Tube insertion
Throughout my illustrious career and experience, I have come to realize what the patients refer to as the ‘feeding tube' that serves their call at the time of need. A medical nasogastric tube, NG, relates to that elongated silicone tube run through the patient’s nostrils passing the digestive tract (esophagus) to the stomach (Bowden & Greenberg, 2016). The tubes are commonly used on not all patients but a few for an array of reasons specific to their unique conditions and ailment characteristics. Insertion of the NG has over my nursing career been within my forte that I have garnered the experience to pass on the basics to my nursing colleagues.
The insertion of the tubes is done on patients by nurses, junior-level doctors and most times by theatre anesthetist specialists; thus, it is imperative for medics to know the proper insertion techniques as well as positioning of the tube (Lippincott & Wilkins, 2015). The purpose of this essay is to explain and outline the proper tube insertion method, intragastric position verification as well as its benefits. However, considerable care ought to be taken in the following scenarios, in case of;
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-Probable esophagus strictures
- Oesophagus varices
-Nose, throat and ear infections or any related abnormalities
-Aspiration risks
Patient consent and tube sizes
First and foremost, one has to gain consent through a proper and understandable language as to why the patient needs the NG tube procedure (Kanopy, 2016). I had to rest my patients’ concerns about the tube going down their throats and after giving them detailed re-assuring explanations I could draw verbal consent from them which is important.
Similarly, the tube sizes are available in many measurements like the 8, 10, 12, 14, 16 & 18 Fr where the stiff tubes are recommendable and easy to use. They are much easier to insert thus by putting them in the fridge along with saline stiffens them up (Wiegand et al., 2005). Particular types of tubes come equipped with their wire guide to help in patient insertion while most come with radio-opaque tip markers to check their positions when inserted via x-ray.
Five Phases of Knowledge Management
The five Knowledge Management steps are;
- Knowledge acquisition, in the form of learning from the more experienced medical personnel on tube sizes as well as patient consent approaches.
-Generation of appropriate NG tube related knowledge was evident and is possible with the continued practice of technique, case in point my attained skill in NG tube insertion.
-Dissemination of this technique was achieved when I observed the more experienced nurse staff insert the tube on patients while they gave me instructions on how to perfect it.
-Knowledge processing and feedback relaying were a trait that ensured I learned what I was taught through comprehending instructions my way and communicating accurate feedback to my supervisors.
Preparation and Insertion technique
Most important is handwashing after which a trolley is got equipped with local anesthetic spray or jelly, gloves, 60ml syringe, sticky tape, kidney tray, pH strip and bag to collect secretions (Kanopy, 2016).
Insertion of the tube
External measurement on the patient’s body by placing the tube on the nose tip to at least halfway between the umbilicus and xiphoid gives a rough estimate of the required distance (Bowden & Greenberg, 2016). This is a technique I perfected with close observation of my senior nurses often incorporating a few new techniques when I practiced on the dummy. When I finally got it right, I used the same technique to teach nurses around the ward and with no time they had mastered it.
The patient should be requested to sit upright, chin up minus any head tilts; an appropriate tube size is then lubricated with aqua gel. In the case that anesthetic gel is used, given that it is a drug, it ought to biomedically approved by a qualified doctor and caution assumed like patient allergy checks (Lippincott & Wilkins, 2015). Observance of how the junior doctors or other senior medical staff do it ensures that nurses learn from the best the most efficient techniques.
A wider nostril is used to slide the tube down along the nasal base, with slight gags from patients as it approaches the pharynx. Most times water is given to patients to help aid the tube down into the stomach (Wiegand et al., 2005). With constant engaging of the patient to use the signs agreed upon to indicate discomfort, the nurse can adjust accordingly. This kind of feedback from the patient ensures that the nurse efficiently transports the tube to where it is supposed to be minus causing any harm to the patient.
With the use of the x-ray technique, proper stomach tube placement stands confirmed and the NG tube placed onto the patient’s forehead plus nose with the use of surgical tape. Finally, stomach content is medical decompressed with the use of the specialized syringe that collects its contents (Lippincott & Wilkins, 2015). Important to note is the flushing of the NG tube open using saline or even air in case it appears to be blocked. Demonstration of these techniques to other nursing staff is vital in case there arises an emergency and a tube is to be inserted well-trained nurses can step in and deliver.
Knowledge Management steps
The five Knowledge Management steps are;
- Knowledge acquisition - Procedures on patient posture, external tube measurement and x-raying were all mastered through constant practice building my experience as well as from my supervisors that trained me.
-Generating and creating new tube insertion knowledge was achieved through my continued practice of this technique that I also passed on to other staff. Initially, I was able to replicate the procedures that my supervisors taught me and eventually pass them to other nursing staff.
-Dissemination- Through this, I was spreading the tube technique throughout the ward the way I learned it, in the beginning, to efficiently ensure it was applied the same way for quality purposes.
-Tube knowledge processing is a trait that I learned and passed on to my trainees garnered through my illustrious nursing career that afforded me the experience to do so. Through observation, comprehension, synthesizing the various medical knowledge, my supervisor passed on to me I was able to facilitate my team to do the same.
-Feedback of learned techniques- Ideally, this is to promote learning by comprehending what is taught one's way and providing necessary feedback to the trainer nurses for appropriate adjustments.
References
Bowden, V. R., & Greenberg, C. S. (2016). Pediatric nursing procedures .
Kanopy (Firm). (2016). Fluid and Nutritional Support. Nasogastric Tube Insertion .
Lippincott Williams& Wilkins. (2015). Lippincott nursing procedures .
Wiegand, D. J. L.-M. H., Carlson, K. K., & American Association of Critical-Care Nurses. (2005). AACN procedure manual for critical care . Philadelphia: Elsevier/Saunders.
