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NGT System for Intake & Output with Auscultation

  Submitted by: Leigh Snead on June 30, 2016
  HomeGrown Solution Number: 281
Identification of the Problem
We needed a low-cost, simulated NG Tube where students could realistically assess NGT placement by auscultation of air bolus.
Unique Idea
Created a mechanism for assessing NGT placement through auscultation using common medical supplies without destruction of mannequin parts. This system also allows for instilling meds/feedings, checking for residual, and providing continuous Foley catheter output as well.
Objectives
Create a mechanism for assessing NGT placement through auscultation using common medical supplies without destruction of mannequin parts. This system also allows for instilling meds/feedings, checking for residual, and providing continuous Foley catheter output as well.
Supplies/Ingredients
1. JP drain
2. 1 gravity set of IV tubing
3. NG Tube
4. Tape to secure NGT to nasal bridge
5. Plumber’s tape, Scissors, Super glue (brush-on works best)
6. Absorbable padding
7. Small, clear, occlusive dressing (optional)
8. Foley bag
9. Mannequin with removable genitalia (gender of choice).
10. Stethoscope & Syringe to instill air and fluid for placement check
Steps to Creating the Solution
1. Open the chest and abdominal cavities of the mannequin. Remove any “wet abdomen” the mannequin may have in place.
2. Place the NG Tube in the desired nare, advancing until it at least reaches the abdominal cavity (further if desired, as long as it can remain in abdominal cavity). May need to manipulate tube to get it to go through chest to abdomen. Secure chest portion of NGT with a clear dressing or tape. Secure the NGT to the nasal bridge with tape per standard procedure.
3. Cut off the tips (to form a clean edge) of the following supplies with the scissors: a. Cut off the insertion tip of the NGT being used b. Cut off the tip of long end of the JP drain c. The tip of the yellow rubber portion of the foley set up d. Cut approximately an 18-inch straight segment of the IV tubing from the main set. Discard remainder.
4. Thread the Foley through the genitalia where it is coming out of the back. Using super glue, connect the Foley tip to one end of IV tubing segment, being careful not to occlude the diameter of the tubes. Reinforce with plumber’s tape.
5. Using super glue, attach the other end of the IV tubing segment to the port on the JP drain. Again, be careful not to occlude the diameter of the tubes. Using super glue, connect the cut long end of the JP drain to the cut insertion tip of NGT, being careful not to occlude the tubes’ diameters.
6. Place the JP drain and surrounding tubing in the abdominal cavity. Wrap in an absorbent pad in case of leakage.
7. Place genitalia in mannequin as usual. Replace abdominal and chest plates. Place Foley bag on an appropriate place on the bed frame.
8. Proceed with testing the system by (1) auscultating placement using air bolus, (2) instilling fluid, (3) removing fluid. (4) Instill enough fluid to test urine output feature.
9. Connection Sequence: NGT------JP drain tube-------JP drain port ------- IV Tubing ----- Genitalia-------Foley with bag Note: When system is not in use, empty fluid contents, wash through with a diluted bleach solution, allow to dry, and store disconnected from the mannequin.
10. Note: This device may work on other mannequins with some manipulation.