Gastric Decompression through a Nasogastric (NG) Tube (Nursing)

00:00 Welcome to the skill, Gastric Decompression through a Nasogastric Tube. So all we're talking about here is that we're going to remove excess contents from the patient's stomach via the nasogastric tube. So let's take a look at what we're going to need. We're going to need a suction set-up and that's going to help facilitate removal of that stomach contents.

00:24 So we're going to need 2 pieces here. We're going to need our canister that typically comes with your suction tubing, and that tubing is going to connect to a suction device that's usually going to be found in the patient's room on the wall. Now that suction device is where we're going to control the strength of that suction. Next, we're going to need absorbent pad that helps protect the patient's gown and their linens, and then we're going to need a clean piston syringe to help check for placement. So before we get started, don't forget to perform your hand hygiene and put on your gloves. Now it's really important in regards to positioning here. So we want our patient in a supine position with the head of bed at least at 90 degrees if they can tolerate it. Now sometimes it's a little too high for your patient so at least at the minimum the patient needs to be head of bed at least 30 degrees. Now is a great time to go ahead and place that absorbent pad over the client's chest to protect their gown. Now, we're going to go back to that suction device that you find in your patient's room typically on the wall. So if you take a look here at this device, you see it's got low, medium, high, full vacuum, you're going to typically see a low intermittent suction ordered by your physician. Now here's a really important step before we start. We want to make sure the tube is at the correct insertion length. So what I mean by that on insertion, we have to take that tube, put it all the way down through the nose in the patient's stomach. Now that's going to vary how long and what measurement that is at depending on your patient's size. So, how you know it's at the correct insertion length? Typically as nurses when we insert it, we usually make a small mark that you may see by the patient's nare or maybe mark it by tape. So make sure you check that before you get started. Now, when a nasogastric tube is not connected to suction, we usually have a little device where we can clamp off that nasogastric tube. Reason being, remember that nasogastric tube is in the stomach, if we don't clamp it there are all kinds of gastric contents that can leak all over the bed. This is what we want to prevent. So make sure, since you know it maybe clamped, unclamp that first. Then we're going to attach a syringe, and it's going to look something like this. So, this is going to be what we're going to use to help aspirate those gastric contents. So we're just going to hook this to the end of our nasogastric tube, pull back is what we mean by aspiration. So again, we're just going to take the plunger and pull this back so we can see that gastric contents. Now, this is what's going to help confirm that that nasogastric tube is indeed in the stomach. Now, here's an important point to remember. Whatever we take away from our patient, we've got to give back. So this is all of the stuff that's in the patient's stomach. So if you remember about your stomach environment, there is good bacteria flora, there are electrolytes, there's a pH balance we need to maintain. So you don't want to rub your patient of that. So after we aspirate and make sure it's in the right place, be sure just to push your plunger back and give those gastric contents back. Now, once we've done that, we can take that same flush syringe. We can go ahead and pull up water, and when I say water if you guys recall the great thing about the GI system this is not a sterile environment. So just room temperature water is totally fine, tap water will work. We want to fill that flush syringe, put that flush syringe back on that NG tube like we did previously, and then push that plunger again to flush it here with at least about 15 ml of water. Now, once we've flushed, we can go ahead take off that syringe, we can take that nasogastric tubing now and hook it to the suction tubing itself. And as you can see here in this image, once we hook that tubing, that tubing's going to go to the suction canister that's going to collect our contents. Now, this is a great time to recheck the suction to make sure we're on the right pressure. And again, it's really common to see like a low intermittent suction. Once you've started suction, you're definitely going to see those gastric contents flowing through that tubing and collecting in your canister. This is important here to make sure keep an eye how much gastric contents is going to be coming out. So we want to make sure we keep strict, intake an output volume measurements. So if you see the canister here, it's usually calibrated and we can measure and see how much we're getting out of the stomach. Hi, let's take a better look at how we're going to perform gastric decompression. So if you remember what that means, all that really means is that we're going to remove excess air or stomach contents from our patient. So I've got my patient sitting here with me and we want to make sure he's in the right position. So ideally at least above 30, but if he can tolerate it we would have him all the way up to 90 degrees. And then of course with the gastric decompression, we may be sucking out some gastric contents and get a little bit messy, so it's really a great idea to protect their gown and put down absorbent pad like you see here. Okay, so now let's make sure our suction device is working. So let's take a look at that specifically. So, many rooms you're going to see a suction device a lot like this. So this is really nice because it's got the dials on here for you and typically you're going to see an order set for low intermittent suction. The reason why we do this because it's usually a little bit more gentle on a patient.

