NCM 112 RLE Equipment
COLOSTOMY CARE & IRRIGATION ------------------------------------------------- - NGT - Emesis basin
o Usually a single lumen Levin - Glass of water with straw
Irrigation tube - Hypoallergenic tape
o Has different sizes – the - Irrigating set with 20ml syringe or
1. Opening clamp – tilt the bottom of the pouch upward and remove bigger the number, the 50ml catheter tip syringe or
the closure clamp bigger the size of the tube aseptosyringe
2. Draining the bag – turn out the cuff on the lower end of the pouch - Water-soluble lubricant - Stethoscope
and allow it to drain into the toilet, bedpan or measuring device - Suction equipment if ordered - Tongue blade
3. Wipe the bottom of the pouch - Clamp for tubing - Pen light
4. Reapply the closure clamp - Towel - Disposable gloves
- Tissues - Normal saline
Removal and Attachment of New Colostomy Bag
1. Remove the old appliance for dressing? Or redressing? Preparatory Phase
2. Clean the peristomal skin or skin surrounding the stoma
- Use towel a basin of warm water to allow for better adhesion of 1. Ask the patient if he has ever had nasal surgery, trauma, a deviated
the pouch septum or bleeding disorder
- It generally isn’t necessary to use soap – can leave a film on the 2. Explain the procedure
skin which can interfere with pouch adherence - Tell how mouth breathing, panting and swallowing will help in
- Gently dry skin thoroughly passing the tube – improves comfort and compliance
3. Remove the paper backing from the prepared pouch barrier and 3. Place patient in Fowler’s position – facilitates passage of tube into
apply the pouch over the stoma esophagus
4. Press the pouch with your fingertips, especially around the base of the 4. Place a towel across the patient’s chest
stoma 5. Determine with patient what sign he might use
5. Apply paper tape in a picture frame fashion to the pouch edges for - E.g. raising index finger to indicate gagging or discomfort
additional security or as needed - Provides method of communication which is reassuring for the
6. When using a clamp to close the pouch, make sure that the end of patient
the pouch is folded over just one time and the clamp is closed 6. Remove dentures – may become loose and interfere with tube insertion
properly – clamp might come open and leak from the weight of the 7. Place emesis basin and tissues within patient’s reach
stool 8. Inspect the tube for defects
- Look for partially closed holes or rough edges
NASOGASTRIC TUBE INSERTION, FEEDING, AND REMOVAL ---------------------- 9. Place rubber tubing in ice-chilled water for a few minutes to make it
firmer
Nasogastric Intubation – refers to the insertion of a tube through the
- Plastic tubing may already be firm enough
nasopharynx into the stomach with use of flexible tube, with various lengths,
- If too stiff, dip in warm water
depending on intended use
10. Determine the length of the tube needed to reach the stomach
Purposes 11. Have the patient blow his/her nose to clear nostrils – to facilitate
passage through the nose
- Stomach decompression 12. Inspect nostrils with penlight – observe for any obstruction
- Diagnostic studies 13. Occlude one nostril and have the patient breathe – help determine
- Lavage the stomach which nostril is more patent
- Treat mechanical obstruction 14. Wash hands
- Administer medications and feeding (gavage) 15. Put on disposable gloves
- Aspirate gastric contents for analysis
, 16. Measure the patient’s nose, earlobe, and xyphoid process and mark the - Ask patient to talk – if the patient cannot, the tube may be
tube appropriately coiled or passed through the vocal tubes
- Some tubes may be premarked to indicate length but may not - Use tongue blade and penlight to examine mouth
correlate exactly with the measurement obtained - If choking or difficulty breathing, the tube has probably
- The distance from the nose to the earlobe is the first mark on the entered the trachea
tube – represents the distance of the nasopharynx 14. Attach a syringe to the end of the NGT
- When the tube reaches the xyphoid process, a second mark is 15. Place a stethoscope over the LUQ of abdomen and inject 10-20 cc of
made on the tube – represents the length required to reach the air while auscultating the abdomen
stomach - Air can be detected by whooshing sound entering the
stomach rather than the bronchus
Performance Phase - If belching occurs the tube is probably in the esophagus
1. Coil the first 3-4 inches or 7-10 cm of the tube around your fingers 16. Obtain and aspirate 30-60 mL of gastric content
- This curves tubing and facilitates the tube passage 17. X-ray may be done to confirm tube placement
2. Lubricate the coiled portion of the tube with water-soluble lubricant 18. After tube is passed and correct placement is confirmed, cover the
- Avoid occluding the tube’s holes with lubricant tube and anchor the tube with hypoallergenic tape
