Nasogastric/Nasojejunal Tubes ( routine securing ) in Adult Critical Care - Clinical Standard Operating Procedure

Publication: 11/07/2006  --
Last review: 19/02/2020  
Next review: 19/02/2023  
Standard Operating Procedure
CURRENT 
ID: 787 
Supported by: Critical Care Governance
Approved By: Critical Care CMT 
Copyright© Leeds Teaching Hospitals NHS Trust 2020  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

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

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.

Description: G:\Adult Critical Care\Shared drive\Quality and Safety\Nutrition\NG tubes\NGT.jpg

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.

Provenance

Record: 787
Objective:

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

Clinical condition:

Patients with NG tubes in situ

Target patient group: All patients with NG tubes in situ
Target professional group(s): Secondary Care Nurses
Registered Nurses Working in Critical Care
Adapted from:

Evidence base

Although a search was conducted no references were found.
Additional information can be found on www.lhp.leedsth.nhs.uk
LTHT Enteral Feeding Policy (2011) and placement confirmation policies and guidance documents and LTHT Guidelines for the Insertion of a Nasogastric Tube (NGT) and On-going Care for Adults (2012)
LTHT Safe Practice Guidelines for the Insertion and Care of nasal retaining loops to secure Naso-Enteral tubes (2012)

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Approved By

Critical Care CMT

Document history

LHP version 1.0

Related information

Not supplied

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