Nasogastric/Nasojejunal Tubes (routine securing) in Adult Critical Care – Clinical SOP

• Background
• Equipment

Aims

To standardise and optimise the routine securing of nasoenteral (nasogastric/nasojejunal) tubes (NET) in patients in Adult Critical Care in a safe manner without causing additional pressure or ‘pull’ on a patient’s nostril/nare.

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Background and indications for standard operating procedure/protocol

Anecdotal evidence is supportive of the need for a suitable fixation technique due to observed incidences where tube placement/securement has resulted in nasal/nostril tissue damage. LTHT Enteral Tube Feeding Policy (2015) does not include any guidance about fixation of tubes. There is some information but no detail is available in LTHT Guidelines for the Insertion of a Nasogastric Tube (NGT) and On-going Care for Adults (2015).

A nasal retaining loop (NRL / “bridle”) may be considered for patients who are at higher risk of Nasoenteral Tubes being dislodged (these include both nasogastric (NG) tubes and nasojejunal (NJ) tubes). The assessment for using these and insertion should be made by on an individual patient basis by suitably qualified staff. Please refer to the Safe Practice Guidelines for the Insertion and Care of nasal retaining loops to secure Naso-Enteral tubes (2016).
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Standard
All patients will have their care needs assessed and documented by a registered nurse.
All patients with a nasoenteral tube will have the tube secured in the prescribed manner.
Securing device will be changed at least every 72hrs.
Care will be recorded on 24hr chart and care plans.

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Equipment

Pre-made nasal enteral tube securing device for nose, thin colloid dressing (eg Duoderm) and (film dressing (eg Tegaderm) for cheek, gloves, and apron.

Action	Rationale
Check nostril area daily	To ensure health and cleanliness of skin.
Wash hands, put apron and gloves on.	Reduces possibility of cross infection.
Inform patient and visitors of proposed care.	Ensure compliance and understanding
If tube already in situ check external length of tube against recorded length on the 24hr charts and care plan.	Ensure tube is secured at correct length.
Wearing gloves remove securing device from tube. Consider asking someone to hold the tube as you discard old securing device (or tape).	For protection and to prevent accidental displacement of the tube.
Using a pre made device secure as per pictures. Secure NET to nose and secure to cheek using colloid dressing and film dressing to prevent accidental removal and to keep NET out of the way for eating and drinking. Ensure the NET is taped flush to the face, without a large loop, to reduce the risk of inadvertent displacement e.g. when asleep.
Re-check external tube length to ensure tube did not move during procedure. If there are any concerns the tube may have moved, carry out a position check following guidance in the LTHT Guidelines for the Insertion of a Nasogastric Tube (NGT) and On-going Care for Adults 2015.	Ensures correct placement of tube before administration of feed and or medications.
Discard waste and wash hands.	Infection Control practices.
Document change on 24hr chart and in care plan describing condition of nostrils.	Evaluative reporting, adherence to LTHT documentation practices.