Ryle's Tube Insertion Nursing Procedure

 

Ryle's Tube Insertion Nursing Procedure :

Introduction: Ryle’s tube (nasogastric tube) insertion is a procedure in which a tube is passed through the nose, down the esophagus, and into the stomach. It is commonly used for feeding, administration of medications, or gastric decompression in patients who cannot take food orally or need stomach drainage.


Required Articles:

  • Ryle's tube (appropriate size)
  • Lubricant (water-soluble)
  • Disposable gloves
  • Kidney tray
  • Tissues or gauze
  • Measuring tape
  • Adhesive tape
  • Stethoscope
  • 50 mL syringe
  • Water for checking tube placement
  • Emesis basin
  • Glass of water with a straw (for conscious patients)
  • Suction apparatus (if required)
  • Towel or drape

Purposes:

  1. To provide nutrition (enteral feeding) when the patient is unable to swallow.
  2. To decompress the stomach in cases of gastric obstruction or ileus.
  3. To administer medication or diagnostic solutions.
  4. To aspirate stomach contents for diagnostic purposes.
  5. To relieve symptoms in patients with gastrointestinal bleeding.

Scientific Principles:

  1. Anatomical Consideration: The Ryle’s tube passes through the nasal cavity, pharynx, esophagus, and into the stomach, utilizing natural body passages.
  2. Gravity and Pressure: When feeding or aspirating, gravity or gentle pressure from the syringe helps to move fluid through the tube.
  3. Lubrication: Using water-soluble lubricants minimizes friction and discomfort during insertion.
  4. Air Entry and Exit: Ensuring that air is expelled from the tube prevents abdominal distension and respiratory complications.

Steps of Procedure

  1. Preparation:
    • Explain the procedure to the patient and provide emotional support.
    • Ensure the patient is in a high Fowler’s position (sitting upright) to facilitate insertion.
    • Measure the length of the tube to be inserted by placing the tip of the tube at the nose, extending it to the earlobe, and then to the xiphoid process. Mark this point on the tube.
  2. Inserting the Tube:
    • Wash hands and put on gloves.
    • Lubricate the tip of the tube with a water-soluble lubricant.
    • Gently insert the tube into one of the nostrils, directing it along the floor of the nose (toward the ear, not upward).
    • As the tube reaches the oropharynx, encourage the patient to swallow (offer sips of water with a straw for a conscious patient).
    • Advance the tube smoothly and gently with each swallow until the marked point reaches the nostril.
  3. Confirm Placement:
    • Attach a syringe to the tube and aspirate to check for gastric contents, or instill 10–20 mL of air into the tube while auscultating over the stomach with a stethoscope to hear the “whoosh” sound.
    • If the tube is in the correct position, secure it to the nose using adhesive tape.
  4. Post-Insertion Care:
    • Check the tube for proper functioning by aspirating gastric contents and noting the color and consistency.
    • Administer feed or medications as ordered.
    • Flush the tube with water after use to prevent blockage.
    • Document the procedure, including the length of the tube inserted and any patient discomfort or complications.
  5. Aftercare:
    • Monitor the patient for any signs of respiratory distress, discomfort, or bleeding.
    • Keep the patient in a semi-upright position for at least 30 minutes after feeding to prevent aspiration.
    • Inspect the nasal area for irritation and ensure the tube remains securely taped.

Indications of Procedure:

  • Nutritional Support: In patients with swallowing difficulties, stroke, or severe oral or esophageal pathologies.
  • Decompression: In patients with bowel obstruction, postoperative gastric distention, or paralytic ileus.
  • Medication Administration: When oral intake is not possible.
  • Gastric Lavage: For cases of poisoning or drug overdose.

Nursing Notes:

  • Date and time of insertion.
  • Size and type of tube used.
  • Patient’s tolerance of the procedure.
  • Confirmation of correct placement and method used.
  • Any abnormalities in aspirated gastric contents.
  • Amount and type of feeding or medications administered.
  • Any patient discomfort, respiratory distress, or complications observed.

This procedure should be done with care and attention to the patient’s comfort and safety, ensuring that the tube is inserted correctly to avoid complications such as aspiration pneumonia or nasal trauma.

 

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