3. Tilt back the patient’s head before inserting tube into nostril - Split tape lengthwise and only halfway
4. Gently pass the tube into the posterior nasopharynx directing - Attach and split ends of tape to nose and and cross split ends
downward and backward towards the ear around tubing (watch vid para ma g)
- The passage of the tube is facilitated by following the natural - Apply another piece of tape to bridge of nose
contours of the body 19. Anchor the tubing to patient’s gown and use rubber band to make a
- The slower the advancement of the tube at this point, the less slip know to anchor the tubing to patient’s gown
likelihood of pushing pressure on the turbinates - Secure the rubber band to gown using safety pin – permits
5. When tube reaches the pharynx, the patient may gag mobility of patient
- Allow patient to rest for a few minutes Follow-Up Phase
6. Have patient’s head to tilt slightly forward
7. Offer several sips of water through a straw or permit to suck on ice chips 1. Assure patient that most discomfort felt will lessen as he gets used to
unless contraindicated tube
8. Advance tube as patient swallows 2. Cleanse nares and provide mouth care every shift – promotes comfort
9. Gently rotate the tube 180 degrees to redirect the tube and decreases risk for infection
- Prevents the tube from entering the patient’s mouth 3. Apply petroleum jelly to nostrils as needed
10. Continue to advance tube gently each time the patient swallows – 4. Assess for skin irritation or breakdown to keep tissue soft and prevent
facilitates movement of tube crusting and skin breakdown
11. If obstruction appears to prevent tube form passing – do not use force 5. Keep head of bed elevated – at least 30 degrees
- Rotating tube gently may help
- If unsuccessful, remove tube and try other nostril to avoid Tube Feeding
discomfort and trauma - Are administered to patients who cannot ingest food orally but do not
- If there are signs of distress such as gasping, coughing or have a problem with absorption of nutrients from GIT
cyanosis, immediately remove tube – this may have entered - May be used as short term or long term nutritional support
the trachea - Equipment
12. Continue to advance tube gently each time the patient swallows until o Large syringe or feeding bag
the mark reaches the patient’s nostrils, the reference point where the o Gloves
tube was measured o Feeding pump if needed
13. To check if the tube is in the stomach o Feeding formula
COLOSTOMY CARE & IRRIGATION ------------------------------------------------- - NGT - Emesis basin
o Usually a single lumen Levin - Glass of water with straw
Irrigation tube - Hypoallergenic tape
o Has different sizes – the - Irrigating set with 20ml syringe or
1. Opening clamp – tilt the bottom of the pouch upward and remove bigger the number, the 50ml catheter tip syringe or
the closure clamp bigger the size of the tube aseptosyringe
2. Draining the bag – turn out the cuff on the lower end of the pouch - Water-soluble lubricant - Stethoscope
and allow it to drain into the toilet, bedpan or measuring device - Suction equipment if ordered - Tongue blade
3. Wipe the bottom of the pouch - Clamp for tubing - Pen light
4. Reapply the closure clamp - Towel - Disposable gloves
- Tissues - Normal saline
Removal and Attachment of New Colostomy Bag
1. Remove the old appliance for dressing? Or redressing? Preparatory Phase
2. Clean the peristomal skin or skin surrounding the stoma
- Use towel a basin of warm water to allow for better adhesion of 1. Ask the patient if he has ever had nasal surgery, trauma, a deviated
the pouch septum or bleeding disorder
- It generally isn’t necessary to use soap – can leave a film on the 2. Explain the procedure
skin which can interfere with pouch adherence - Tell how mouth breathing, panting and swallowing will help in
- Gently dry skin thoroughly passing the tube – improves comfort and compliance
3. Remove the paper backing from the prepared pouch barrier and 3. Place patient in Fowler’s position – facilitates passage of tube into
apply the pouch over the stoma esophagus
4. Press the pouch with your fingertips, especially around the base of the 4. Place a towel across the patient’s chest
stoma 5. Determine with patient what sign he might use
5. Apply paper tape in a picture frame fashion to the pouch edges for - E.g. raising index finger to indicate gagging or discomfort
additional security or as needed - Provides method of communication which is reassuring for the
6. When using a clamp to close the pouch, make sure that the end of patient
the pouch is folded over just one time and the clamp is closed 6. Remove dentures – may become loose and interfere with tube insertion
properly – clamp might come open and leak from the weight of the 7. Place emesis basin and tissues within patient’s reach
stool 8. Inspect the tube for defects
- Look for partially closed holes or rough edges
