Pricing for Pennine Ryles Nasogastric Tubes:

Pennine Ryles Nasogastric Tubes

• Closed distal end coned with radio-opaque material for accurate placement
• Four lateral eyes
• Tube with radio-opaque line
• Soft, frosted and kink resistant PVC tubing
• Sterile

Ryles Nasogastric Tubes

A nasogastric tube is a narrow-bore tube passed into the stomach via the nose. It is used for short- or medium-term nutritional support, and also for aspiration of stomach contents – eg, for decompression of intestinal obstruction.

A wide-bore tube is used if drainage is needed; otherwise, a finer-bore tube is used. Fine-bore feeding tubes (gauge less than 9) cause less discomfort and less risk of rhinitis, pharyngitis or oesophageal erosion.

The use of a nasogastric tube is suitable for enteral feeding for up to six weeks. Polyurethane or silicone feeding tubes are unaffected by gastric acid and can therefore remain in the stomach for a longer period than PVC tubes, which can only be used for up to two weeks. For long-term enteral feeding, the use of percutaneous endoscopic gastrostomy (PEG) is associated with improved survival, better tolerance by the patient and lower incidence of aspiration.

Feeding by nasogastric tubes

• Bolus: by gravity – very simple, requiring minimal equipment but increases the risk of gastrointestinal symptoms.
• Intermittently: by gravity or pump – gives time free of feeding but increases the risk of gastrointestinal symptoms.
• Continuously: by pump system – reduces the rate of gastrointestinal symptoms but the patient is connected to the system most of the time and this may limit mobility.
• Semi-recumbent positioning of the patient reduces the risk of airway aspiration.
• Contamination of feeds can be minimised by minimal, meticulous handling and the use of closed rather than open systems.

Contra-indications

The nasogastric feeding route is not suitable for all patients, including those with:

• High risk of aspiration.
• Gastric stasis.
• Gastro-oesophageal reflux.
• Upper gastrointestinal stricture.
• Nasal injuries.
• Base of skull fractures.

Inserting a nasogastric tube

• Explain the procedure and obtain consent.
• Provide a signal for the patient to stop the procedure.
• Sit the patient in a semi-upright position with the head supported with pillows and tilted neither backwards nor forwards.
• Examine the nostrils for deformity or obstructions to determine the best side for insertion.
• Measure the tubing from the bridge of the nose to the earlobe, then to the point halfway between the lower end of the sternum and the navel.
• Mark the measured length with a marker or note the distance.
• Lubricate 2-4 inches of tube with lubricant (Silkospray).
• Pass the tube via either nostril, past the pharynx, into the oesophagus and then into the stomach
• Instruct the patient to swallow and advance the tube as the patient swallows (sipping a glass of water helps).
• If resistance is met, rotate the tube slowly while advancing downwards. Do not force.
• Stop immediately and withdraw the tube if the patient becomes distressed, starts gasping or coughing, becomes cyanosed or if the tube coils in the mouth.
• Advance the tube until the mark is reached.
• Check the tube’s position (see below).
• Secure the tube with tape.

Checking tube position

It is essential to confirm the position of the tube in the stomach by one of the following:

• Testing pH of aspirate: gastric placement is indicated by a pH of less than 4, but may increase to between pH 4-6 if the patient is receiving acid-inhibiting drugs. The use of blue litmus paper to check the acidity of aspirate is insufficiently sensitive to distinguish between levels of acidity.
• X-rays: will only confirm position at the time the X-ray is carried out. The tube may have moved by the time the patient has returned to the ward. In the absence of a positive aspirate test, where pH readings are more than 5.5, or in a patient who is unconscious or on a ventilator, an X-ray must be obtained to confirm the initial position of the nasogastric tube.

The old test of introducing a small quantity of air into the stomach and checking for a bubbling sound over the epigastrium is not recommended, as it is unreliable and can give false reassurance.

