the event that no sterile solution container is available )3+ To assess if patient is ready to have chest tube removed )which is done by physician=s order+> the solider medic must monitor patient for recreation of pneumothorax %osition the patient to permit optimal drainage )*+ /emi"1lower=s position to evacuate air )pneumothorax+ )-+ 'igh 1lower=s position to drain fluid )hemothorax+

d#

e#

f# g# h#

9aintain tube connection between chest and drainage tubes intact and taped )*+ Water"seal vent must be without occlusion )-+ /uction"control chamber vent must be without occlusion when suction is used $oil excess tubing on mattress next to patient# /ecure with rubber band and safety pin or system=s clamp Ad?ust tubing to hang in straight line from top of mattress to drainage chamber# If chest tube is draining fluid, indicate time )e#g#, @A@@+ that drainage was begun on drainage bottle=s adhesive tape or on write"on surface of disposable commercial system )*+ /trip or milk chest tube only per 97B%A orders only )-+ 1ollow local policy for this procedure

&rob'ems so'(ing %ith chest tubes a# %roblem8 Air leak )*+ %roblem8 $ontinuous bubbling is seen in water"seal bottleBchamber, indicating that leak is between patient and water seal )a+ !ocate leak )b+ Tighten loose connection between patient and water seal )c+ !oose connections cause air to enter system# )d+ !eaks are corrected when constant bubbling stops )-+ %roblem8 Bubbling continues, indicating that air leak has not been corrected )a+ $ross"clamp chest tube close to patient=s chest, if bubbling stops, air leak is inside the patient=s thorax or at chest tube insertion site )b+ 0nclamp tube and notify physician immediatelyC )c+ :einforce chest dressing !eaving chest tube clamped caused a tension pneumothorax and mediastinal shift

)arning# ).+

b#

%roblem8 Bubbling continues, indicating that leak is not in the patient=s chest or at the insertion site )a+ Gradually move clamps down drainage tubing away from patient and toward suction"control chamber, moving one clamp at a time )b+ When bubbling stops, leak is in section of tubing or connection distal to the clamp )c+ :eplace tubing or secure connection and release clamp )2+ %roblem8 Bubbling continues, indicating that leak is not in tubing )a+ !eak is in drainage system )b+ $hange drainage system %roblem8 Tension pneumothorax is present )*+ %roblems8 /evere respiratory distress or chest pain )a+ 7etermine that chest tubes are not clamped, kinked, or occluded# !ocate leak )b+ ,bstructed chest tubes trap air in intrapleural space when air leak originates within patient )-+ %roblem8 Absence of breath sounds on affected side )a+ otify physician immediately ).+ %roblems8 'yperresonance on affected side, mediastinal shift to unaffected side, tracheal shift to unaffected side, hypotenstion or tachycardia )a+ Immediately prepare for another chest tube insertion

)b+ )2+ )3+ )D+

)E+

,btain a flutter )'eimlich+ valve or large"guage needle for short"term emergency release or air in intrapleural space )c+ 'ave emergency e5uipment )oxygen and code cart+ near patient %roblem8 7ependent loops of drainage tubing have trapped fluid )a+ 7rain tubing contents into drainage bottle )b+ $oil excess tubing on mattress and secure in place %roblem8 Water seal is disconnected )a+ $onnect water seal )b+ Tape connection %roblem8 Water"seal bottle is broken )a+ Insert distal end of water"seal tube into sterile solution so that tip is - cm below surface )b+ /et up new water"seal bottle )c+ If no sterile solution is available, double clamp chest tube while preparing new bottle %roblem8 Water"seal tube is no longer submerged in sterile fluid )a+ Add sterile solution to water"seal bottle until distal tip is - cm under surface )b+ ,r set water"seal bottle upright so that tip is submerged

"MMAR* $aring for a patient with a chest tube re5uires problem solving and knowledge application# :emember, a chest tubes is a catheter inserted through the thorax to remove air and fluids from the pleural space and to reestablish normal intrapleural and intrapulmonic pressures# When caring for and maintaining a patient with a chest tube, it is important to note the patency of chest tubes, presence of drainage, presence of fluctuations, patientFs vital signs, chest dressing status, type of suction, and level of comfort#

