NGT / OGT INSERTION

PERITONEAL LAVAGE

NGT insertion
indications:
- feeding
- med intake
- lavage

inserting the NGT

1. ask the patient which side is easier to breathe through then look into both
nostrils and check for problems
2. premedicate the patients nostrils with a vasoconstrictive spray
(phenylephrine or oxymetazoline)
inferior turbinate

path of the
NGT
before
phenylephrine
spray
nasal septum

after
phenylephrine
spray

inserting the NGT

3. 5-10 cc of 2% lidocaine jelly is administered into the selected naris via a 10 cc syringe
(without a needle) - to reduce patient discomfort
4. prepare yourself / the equipment / and the patient
a. yourself - observe universal precautions:
- a face shield, protective gown, and gloves should be donned as
patients may gag, spit, or vomit
b. equipment - determine the depth-of-insertion of the NGT
- Measure the length from the naris to the ipsilateral ear to the xiphoid
process. Then measure up this same distance from the distal tip of
the NGT and note the location by the black marks inscribed on the
proximal portion of the tube.
- Remove the NGT tube from its packaging and apply viscous lidocaine
(water soluble) to the distal end. Tear off a 10 cm piece of tape and have it
ready at the bedside.
c. Sit the patient upright to facilitate easy passage of the tube. Drape the patient with
a towel and provide a basin to collect any secretions or emesis.

inserting the NGT

5. insert the NGT
- instruct the patient to sip water through a straw and advance
the tube as the patient swallows; coordinating the passage of the tube with
the swallowing mechanism helps to avoid tracheal intubation and facilitates
passage of the tube into the esophagus
- instruct the patient to bend the head forward to close the epiglottis and open
the esophagus
6. secure the NGT

7. NGT - usually changed every 3 days

determining NGT placement

3 methods:
1. x-ray confirmation
- most reliable
2. introduction of air / dipping free
end into a glass of water
3. aspiration of the gastric
contents (acceptable)
- pH must be 4 or less
- if pH is 6 and above intestinal placement

orogastric tube insertion

> failure to pass the tube through either side, and if absolutely
necessary - insert the tube orally
> the technique is generally the same as for nasal insertion
although greater attention to topical anesthesia is
necessary (most patients find this procedure extremely
uncomfortable)
> oral tubes are generally not recommended for long term use,
except in intubated patients; they may be helpful for
diagnostic purposes when they can be removed in a
short time

orogastric tube insertion

PERITONEAL LAVAGE

> technique of irrigation of the peritoneal cavity and examination of the irrigating
fluid to evaluate the trauma to the abdomen

indications:
1. D.P.L. is performed when there is a high suspicion of intraperitoneal bleeding
2. to prepare the patient for abdominal surgery depending on the result of
peritoneal lavage
3. for diagnostic purposes

how to do it
1. insert indwelling catheter to prevent injury to the urinary bladder
2. prepare the abdomen as for surgery (supine position)
3. catheter is inserted into the peritoneal cavity (2-3cm., midline, below the
umbilicus) in 2 ways:
a) catherther inserted under direct visualization

open DPL

b) large-bore needle inserted first; wire inserted through the needle;

cathether inserted using the flexible wire as guide

closed DPL

4. syringe is attached to the catheter; aspiration done

how to do it
5. if less than 10 ml of blood (or no blood at all) is aspirated, infuse 500 - 1000ml
of IVF through an IV tubing attached to the catheter
6. after the infusion, lower the IV bag below the level of the abdomen to siphon
fluid via gravity
7. catheter is then removed and the insertion site is closed
8. the fluid is then sent to the lab

lab results what do they mean ?

LAVAGE FLUID INTERPRETATION:
clear fluid - means no bleeding
criteria for positive result:
Aspiration of free blood from peritoneal cavity
RBC >100,000 per mm3
WBC >500 per mm3
Amylase 110 IU/dl
Presence of bile, bacteria / fecal / food particles in lavage fluid