Nasogastric Tube Removal Procedure (Nursing)

00:00 Let's take a look at nasogastric tube removal. Now this can usually occur when the patient's enteral tube feeding nutrition is no longer needed or they're treatment is complete. So let's take a look what we're going to need. We're going to need our stethoscope to assess lung sounds, an absorbent pad to protect the patient's clothing, a washcloth, and also a clean piston syringe. Now first of all, when we're dealing with nasogastric tube and we're pulling this out, we want to make sure that client's head of bed is up at least 90 degrees. Now, if they can't tolerate that, 30 degrees is sufficient. This is a good time to make sure we put the absorbent pad over the patient's chest. Now if applicable, if the patient has suction going, we want to discontinue it at that time. Great time to perform hand hygiene and now we can put on our gloves. Now we want to verify the NG tube is in the right place by aspirating gastric residual. And every time we do this, we want to make sure we put that gastric content back and then we want to flush it with a small bolus of air to remove any gastric contents out of the tube before we remove it. And if it's secured by a nasogastric strip or tape, take that securement device off. Now, we want to clamp or fold the NG tube to prevent gastric back flow and ask the client to hold their breath as you gently withdraw the nasogastric tube. This is a great time to reassess the client's GI status, making sure they feel okay, and they're back to baseline. And oral care is key to help promote comfort. We can remove the absorbent pad and position the client back to comfortable position, but at least 30 degrees with the head up is ideal. Before we leave the room, return the bed to the lowest position for safety, discard any supplies that we used, take off our gloves, perform your hand hygiene, and then document the procedure. Let's take a look at nasogastric tube removal. So let's take a look at our supplies. So I'm going to have my stethoscope with me to assess lung sounds. I'm also going to have an absorbent pad or towel for the patient to protect their clothing, and also my pair of gloves, and also our piston syringe. Okay, so now let's take a look. Let's perform our hand hygiene and I'm going to place on my gloves. Now before we get too far either before I put on my gloves or right when we get into the room, we want to make sure the head of the bed of our patient is at least 30 degrees, the higher the better, closer to 90 is best. So now that the patient's upright, I want to discontinue suction at this time if the patient has that going. So once suction is discontinued, we need to make sure the NG tube placement is in the right place. So I'm going to take my piston syringe and aspirate gastric contents. So I'm going to do this by opening up this valve, placing my piston syringe on here and connecting this, and if your patient's got a Lopez valve like this one does here, now this valve is connected to the nasogastric tube. You want to make sure right now you can see that the off switch is in line with the tube, that means we won't be able to pull anything out. So make sure you turn that on first. Now we've got that on the on button and now I can pull back and aspirate any gastric contents. Now once we've done this, we want to make sure that we place the gastric contents back and then we are going to stop here, we're going to pull back a bolus of air, turn back on my Lopez valve, and again you can see that it's on because the arrows are in line with the tube, we're going to bolus a little bit of air. So this seems a little odd to you because we we're talking about a lot of air in the stomach can be an issue, but what we want to do since we've aspirated gastric contents through here, we don't want that to stay in the line when we're removing out of the patient. So we want to clear the line before we take it out. So I'm going to bolus a small amount of air. I'm going to remove my piston syringe, get rid of that, and then we can turn this back off. Now, if you don't have a Lopez device, really we can just take this off, remove this, and we would do the same thing with the piston syringe here. So, before we get too much farther, make sure you take off the securement device of the patient's nose.

05:21 I like to keep this in my hand just so nasogastric tube or gastric contents don't leak out.

05:31 Now one thing I want you to be mindful of, the nasogastric securement strips can be very sticky and over time it can really wear down on the patient's nose and their skin. So be really conscious about assessing this when you take out the nasogastric tube. Okay, so once I've taken off my nasogastric tube strip, if the tubing has been resting on the nose or the nasogastric tube's been in place for a long time, be conscious that this two can cause really serious breakdown underneath the nostril of the patient. So you want to assess that as well. So now that we've taken off the securement strip, we want to clamp or fold the nasogastric tube, we want our patient to lower their chin, we want them to hold their breath as we gently withdraw the nasogastric tube. So I'm going to just assist their head down for their chin to their chest, and I'm just going to quickly withdraw this. Okay, so now this is out.

06:33 Now after we've removed our patient's nasogastric tube, we want to reassess their gastrointestinal status and provide oral care for comfort. As you can imagine, this nasogastric tube's been in, their secretion's on it, so great oral care is going to help provide comfort for them. We want to remove the absorbent pad or any supplies that we use out of the way and then don't forget after the nasogastric tube removal, we want to keep the patient's head of bed up at least 30 degrees.