A nurse is contributing to the plan of care of a client who is postoperative following a gastrectomy and has a double-lumen nasogastric (NG) tube. Which of the following interventions should the nurse include in the plan?
A.
Avoid replacing the NG tube if it is accidentally dislodged.
B.
Irrigate the blue pigtail port with sterile saline.
C.
Verify tube placement by injecting air into the larger lumen.
D.
Avoid the nares when providing hygiene care.
The Correct Answer and Explanation is:
The correct answer is:
B. Irrigate the blue pigtail port with sterile saline.
Explanation:
A client who is postoperative following a gastrectomy and has a double-lumen nasogastric (NG) tube requires specific care to ensure proper functioning and minimize complications. The double-lumen NG tube has two distinct lumens: a larger lumen for drainage and a smaller “blue pigtail” lumen for venting and maintaining the function of the larger lumen.
1. Irrigating the Blue Pigtail Port: The blue pigtail port of the double-lumen NG tube is used to vent the stomach and prevent excess negative pressure within the stomach, which could potentially cause mucosal damage or erosion. It is crucial to irrigate this port with sterile saline to ensure it remains patent and continues to function properly. This prevents the accumulation of debris and keeps the venting system working efficiently, thus preventing complications such as tube obstruction.
2. Avoid Replacing the NG Tube if Dislodged: If the NG tube is accidentally dislodged, it is essential to notify the healthcare provider immediately rather than attempting to replace it independently. The healthcare provider will assess the need for reinsertion and ensure proper placement, as incorrect replacement can lead to complications like misplacement into the lungs or esophagus.
3. Verify Tube Placement by Injecting Air: Injecting air into the larger lumen to verify tube placement is not recommended. This method is not reliable and may cause discomfort to the patient. Instead, correct placement of the NG tube is usually verified using an aspirate test (checking the pH of gastric aspirate), auscultation (listening for a whooshing sound), or X-ray confirmation.
4. Avoid the Nares During Hygiene Care: Proper hygiene care around the nares is essential. The nurse should carefully clean the area without causing trauma to the nostrils. Avoiding the nares entirely during hygiene care is not practical and could lead to irritation or infection if proper cleaning techniques are not used.
In summary, irrigating the blue pigtail port is a key intervention to maintain the functionality of the NG tube and ensure effective stomach decompression.