NASOGASTRIC TUBE INSERTION, FEEDING, AND REMOVAL ---------------------- 9. Place rubber tubing in ice-chilled water for a few minutes to make it
firmer
Nasogastric Intubation – refers to the insertion of a tube through the
- Plastic tubing may already be firm enough
nasopharynx into the stomach with use of flexible tube, with various lengths,
- If too stiff, dip in warm water
depending on intended use
10. Determine the length of the tube needed to reach the stomach
Purposes 11. Have the patient blow his/her nose to clear nostrils – to facilitate
passage through the nose
- Stomach decompression 12. Inspect nostrils with penlight – observe for any obstruction
- Diagnostic studies 13. Occlude one nostril and have the patient breathe – help determine
- Lavage the stomach which nostril is more patent
- Treat mechanical obstruction 14. Wash hands
- Administer medications and feeding (gavage) 15. Put on disposable gloves
- Aspirate gastric contents for analysis
, 16. Measure the patient’s nose, earlobe, and xyphoid process and mark the - Ask patient to talk – if the patient cannot, the tube may be
tube appropriately coiled or passed through the vocal tubes
- Some tubes may be premarked to indicate length but may not - Use tongue blade and penlight to examine mouth
correlate exactly with the measurement obtained - If choking or difficulty breathing, the tube has probably
- The distance from the nose to the earlobe is the first mark on the entered the trachea
tube – represents the distance of the nasopharynx 14. Attach a syringe to the end of the NGT
- When the tube reaches the xyphoid process, a second mark is 15. Place a stethoscope over the LUQ of abdomen and inject 10-20 cc of
made on the tube – represents the length required to reach the air while auscultating the abdomen
stomach - Air can be detected by whooshing sound entering the
stomach rather than the bronchus
Performance Phase - If belching occurs the tube is probably in the esophagus
1. Coil the first 3-4 inches or 7-10 cm of the tube around your fingers 16. Obtain and aspirate 30-60 mL of gastric content
- This curves tubing and facilitates the tube passage 17. X-ray may be done to confirm tube placement
2. Lubricate the coiled portion of the tube with water-soluble lubricant 18. After tube is passed and correct placement is confirmed, cover the
- Avoid occluding the tube’s holes with lubricant tube and anchor the tube with hypoallergenic tape
3. Tilt back the patient’s head before inserting tube into nostril - Split tape lengthwise and only halfway
4. Gently pass the tube into the posterior nasopharynx directing - Attach and split ends of tape to nose and and cross split ends
downward and backward towards the ear around tubing (watch vid para ma g)
- The passage of the tube is facilitated by following the natural - Apply another piece of tape to bridge of nose
contours of the body 19. Anchor the tubing to patient’s gown and use rubber band to make a
- The slower the advancement of the tube at this point, the less slip know to anchor the tubing to patient’s gown
likelihood of pushing pressure on the turbinates - Secure the rubber band to gown using safety pin – permits
5. When tube reaches the pharynx, the patient may gag mobility of patient
- Allow patient to rest for a few minutes Follow-Up Phase
6. Have patient’s head to tilt slightly forward
7. Offer several sips of water through a straw or permit to suck on ice chips 1. Assure patient that most discomfort felt will lessen as he gets used to
unless contraindicated tube
8. Advance tube as patient swallows 2. Cleanse nares and provide mouth care every shift – promotes comfort
9. Gently rotate the tube 180 degrees to redirect the tube and decreases risk for infection
- Prevents the tube from entering the patient’s mouth 3. Apply petroleum jelly to nostrils as needed
10. Continue to advance tube gently each time the patient swallows – 4. Assess for skin irritation or breakdown to keep tissue soft and prevent
facilitates movement of tube crusting and skin breakdown
11. If obstruction appears to prevent tube form passing – do not use force 5. Keep head of bed elevated – at least 30 degrees
- Rotating tube gently may help
- If unsuccessful, remove tube and try other nostril to avoid Tube Feeding
discomfort and trauma - Are administered to patients who cannot ingest food orally but do not
- If there are signs of distress such as gasping, coughing or have a problem with absorption of nutrients from GIT
cyanosis, immediately remove tube – this may have entered - May be used as short term or long term nutritional support
the trachea - Equipment
12. Continue to advance tube gently each time the patient swallows until o Large syringe or feeding bag
the mark reaches the patient’s nostrils, the reference point where the o Gloves
tube was measured o Feeding pump if needed
13. To check if the tube is in the stomach o Feeding formula