PREPROCEDURE CARE Ensure a signed informed consent for chest tube insertion.This invasive procedure requires informed consent. Provide additiona information as indicated. E!p ain that oca anesthesia "i be used but that pressure ma# be fe t as the trochar is inserted. Reassure that breathing "i be easier once the chest tube is in p ace and the ung ree!pands. The c ient ma# be e!treme # d#spneic and an!ious and ma# need reassurance that this invasive procedure "i provide re ief. $ather a needed supp ies% inc uding thoracostom# tra#% in&ectab e idocaine% steri e g oves% chest tube drainage s#stem% steri e "ater% and a arge steri e catheter'tipped s#ringe to use as a funne for fi ing "ater'sea and suction chambers. These supp ies are used during the insertion procedure to estab ish a "ater'sea drainage s#stem.

 Position as indicated for the procedure. Either an upright position (as for thoracentesis) or side' #ing position ma# be used% depending on the site of the pneumothora!. Assist "ith chest tube insertion as needed.The procedure ma# be performed in a procedure room% in the surgica suite% or at the bedside. A though chest tube insertion is a re ative # simp e procedure% nursing assistance is necessar# to support the c ient and rapid # estab ish a c osed drainage s#stem. PO*TPROCEDURE CARE Assess respirator# status at east ever# + hours. ,requent assessment is necessar# to monitor respirator# status and the effect of chest tube. -aintain a c osed s#stem. Tape a connections% and secure the chest tube to the chest "a . These measures are important to prevent inadvertent tube remova or disruption of the s#stem integrit#. .eep the co ection apparatus be o" the eve of the chest. P eura f uid drains into the co ection apparatus b# gravit# f o". Chec/ tubes frequent # for /in/s or oops. These cou d interfere "ith drainage. Chec/ the "ater sea frequent #. The "ater eve shou d f uctuate "ith respirator# effort. 0f it does not% the s#stem ma# not be patent or intact. Periodic air bubb es in the "ater'sea chamber are norma and indicate that trapped air is being removed from the chest. ,requent assessment of the s#stem is important to ensure appropriate functioning. -easure drainage ever# 1 hours% mar/ing the eve on the drainage chamber. Report drainage that is c oud#% in e!cess of 23 m4 per hour% or red% "arm% and free f o"ing.Red% free'f o"ing drainage indicates hemorrhage5 c oudiness ma# indicate an infection. Empt#ing the drainage "ou d disrupt integrit# of the c osed s#stem. Periodica # assess "ater eve in the suction contro chamber% adding "ater as necessar#.Adequate "ater in the suction contro chamber prevents e!cess suction from being p aced on de icate p eura tissue. Assist "ith frequent position changes and sitting and ambu ation as a o"ed. Chest tubes shou d not prevent performance of a o"ed activities. Care is needed to prevent inadvertent disconnection or remova of the tubes. 6hen the chest tube is removed% immediate # app # a steri e occ usive petro eum &e # dressing. An occ usive dressing prevents air from reentering the p eura space through the chest "ound.

How is a Chest Tube Placed? When a chest tube is inserted for a collapsed lung, a small area on the chest is numbed by using a local anesthetic. The chest tube is then inserted, and connected to a machine which uses suction to remove the air allowing the lung to reexpand. The tube is sutured in place so it wont pull out with movement. When a chest tube is inserted following surgery, it is placed under general anesthesia in the operating room. The tube is then connected to a container lower than the chest, using gravity to allow the excess fluids to drain. How Long is a Chest Tube Left in Place? The amount of time a chest tube will remain in place can vary depending upon the reason it is placed, and how long an air leak or fluid drainage continues. With a pneumothorax, doctors will look at an x-ray to make sure all of the air has been removed, and the lung has expanded completely. Following lung cancer surgery, the chest tube will be left in place until only minimal drainage remains, often a period of to ! days. How is a Chest Tube Removed? "emoval of a chest tube is usually a fairly easy procedure, and can be done comfortably in your hospital bed without any anesthesia. The sutures are separated and the tube is then clamped. #our doctor will ask you to take a breath and hold it, and the tube is pulled out. The suture is then tied to close the wound and a dressing applied. $f the chest tube was placed for a collapsed lung, an x-ray will be done to make sure the lung remains expanded after removal.