06:27 We don't want continuous forceful suction so we typically see decompression ordered at low intermittent suction. So just looking at the dial, let me show you here. So this dial has here labeled for you; off, continuous, and low. So we'll check it to low, or intermittent, we're going to turn that up for you and this dial is you're going to move this dial and you see how there's low, medium, and high here for you. So you just want to adjust the setting accordingly. Okay, so let's talk about our case. Today, we're going to call this guy Nate, for example. Let's just give him a name. So I'm here with Nate and so he was clamped off which means just like this, he was not hooked to suctioning. Now the problem was Nate was having quite a bit of nausea. So because of that, now we're going to try to decompress his stomach by connecting him to suctioning. So, you may see his tube like this if it's clamped. So this is really common. But before we start our suction, we've got to make sure the tube is even in the right place. So if you remember how do we do that? It's going to be by aspirating the gastric contents. So, now I'm going to take my piston syringe, I'm going to unclamp my tube, and then take out my catheter tip here, and if you remember to aspirate we simply put our piston syringe in the nasogastric tube and then we're going to pull back. So we just need to pull back enough to make sure we see gastric contents being aspirated. So now that we know this, that's great. All we want to do is push those back in. Now, as you can imagine, we don't want a lot of gastric contents in here. So now we're going to take our piston, we're going to fill it up to flush it, and then we're going to flush it with 15 ml of water. So once we've done that, just so everything doesn't spill back I'm going to clamp it for a second. Okay, so my suction's on. Now, I can attach my NG tube to the suction tubing. So, there are packages that this will come in and as you can see it's a pretty lengthy cord. So don't be as nervous here because remember anything nasogastric or gastric is not a sterile procedure, so just remember that. Okay, so we're going to take one end of our very long tubing; one end will go to the patient, the next end will go to the suction canister itself. So, we're going to take off the air vent, take off the catheter tip. Sorry, we're going to make sure this catheter tip is in here because if you notice we have to have this to connect it to. So that's connected to my patient. Now I'm going to take my tubing and I'm going to connect it to the canister. So let me show you the top of this canister. I think this is important to know because it's really helpful for you. So it actually has a piece that says "to the patient." So think of nasogastric tube to the patient, we're going to fix this here, then you're going to have another tube that goes from the canister to the vacuum so the vacuum's going to provide the suction then that's going to pull all the way through and pull the contents and it will dump out into this canister. So, when you have a suctioning, also make sure all the connections are secure and make sure all of these, which have caps, are close so we can make sure suction pressure is going and we're getting our gastric contents.

10:13 So now that this is hooked up, we should be seeing gastric contents flowing through the nasogastric tube all the way to the tubing and going into our canister. So as you can imagine, this can fill up pretty quickly so make sure you keep an eye on this, you're assessing your patient, making sure your patient's tolerating the suction as well. Now let's take a look at some special considerations with this procedure. Now, of course we're pulling a lot of gastric contents out of the patient's stomach so we could be rubbing them of some really important electrolytes, so we need to monitor those. Also, because of the suction, there may be some inherent to the gastric wall. Now, that's why we usually like to use low intermittent suction, for example, it's a lot more gentle on the suction on the gastric environment. Also, it's really helpful. If you remember, we've got that blue air port that also helps prevent this. And a couple of more points, if you administer meds down a nasogastric tube, if we try to suction too quickly, we can remove all those meds we just gave. So we need to be conscious of this.

11:30 And lastly, because that tube has gastric contents or maybe we gave meds down it, that tube can clog and we need to make sure we clear it before we start suction. Thanks for watching.