Establish_Consent_for_an_Activity_or_Action

Reflective account of Inserting a Nasogastric Tube I was asked to insert an NG tube into a patient in one of our side rooms. The patient was Nil by mouth due to severe vomiting. The patient was in a side room due to coming from another hospital, she had been screened for MRSA, until the result was back she would remain as in isolation. (Infection prevention control). I applied PPE, yellow apron and gloves outside of the room. I knocked on the door and introduced myself to the patient, I explained that she needed to have an NG tube inserted and that I would be doing the procedure, I asked the patient if she could confirm her name and date of birth and if she was happy to consent for me to do the procedure and she confirmed she was happy for me to do it. (A patients consent must always be obtained before undertaking any procedure). I explained that I would go an gather all the equipment and be back shortly. I took off the apron and gloves and disposed of them in the yellow waste disposal bin and then washed my hands before leaving the room. I went to the treatment and cleaned down one of the dressing trolleys with clinell wipes, starting from the top shelf working down wards to the feet. (ANTT) I then went to the cupboard where the NG equipment is kept; I picked out a size 14 Ryle’s NG tube and a 500ml Bile bag, I also got PH strips and a 50ml syringe and a strip of Hypofix. I then went into the sluice room and obtained a disposable measuring jug and an orange plastic disposable bag (Waste disposal management). I then went into the kitchen area and got a white disposable cup and straw, and filled with water. I informed the Nurse in charge I had gathered all the equipment together and I asked if she would observe me whilst doing the procedure as I had not been signed off to do an NG tube insertion on my own.. We went along to the side room and put alcohol gel on our hands, then put on our PPE, yellow apron and gloves, (I did not need to wear sterile gloves for this procedure). I then knocked on the door and went inside with Nurse in charge; I asked the patient if she minded the Nurse in charge being here to observe me doing the procedure, she replied she did not mind at all. I closed the door and pulled the curtain across the door (Patient Privacy and Dignity). I again explained to the patient what would be happening and was she still happy for me to go ahead with the procedure, she said yes. I raised the bed to the level I was comfortable with, so I would not have to twist and bend my back to much, (Health and Safety) Manual Handling). I then sat the patient in a semi upright position with her head supported with a pillow. Before I started I asked the patient if she had every had any nasal surgery or if she had ever broken her nose, she said she had not. (I asked the question as I would not have wanted to cause unnecessary discomfort and would have gained the advice from a Dr before going any further. I explained to the patient I needed to shine my torch up each nostril to make sure there were no obstructions; both nostrils looked fine, I decided to go for the right nostril. I measure the tubing from the bridge of the patient’s nose across to the earlobes then to the point halfway between the lower end of the sternum and the naval, this measured 50 centimetres, I noted the distance for later on. I opened all the equipment ready, I then informed the patient I would be starting the procedure but if at any time she experienced severe discomfort or pain to let me know and I would stop the procedure and withdraw the tube immediately. (If the patient were to gasp for breath or start coughing or become cyanosed or if the tube became coiled in the mouth I would withdraw immediately). I placed the tip of the tube into the water and then held the tube as though I was holding a dart, I gently started to pass the tube up the back of the right nostril and at this point I asked the patient to take a sip of water threw the straw and continued passing the tube past the pharynx, I rotated the tub on a couple of occasions, I tried to comfort the patient as I was going along, telling her she was doing really well. I continued advancing downwards with the tube (at no time did I or would I have forced the tube down). As soon as the tube was in at 50 centimetres I stopped. I then took a piece of Hypofix and taped it around the tape just outside the nostril then taped it on to the nose so the tube would not fall out. I informed the patient the tube was in but I now needed to aspirate to make sure I was in the right position with the NG tube. I took the syringe and applied it onto the port of the tube and started to slowly draw back on the syringe, dark green fluid appeared. I drew back 130 mills in all; this was emptied into the disposable measuring jug. I took the bile bag and connected it to the NG tube; I made sure the bag was closed at the bottom so no leakage would occur. I took a PH strip and applied a small amount of aspirate fluid onto the strip, within a few seconds this indicated that the PH level was 4, (sometimes the PH level can reach around 4.6 if the patient is on an acid type drug). If the PH level had recorded over 5 the patient would have had to go to x-ray as the tube would not be in the correct position. I explained to the patient the tube was in and I had aspirated quite a lot from the stomach. I also the patient if she felt any discomfort or pain, she replied she was feeling fine and happy it was over. The patient had a bathroom in her room so I disposed of the aspirated fluid down the toilet; I then placed the disposable jug into the yellow bin with Orange plastic bag for contaminated waste. I went back to the patient and lowered the bed back down to a safe height for when the patient got out of bed. I made sure the patient was comfortable in the bed; I gave her the call bell just in case she needed us. I disposed of the syringe my gloves and apron in the yellow contamination bin. I then washed my hands with soap and water (Hand washing policy). I took the trolley out of the room applied a pair of gloves and wiped from top to bottom with clinell wipes making sure the trolley was completely clean. I then removed my gloves applied alcohol gel onto my hands and then took the trolley back to the treatment area. I then wrote in the patient day care notes that I had inserted an NG tube and dated, signed and documented the time. I also wrote on the fluid chart in the output column and wrote NG aspirated at the top of a column and documented 130mls. The Nurse informed me she was very happy with how I performed the Insertion of NG tube and would be happy to write an witness statement for me.