A chest tube is a hollow, flexible tube in the chest# It acts like a drain#

$hest tubes drain blood, fluid, or air from around your lungs# This allows your lungs to fully expand# The tube is placed between your ribs and into the space between the inner lining and the outer lining of your lung# This is called the pleural space#

Description When your chest tube is inserted, you will lie on your side or sit partly upright, with one arm over your head#

The area where the tube will be inserted is numbed# /ometimes you will receive medicine through a vein )intravenous, or I4+ to make you relaxed and sleepy# Gour skin where the tube will be inserted will be cleaned# The chest tube is inserted through a *"inch cut in your skin between your ribs# Then it is guided to the correct spot# The tube is connected to a bottle or canister# /uction is often used to help it drain# ,ther times, gravity alone will allow it to drain# A stitch )suture+ and tape keep the tube in place#

After your chest tube insertion, you will have a chest x"ray to make sure the tube is in the right place# The chest tube usually stays in place until x"rays show that all the blood, fluid, or air has drained from your chest and your lung has fully re"expanded# The tube is easy to remove when it is no longer needed# 9ost people do not need medicine to relax or to numb the area when it is removed# /ome people may have a chest tube inserted that is guided by x"ray or ultrasound# If you have ma?or lung or heart surgery, a chest tube will be placed while you are under general anesthesia )asleep+# Why the Procedure is Performed $hest tubes are used to treat conditions that can cause a lung to collapse# /ome of these conditions are8

After surgery or trauma in the chest Air leaks from inside the lung into the chest )pneumothorax+ 1luid buildup in the chest )called a pleural effusion+ due to bleeding into the chest, buildup of fatty fluid,abscess or pus buildup in the lung or the chest, or heart failure

Risks /ome risks from the insertion procedure are8

9oving the tube by accident )this could damage tissue around the tube+ Bleeding or infection where the tube is inserted Buildup of pus Improper placement of the tube )into the tissues, abdomen, or too far in the chest+ In?ury to the lung, which could cause more breathing problems In?ury to organs near the tube, such as the spleen, liver, stomach, or diaphragm

After the Procedure Gou will usually stay in the hospital until your chest tube is removed# %eople do not usually go home with a chest tube# While the chest tube is in place, your nurses will carefully check for air leaks, breathing problems, and if you need oxygen# They will also make sure the tube stays in place# Gour nurses will tell you whether it is okay to get up and walk around or sit in a chair# What you will need to do8

Breathe deeply and cough often )your nurse will teach you how to do this+# 7eep breathing and coughing will help re"expand your lung, help with drainage, and prevent fluids from collecting in your lungs# Be careful there are no kinks in your tube# The drainage bottle should always sit upright and be placed below your lungs# If it is not, the fluid or air will not drain and your lungs cannot re"expand#

Get help right away if8

Gour chest tube comes out or shifts The tubes become disconnected Gou suddenly have a harder time breathing or have more pain

Outlook (Prognosis) The outlook depends on the reason a chest tube is inserted# %neumothorax usually improves if the lungs are not sick# In cases of infection, the patient improves when the infection is treated, although sometimes scarring of the lining of the lung can occur )pleural fibrosis+#

Alternative Names $hest drainage tube insertion> Insertion of tube into chest> Tube thoracostomy

Chest u!e "aintenance

A chest tube is a drain placed into the pleural space to restore intrapleural pressure and reinflate the lung after it has collapsed# It also acts to prevent fluid and air from returning to the chest# $hest tube maintenance includes the actions performed by the nurse or other health care professional to keep the tube functioning properly#

