Nursing How To’s: NGT Irrigation

Liezl, a first year nursing student, is studying for their lessons on Monday. While browsing through her nursing book, she finds a picture of a patient with a tube hanging out from his nose. Ah, a nasogastric tube, she thinks to herself as she looks closer. She has seen those in television, and in the internet, but is yet to see a patient with one in person. They still haven’t been exposed in the clinical area. However, she finds herself getting curious about it and how it’s done, even more, irrigated.

Interested to learn, she starts to read about the procedure to get to know more about it.

Supplies and Equipment

  • Nasogastric tube connected to continuous or intermittent suction.
  • Irrigation or Toomey syringe and container for irrigating solution.
  • Normal saline for irrigation.
  • Disposable pad or bath towel
  • Disposable gloves (optional)
  • Stethoscope
  • Clamp

Steps in Irrigating Nasogastric Tubes

The following is the step-by-step procedure in irrigating nasogastric tubes:

  1. Check physician’s order for irrigation. Explain procedure to client. Clarifies schedule and irrigating solution. An explanation encourages client cooperation and reduces apprehension.
  2. Gather necessary equipment. Check expiration dates on irrigating saline and irrigation set. Provides for organized approached to task. Agency policy dictates safe interval for reuse of equipment.
  3. Wash your hands. Handwashing deters the spread of microorganisms.
  4. Assist client to semi-Fowler’s position unless this is contraindicated. Minimizes risk of aspiration.
  5. Check placement of NG tube using the following techniques: 

    A. Attach Asepto or Toomey syringe to the end of tube and aspirate gastric contents. The tube is in the stomach if its contents can be aspirated.

    B. Place 10mL-50ml of air in syringe and inject into the tube. Simultaneously, auscultate over the epigastric area with a stethoscope. A whooshing sound can be heard when the air enters the stomach through the tube.

    C. Ask client to speak. If tube is misplaced in trachea, client will not be able to speak.

  6. Clamp suction tubing near connection site. Disconnect NG tube from suction apparatus and lay on disposable pad or towel. Protects client from leakage of NG drainage.
  7. Pour irrigating solution into container. Draw up 30 ml of saline (or amount ordered by physician) into syringe. Delivers measured amount of irrigant through NG tube. Saline compensates for electrolytes lost through NG drainage.
  8. Place tip of syringe in NG tube. Hold syringe upright and gently insert the irrigant (or allow solution to flow in by gravity if agency or physician indicates). Do not force solution into NG tube. Position of syringe prevents entry of air into stomach. Gentle insertion of saline (or gravity insertion) is less traumatic to gastric mucosa.
  9. If unable to irrigate tube, reposition client and attempt irrigation again. Check with physician if repeated attempts to irrigate tube fail. Tube may be positioned against gastric mucosa making it difficult to irrigate.
  10. Withdraw or aspirate fluid into syringe. If no return, inject 20 ml of air and aspirate again. Injection of air may reposition the end of tube.
  11. Reconnect NG tube to suction. Observe movement of solution or drainage. Determine patency of NG tube and correct operation of suction apparatus.
  12. Measure and record amount and description of irrigant and return solution. Irrigant placed in NG tube is considered intake: solution returned is recorded as output.
  13. Rinse equipment if it will be reused. Promotes cleanliness and prepares equipment for next irrigation.
  14. Wash your hands. Handwashing prevents the spread of microorganisms.
  15. Record irrigation procedure, description of drainage and client’s response. Facilitates documentation of procedure and provides for comprehensive care.

Sources:

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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