Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Decompression of the upper gastrointestinal tract (eg, pancreatitis, intestinal obstruction).• Gastric lavage.• Enteral feeding. +++ Absolute + • Unstable airway.• Intestinal perforation.• Cervical spine trauma.• Facial trauma. +++ Relative + • Coagulopathy (prothrombin time > 18 seconds).• Thrombocytopenia (platelet count < 100,000/mcL).• Recent intestinal tract surgery (< 1 month ago). + • Lubricant gel.• Nasogastric (NG) tube.• Larger diameter, polyethylene NG tube for suction and decompression.• Smaller diameter, silicone NG tube for enteral feeding.• Water or normal saline at room temperature.• Drainage bag or feeding pump.• 60-mL catheter tip syringe.• Stethoscope. + • Bleeding.• Perforation. + • Measure length of tube insertion by positioning the tube from the nares or mouth to the ear, then to the umbilicus.• There is also a standard table, which uses height of child.• If the tube is obstructed, flush first with water; longstanding obstruction may be removed by flushing the tube with caffeinated soda. + • Explain indication and risks to the patient and parents.• Inform the patient of the intention of the procedure. + • Patient should be sitting. + • Tube position from the nose to the stomach. + • Measure the length of insertion from the nares to the ear and to the epigastrium (Figure 25–1); mark it on the tube with an indelible pen. + • Lubricate tube with gel.• Insert the tube through the nose (Figure 25–2). + • Ask the patient to cooperate by swallowing while the tube is being inserted.• Advance the tube to the length mark.• To check position, aspirate tube with 50-mL syringe (Figure 25–3); gastric aspirate (pH = 1–3) confirms positioning in stomach. + • Insert small amount of air (20–30 mL) via NG tube while listening to epigastric area of stomach with stethoscope.• If unsure about tube placement, verify tube position by obtaining a chest film before starting enteral feeding or drug treatment.• Secure tube to the face with tape. ++Figure 25–1.Graphic Jump LocationView Full Size||Download Slide (.ppt)Measuring the length of tube for insertion.++Figure 25–2.Graphic Jump LocationView Full Size||Download Slide (.ppt)Inserting the nasogastric tube.++Figure 25–3.Graphic Jump LocationView Full Size||Download Slide (.ppt)Checking the position of the tube. + • Monitor intake and output volume.• Evaluate tube position.• Patient symptoms. + • Aspiration.• Infection.• Sinusitis (caused by long-term NG tube feeding).• Bleeding.• Perforation.• Mucosal tears. + • Call a doctor when any of the following clinical signs are present:• Fever.• Nausea and vomiting.• Melanotic stool or bright red hematemesis.• Persistent abdominal pain.• Abdominal ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.