Purpose
0nder normal circumstances, intrapleural pressure is below atmospheric pressure# When this pressure changes because of excess air andBor fluid, the lung may collapse# If this occurs, a chest tube is inserted into the intrapleural space# This lets excess fluids drain, restores normal pressure, reinflates the lung, and allows ade5uate gas e+change# %ersons experiencing a pleural effusion )accumulation of fluid in the spaces of the pleura+, hemothorax )accumulation of b'ood in the pleural cavity+, pneumothorax )collapsed lung+, and empyema )accumulation of pus in the pleural cavity+ may all re5uire the insertion of a chest tube#

Precautions
The patient re5uiring a chest tube is acutely ill because any change in the intrapleural pressure compromises the patientFs ability to breathe# An oxygen source, suction, and emergency e5uipment must be nearby when this procedure is performed#

Description
7epending on the patientFs condition, the chest tube insertion may occur at the bedside, in the emergency room, or in the operating room# In any case, the insertion of a chest tube is a sterile procedure# 9ost hospitals have chest tube insertion trays containing all of the necessary supplies# 1irst, the health care provider administers a local anesthetic# The patient is positioned according to the type of lung collapse being treated# After making a small incision, the physician inserts the chest tube# To avoid accidental puncture of the lung or pleura, the patient should be reminded not to cough or move during the procedure# ,nce the chest tube is in and sutured in place, the tube will be attached to a drainage system# 4aseline gauHe may be placed at the chest tube insertion site to make certain an ade5uate seal has been achieved# /terile 2 2 gauHe pads will be placed over the 4aseline gauHe, then securely taped# It is wise to tape the far end of the chest tube to the patientFs chest to prevent dislodgement#

Preparation
The patient may be anxious about the procedure# %roviding privacy and emotional support, along with explaining the procedure may help calm the patient# The nurse should perform a baseline assessment and take (ita' signs# An informed consent should be signed if the patient is able to do so# The physician may order premedications, which should be administered by the nurse as prescribed#

Aftercare
After the chest tube has been inserted, it is the nurseFs responsibility to maintain a patent )clear+ and intact pleural drainage system# The chest tube will be connected to about D ft )*#< m+ of rubbery tubing that leads to a collection device several feet below the chest# The patient should be Instructed to avoid lying on the tubing, and the nurse must make certain no kinks occur# All tubing connections should be taped to prevent air leaks# The chest drainage system has a separate water seal that acts as a one"way valve# The nurse adds a specified amount of sterile saline to this water seal chamber and makes sure the end of the tubing stays in the fluid# When air is pushed out of the pleural space and through the tubing, it bubbles into the saline and cannot return to the chest# If necessary, suction may be added to the drainage system# The depth of the saline determines the maximal allowable suctioning for the system# The nurse should note and document the amount and color of the chest tube drainage, and the level of drainage should be marked at the end of each shift# The patientFs respiratory status should be assessed fre5uently# It is normal to note decreased breath sounds on the side of the chest tube# The patient should be encouraged to perform coughing and deep"breathing exercises#

Complications
/everal complications can occur when managing a patient with a chest tube# If the tube accidentally becomes dislodged, the open insertion site should be 5uickly covered with 4aseline gauHe and the physician notified# If the tubing becomes disconnected from the drainage system, the chest tube should be clamped# )%added clamps should be kept at the bedside at all times#+ Both of these situations, if untreated, could allow air to enter the lung# /ometimes clots can form within the tube and prevent free drainage# If this happens, the tube should be milked gently, s5ueeHing it to move the clot, but not handling it so firmly that the tubing becomes occluded# If the drainage system unit is damaged or cracked, allowing atmospheric pressure into the system, the uncontaminated end of the connective tubing should be placed into sterile saline or water to a depth of @#EA in )- cm+ until a new system can be obtained# 1inally, a patient with a chest tube is at increased risk for infection# This risk can be reduced by cleaning the chest tube site and changing the dressing regularly#

Results
The chest tube can be removed when one of the following has happened8

The lung has fully expanded# o air leak has developed during a -2< hour period# !ess than 3#@E oH )*3@ ml+ of fluid has drained in a -2" hour period#

ormally, the physician removes the chest tube while the patient performs a 4alsalva maneuver# 4aseline gauHe is immediately applied over the insertion point# This prevents any air from entering the pleural space#

