Naso gastric tube insertion- skill lab- osce

NASO-GASTRIC TUBE INSERTION- Skill Lab- OSCE

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Dear viewers,
• Greetings from “Surgical Educator”
• Today I am starting a new series of videos on Skill Lab procedures for your OSCE exam.
• In this episode, I am talking about the Naso-gastric tube insertion, the skill which should be mastered by all medical students.
• I hope you can master the skill by watching this video and can do all the steps in the correct sequence.
• You can enjoy all my videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.

1. NASO-GASTRIC TUBE INSERTION SKILL LAB OSCE Dr.B.SELVARAJ MS;Mch;FICS ; “SURGICAL EDUCATOR” MALAYSIA

2. NASO-GASTRIC TUBE INSERTION DEFINITION Insertion of NG tube through the nose into the patient’s stomach- Ryle’s tube, Levin’s tube- 16F size INDICATIONS 1. Bowel obstruction- small & large & GOO 2. Tube feeding in Neurological patients who are unable to swallow 3. For Gastric Lavage in poisoning- Oro-Gastric- Ewald’s tube 24F 4. For instilling barium into esophagus for barium swallow in patients who are unable to swallow.

3. NASO-GASTRIC TUBE INSERTION CONTRAINDICATIONS ABSOLUTE Severe facial trauma- Maxilla # # Cribriform plate of sphenoid bone Corrosive esophagitis Recent esophageal surgery CONTRAINDICATIONS RELATIVE Stricture esophagus- benign & malignant Unstable cervical spine # Bleeding diathesis Compromised air way

4. NASO-GASTRIC TUBE INSERTION EQUIPMENTS

5. NASO-GASTRIC TUBE INSERTION SEQUENTIAL STEPS 1.Introduction & Informed consent Introduce yourself to the patient Tell the patient why and what you are going to do? Tell the possible complications also and then obtain the informed consent. 2. Chaperone & Privacy Ask for a chaperone Maintain privacy by putting the curtain

6. NASO-GASTRIC TUBE INSERTION SEQUENTIAL STEPS 3. Wear PPD, wash hands and wear glove PPD/PPE: Wear apron, cap, mask and goggles Wash hands Wear sterile glove

7. NASO-GASTRIC TUBE INSERTION SEQUENTIAL STEPS 4. Patient’s position Patient should lie in bed in Fowler’s position- 45* angle 5. Inspect nasal cavity Use pen torch to visualize any polyp or median septal deviation in nostrils

8. NASO-GASTRIC TUBE INSERTION SEQUENTIAL STEPS 6. Measure length of the tube to be inserted Nose loop around ear  xiphisternum and mark 7. Apply lubricant to NGT Apply Xylocaine jelly liberally to NGT tip

9. NASO-GASTRIC TUBE INSERTION SEQUENTIAL STEPS 8. Insert NGT gently through floor of nostril Patient in sniffing position Gently introduce NGT 9. Ask patient to sip water when experiencing Gag reflex Epiglottis closes the tracheal inlet

10. NASO-GASTRIC TUBE INSERTION SEQUENTIAL STEPS 10. Insert NGT upto the mark Advance NGT upto the mark 11. Confirm the position in the stomach Pushing air & hearing the hissing sound in epigastrium Aspirating & testing with litmus paper , and AXR

11. NASO-GASTRIC TUBE INSERTION SEQUENTIAL STEPS 12. Fix NGT to nose Fix NGT to nose with tape- two tail technique 13. Thank the patient

12. NASO-GASTRIC TUBE INSERTION SEQUENTIAL STEPS 14. Throw the glove into yellow color bin

13. NASO-GASTRIC TUBE INSERTION SEQUENTIAL STEPS-RECAP Introduce yourself ,Explain the procedure and take informed consent Ask for a chaperone &Provide privacy Position patient Don apron/ wash hands/ don gloves Inspect nasal cavity Measure length of tube to be inserted (nose  loop around ear  xiphisternum) & mark it 7. Put adequate jelly (at tip of tube/ nasal cavity) 8. Insert tube gently through floor of nasal cavity 9.Ask patient to swallow water while inserting 10. Insert tube up to the marking 11.Confirm tube position (by aspiration of contents/ auscultation) 12.Fix tube to nose 13.Dispose gloves 14. Thank patient