Securing and monitoring the tube

• Nasogastric tubes should be taped securely at the nose to avoid displacement.
• The tube should be flushed regularly to prevent the build-up of feed and medication leading to occlusion.
• The position of the tube should be monitored by recording the length of the tube at the point of exit from the nostril, regularly checking the pH of the aspirate, checking the nasal fixation tapes daily and checking for signs of respiratory discomfort or regurgitation.
• The tube position must be checked:
  • On initial placement.
  • At least once daily during continuous feeds, or before the administration of feed following a break or if bolus feeding.
  • Before the administration of drugs if the tube is not used for any other purpose.
  • After episodes of coughing, retching or vomiting.
  • After oropharyngeal suction.
  • Where there is any suspicion of a change in length of the visible part of the tube.
  • Where there is discomfort or reflux of feed into the throat.
  • If there are any signs of respiratory distress.
  • If the patient is transferred from one clinical area to another.

 

 

DELIVERY / CARRIAGE CHARGES:

TRADE CUSTOMERS (Veterinary Practices & Hospitals Only)

Trade customers will receive free next working day delivery on all UK Mainland orders over £75 (ex. VAT). An order under £75 will incur a handling charge of £6.99 (ex. VAT). Charges for international or remote locations (for example, Scottish Highlands and Islands) will always be incurred and the final amount will be determined upon receipt of order. Orders will be delivered by our nominated carrier to the address given on the order. Orders received by 5 p.m. are processed the same day for delivery the next working day.

PRIVATE CUSTOMERS

Private customers can choose one of the following options;

3-5 working day service – £6.99 + VAT

1-2 working day service – £9.99 + VAT

Next working day service – £12.99 + VAT

Please note these timescales are working days and will not include weekends or Bank Holidays. These charges cover packaging & carriage irrespective of the amount spent. Additional charges will apply for heavier and bulkier orders and customers will be contacted directly for approval before despatch. Orders will be delivered by our nominated carrier to the address given on the order. Orders received by 5 p.m. are processed the same day.

CARRIERS

The Vet Store reserves the right to choose a logistics partner of their choice and this may vary from time to time. Currently this may vary between TNT, Hermes and Royal Mail.

DELAYS

Whilst every endeavour is made to ensure delivery within the above timescales, no guarantee can be given due circumstances beyond our control and no liability will be accepted for any loss or damage occasioned by delay however caused.

SHORTAGES

In the event of short delivery or damage, The Vet Store must be notified within 48 hours. Non-receipt of goods invoiced must be brought to our attention within 24 hours of the date of delivery. The Vet Store cannot accept responsibility for delivery problems resulting from incorrect information supplied by the customer.

OVERSEAS CUSTOMERS

EU: £45 or £55 carriage per 20kg will be levied regardless of amount spent dependent on which country the order is being delivered.

REST OF THE WORLD: £125 carriage per 20kg will be levied regardless of amount spent.

These amounts are for indication purposes only and in certain circumstances, it may be necessary to contact you for an additional carriage payment, for example if the parcel is large or heavy.

RETURNS

In the unlikely event that goods need to be returned, we offer a “no quibble” 10 working day returns policy which has been designed for minimum inconvenience.

For goods ordered in error you will be responsible for the full cost of postage and packaging.

Approval must be sought before items are returned.

Please fill out the returns form and once you have obtained a unique returns number (URN#) and approval, return it along with the goods for return – click here to download.

PLEASE NOTE – We strongly recommend for security purposes when sending items back you use a ‘signed for’ delivery service, such as Royal Mail Recorded or Special Delivery and ensure the package is adequately insured. We are not liable for any packages lost in the post and do not accept responsibility for any item(s) until a member of our staff has signed for the package. Goods need to be returned in adequate packaging to avoid damage in transit.

Credit will only be issued for returned stock received in a re-saleable condition.

You can telephone our customer services team on 01274 736319 to place an order, Monday to Friday from 9.00am to 5.30pm.

Alternatively, you can fax us on 01274 491585, or email us on sales@thevetstore.net