#ealth care team roles

The physician is responsible for inserting the chest tube and is usually responsible for its removal# )/ome nurse practiced acts allow nurses to remove chest tubes#+ The nurse assists with the insertion procedure, assesses the patientFs respiratory status afterwards, and maintains a patent chest tube#

$%& %R"'
Atmos$heric $ressurehe force exerted by air at any point on the earthFs surface# 9ean atmospheric pressure at sea level is approximately *,@@@ millibars )*@@ kilopascals+, give or take 3I# Em$!ema collection of pus in the pleural space# ,emothora+lood in the pleural cavity, usually caused by a chest in?ury# Intra$'eura'ituated within the pleura or pleural cavity &'eurahin membrane that covers each half of the thorax, surrounding and protecting the lung on that side# &'eura' ca(it!he space within each pleura, which contains the lungs# &'eura' effusionluid in the pleural cavity, caused by, among other things, congestive heart failure, cancer, tuberculosis, and lung infections# &neumothora+ir in the pleural cavity, which causes the lung to collapse# $auses include lung disease, penetrating trauma, and certain medical procedures, including ventilation and cardiopulmonary resuscitation# Va'sa'(a maneu(erolding the breath while bearing down# This maneuver may be used to interrupt a mild heart arrhythmia or to prevent air from entering the pleural cavity when a chest tube is removed#

Phoebe C arisse A. 7enda8a

asogastric intubation
Nasogastric intubation
Intervention

*tomach tube (4evin t#pe)% 91 ,r : +1 in (9;9 cm)

ICD-9-CM

<=.32% <=.=

Nasogastric intubation is a medical process involving the insertion of a plastic tube ) nasogastric tube or NG tube+ through the nose, past thethroat, and down into the stomach#

(ses
A nasogastric tube is used for feeding and administering drugs and other oral agents such as activated charcoal# 1or drugs and for minimal 5uantities of li5uid, a syringe is used for in?ection into the tube# 1or continuous feeding, a gravity based system is employed, with the solution placed higher than the patientFs stomach# If accrued supervision is re5uired for the feeding, the tube is often connected to an electronic pump which can control and measure the patientFs intake and signal any interruption in the feeding# asogastric aspiration )suction+ is the process of draining the stomachFs contents via the tube# asogastric aspiration is mainly used to remove gastric secretions and swallowed air in patients with gastrointestinal obstructions# asogastric aspiration can also be used in poisoning situations when a potentially toxic li5uid has

been ingested, for preparation before surgery under anesthesia, and to extract samples of gastric li5uid for analysis# If the tube is to be used for continuous drainage, it is usually appended to a collector bag placed below the level of the patientFs stomach> gravity empties the stomachFs contents# It can also be appended to a suction system, however this method is often restricted to emergency situations, as the constant suction can easily damage the stomachFs lining# In non"emergent situations, intermittent suction may be applied giving the benefits of suction without the untoward effects of damage to the stomach lining# /uction drainage is used for patients who have undergone a pneumonectomy in order to prevent anesthesia" related vomiting and possible aspiration of any stomach contents# /uch aspiration would represent a serious risk of complications to patients recovering from this surgery#

