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Ryles Tube R.T.

Care of Person On Ryles Tube

Ryles Tube Insertion of small-bore tube to the stomach through the nasopharynx and administration of feed directly into the stomach through a tube passed into the stomach through the nose or mouth. To provide adequate nourishment to person who cannot feed themselves and administer medication.

Insertion of Ryles Tube

  • Clean tray.
  • Nasogastric Tube – Spigot.
  • Container with gauze pieces.
  • Adhesive Tape.
  • 10 ml Syringe.
  • Kidney Tray.
  • Glass of water.
  • Stethoscope
  • Jelly
  • Clean gloves.
  • Explain the procedure to the person.
  • Place towel to protect chest.
  • Arrange a signal by which the person can communicate if he / she wants to stop e.g. by raising his / her hand.
  • Assist the person to sit in a semi upright position in bed or chair. Support the person’s head with pillows.
  • Mark the distance at which the tube is passed by measuring the distance on the tube from the person’s earlobe to the tip of the nose plus the xiphisternum. Mark this distance with adhesive tape.
  • Wash your hands and assemble the equipment needed.
  • Check the person’s nostrils are patent by asking him / her to sniff with one nostril closed. Repeat with other nostril.
  • Lubricate the proximal end of the tube for 15-20 cms with a thin coat of lubricant or water.
  • Insert the proximal end of the tube into the cleanest nostril and push it backwards and inwards along the floor of the nose of the nasopharynx. If an obstruction is felt, withdraw the tube and try again in a slightly different direction, or use the other nostril.
  • As the tube passes down into the nasopharynx, ask the person to start swallowing and sipping water.
  • Advance the tube through the pharynx as the person  swallows until the tape marked tube reaches the point of entry into the external nares. If the person shows signs of distress e.g. coughing, cyanosis and gasping withdraw and reinsert tube.  If passage is blocked, withdraw the tube slightly, rotate and reinsert it.
  • Check whether the tube is in the stomach by –
  • Checking if the tube is coiled in the mouth.
  • Aspirating the contents of the stomach with a 10 ml syringe.
  • Place the stethoscope over the epigastrium and injecting 2-5 ml air through the tube.
  • Secure the tube firmly on the person’s nose with a small piece of adhesive tape and then along the check.
  • Close the end of the tube with a spigot.

Administration of Nasogastric Feeds

  • Glass of clean water.
  • Prescribed measured feed.
  • 20 ml syringe.
  • Towel
  • Ounce glass.
  • Additional articles may include those for gastric intubation, if required.
  • Explain the procedure to the person.
  • Wash hands.
  • Take the feed and necessary equipment to person’s bedside, if the person is capable of doing so, he / she should assist in the procedure.
  • Place the person in semi recumbent / fowlers position unless contra indicated. Ensure that comfort is maintained.
  • Place towel / napkin over person’s chest.
  • Check the position of the nasogastric tube by aspiration with syringe or auscultation.
  • Using the barrel of the syringe, first pour 1 ounce of water and then the feed. In case of persons with estimated fluid intake, this can be avoided. Allow it to flow in slowly.  Continue to give the whole feed.  Regulate the flow by raising or lowering the barrel.
  • At the end of the feed, allow one ounce of water to passes through the tube to remove food particles. Remove barrel and clamp end of tube with spigot.
  • Instruct person to remain in the same position and avoid exertion for atleast 20 mins.
  • Make person comfortable.

Removing A Nasogastric Tube

  • Towel
  • Gauze pieces.
  • Kidney Tray.
  • Clean Gloves.
    • Place the towel on the persn’s chest.
    • Take gauze piece in dominant hand place under chin.
    • Pinch tube near nostril and remove with a continuous steady pull. As the tube is being removed, hold the tube in gauze and discard in kidney tray.
    • Clean person’s face especially nares.
    • Encourage person to rinse mouth.
    • Assist to a comfortable position.