Question

The charge nurse is observing another nurse who is inserting a nasogastric tube in a preterm infant. The charge nurse observes the following activities. Which action would the charge nurse correct? The nurse A. checks placement by aspirating stomach contents. B. lubricates the tip of the tube with a water-soluble lubricant. C. measures the length to be inserted from the tip of the nose to the ear to the sternum. D. checks placement by inserting \(5 \mathrm{~mL}\) air while listening over the stomach for the gurgle.

Short answer

Action D should be corrected.

Step-by-step solution

Identify Correct Practices for Nasogastric Tube Insertion

First, review the practices and guidelines for inserting a nasogastric (NG) tube in a preterm infant.

Analyze Each Action

Evaluate the provided actions (A, B, C, and D) to determine which ones align with best practices for NG tube insertion.

Check Action A

Action A involves checking placement by aspirating stomach contents. This is a correct practice to verify proper placement of the NG tube.

Check Action B

Action B involves lubricating the tip of the tube with a water-soluble lubricant. This is also correct as it helps with a smooth insertion and reduces discomfort for the infant.

Check Action C

Action C involves measuring the length to be inserted from the tip of the nose to the ear to the sternum. This is appropriate to ensure the tube reaches the stomach.

Check Action D

Action D involves checking placement by inserting 5 mL air while listening over the stomach for the gurgle. This method is not recommended because the amount of air might be too much for a preterm infant, and auditory methods are less reliable than other verification techniques.

Identify the Incorrect Action

Based on the analysis, identify Action D as the one that the charge nurse should correct.

Key concepts

Preterm Infant Care

Caring for preterm infants requires specialized knowledge and techniques. These babies have unique medical needs due to their premature birth. One crucial aspect is ensuring they receive appropriate nutrition, often facilitated through nasogastric (NG) tube feeding. Besides feeding, preterm infants require monitoring for signs of distress and proper positioning to aid in their development.
Proper handwashing and sanitization are essential to avoid infections.
Rather out common sense when it comes to observation It's also essential to gently handle the infant to avoid causing any harm during medical procedures or everyday care.

• Frequent monitoring of vital signs.
• Maintaining a warm and calm environment.
• Facilitating skin-to-skin contact.
• Encouraging kangaroo care for bonding and stability.

Understanding these basics sets the foundation for more specific medical procedures like NG tube insertion.

NG Tube Placement Verification

Verifying NG tube placement in preterm infants is critical to ensure that the tube is correctly positioned in the stomach, thereby preventing complications like aspiration or improper feeding. Action D from the exercise involves inserting 5 mL of air and listening for a gurgle, which is not recommended. More reliable methods include:

• Aspirating stomach contents (Action A) and checking pH levels.
• Observing for reflux of formula.
• Continuous monitoring via radiographic confirmation for initial placement.

These methods are more reliable than the auditory verification technique and safer, as they avoid introducing excessive air into the fragile stomach of a preterm infant.

Best Practices in Nursing

Nursing best practices ensure that procedures like NG tube insertion are performed safely and effectively. Here are some best practices highlighted from the exercise:
Using a water-soluble lubricant (Action B) helps to reduce friction and discomfort during the insertion process.

• Measuring the tube length from the nose, ear, to the sternum (Action C) ensures it reaches the stomach accurately.
• Regularly reviewing and adhering to updated guidelines and protocols.
• Maintaining sterile techniques to prevent infections.
• Communicating effectively with the healthcare team.

By following these practices, nurses can provide high-quality care, minimize risks, and ensure the well-being of preterm infants undergoing NG tube insertion.