echni)ue
Before an G tube is inserted the health care provider must measure with the tube from the tip of the patientFs nose to their ear and down to the xyphoid process# Then the tube is marked at this level to ensure that the tube has been inserted far enough into the patientFs stomach# 9any commercially available stomach and duodenal tubes have several standard depth markings, for example *<J )2D cm+, --J )3D cm+, -DJ )DD cm+ and .@J )ED cm+ from distal end> infant feeding tubes often come with * cm depth markings# The end of a plastic tube is lubricated )local anesthetic, such as -I xylocaine gel, may be used> in addition, nasal vasoconstrictor spray may be applied before the insertion+ and inserted into one of the patientFs anterior nares# The tube should be directed aiming down and back as it is moved through the nasal cavity and down into the throat# When the tube enters the oropharynx and glides down the posterior pharyngeal wall, the patient may gag> in this situation the patient, if awake and alert, is asked to mimic swallowing or is given some water to sip through a straw, and the tube continues to be inserted as the patient swallows# ,nce the tube is past the pharynx and enters the esophagus, it is easily inserted down into the stomach# Great care must be taken to ensure that the tube has not passed through the larynx into the trachea and down into the bronchi# To ensure proper placement it is recommended )though not une5uivocally confirmed+ that in?ection of air into the tube be performed,K*L if the air is heard in the stomach with a stethoscope, then the tube is in the correct position# Another more reliable method is to aspirate some fluid from the tube with a syringe# This fluid is then tested with p' paper )note not litmus paper+ to determine the acidity of the fluid# If the p' is 3#3 or below then the tube is in the correct position# If this is not possible then correct verification of tube position is obtained with an M"ray of the chestBabdomen# This is the most reliable means of ensuring proper placement of an G tube#K-L 1uture techni5ues may include measuring the concentration of enHymes such G tube# As enHyme testing becomes

as trypsin, pepsin, and bilirubin to confirm the correct placement of the

more practical, allowing measurements to be taken 5uickly and cheaply at the bedside, this techni5ue may be used in combination with p' testing as an effective, less harmful replacement of M"ray confirmation# K.L If the

tube is to remain in place then a tube position check is recommended before each feed and at least once per day#

%olyurethane

G tube )4iasys $orflo+, < 1r N .D in )A* cm+# This fine bore tube is appropriate for longer use

)up to 2 weeks+# ,nly smaller diameter )*- 1r or less in adults+ nasogastric tubes are appropriate for long"term feeding, so as to avoid irritation and erosion of the nasal mucosa# These tubes often have guidewires to facilitate insertion# If feeding is re5uired for a longer period of time, other options, such as placement of a%(G tube, should be considered#

Contraindications
The use of nasogastric intubation is contraindicated in patients with base of skull fractures, severe facial fractures especially to the nose and obstructedesophagus, esophageal varices, andBor obstructed airway# The use of an G tube is also contraindicated in patients who have had gastric bypass surgery#

Complications
9inor complications include nose bleeds, sinusitis, and a sore throat# /ometimes more significant complications occur including erosion of the nose where the tube is anchored, esophageal perforation, pulmonary aspiration, a collapsed lung, or intracranial placement of the tube#

Nasogastric feeding tube

(mail this page to a friend/hare on facebook/hare on twitterBookmark ; /hare%rinter" friendly version A nasogastric tube, or G tube, is a special tube that carries food and medicine to the stomach through the nose# It can be used for all feedings or ?ust, sometimes, for giving your child extra calories# It=s important to take good care of the feeding bag and tubing so that they work properly# It=s also important to take good care of the skin around the nostrils so that it does not get irritated# Try to keep your child from touching or pulling on the tube# Try to make care of this feeding tube part of your daily routine# *lushing u!e 1lushing the tube will help to release any formula attached to the tube# 1lush the tube after each feeding, or as often as your nurse recommends#

9ake sure your hands are washed with soap and water# After the feeding is finished, add warm water to the feeding syringe and let it flow by gravity# If the water does not go through, try changing positions a bit or attach the plunger to the syringe, and gently push the plunger part"way# 7o not press all the way down or press fast# :emove the syringe# $lose the G tube cap#

aking Care of the 'kin Taking good care of the skin will help to keep your child comfortable and make it easier to deliver feedings# 1ollow these general guidelines8

$lean the skin around the tube with warm water and a clean washcloth after each feeding# :emove any crust or secretions in the nose#

When removing a bandage or dressing from the nose, loosen it with a bit of mineral oil and gently take it off# Gently wash this, or other lubricants, off the nose after removing bandages# If you notice redness or irritation, try putting the tube in the other side of the nose#

When to Call the Doctor $all your child=s doctor or nurse if you notice8

There is redness, swelling and irritation in both nostrils The tube keeps getting clogged and you are unable to unclog it with water The $orpak tube falls out

Alternate Names 1eeding " nasogastric tube> G tube> Bolus feeding> $ontinuous pump feeding> Gavage tube