Indications

• IV fluids administration (hydration)
• IV medications (antibiotics, analgesics)
• Blood/blood product transfusions
• Frequent blood sampling
• Contrast administration for imaging
• Parenteral nutrition

Contraindications

• Infected or inflamed area
• Burnt skin
• Edematous limb
• Limb with AV fistula
• Cellulitis over insertion site
• Mastectomy on same side

Step 1
Explain procedure to patient

Step 2
Wash hands and wear gloves

Step 3
Select suitable vein

Step 4
Clean site with antiseptic

Step 5
Apply tourniquet

Step 6
Insert cannula at proper angle

Step 7
Check blood return

Step 8
Remove needle and secure

Step 9
Fix with dressing and label

Step 10
Dispose sharps safely

Definition & Indications

Definition: Insertion of a flexible tube through nose → esophagus → stomach.

Indications

• Feeding patients who cannot swallow
• Gastric decompression (post-surgery, obstruction)
• Administration of medications
• Gastric lavage (poisoning)
• Aspiration of gastric contents for analysis

Common Sizes (French Gauge)

• Adults: 12 Fr to 18 Fr
• Children/Infants: 5 Fr to 12 Fr
• Smaller for feeding, larger for drainage

Procedure Steps

1. Explain & Position: Sitting upright, head slightly forward
2. Measure & Mark: Nose → earlobe → xiphisternum
3. Lubricate & Insert: Water-soluble gel, advance horizontally
4. Swallow & Advance: Patient swallows water as tube advanced
5. Confirm Placement: CRITICAL – Aspirate gastric contents (pH <5.5) or X-ray
6. Secure & Care: Secure to nose, provide mouth/nasal care

Complications

• Incorrect placement → aspiration pneumonia
• Nasal/pharyngeal irritation, ulceration
• Sinusitis, otitis media
• Tube clogging
• Aspiration of gastric contents
• Electrolyte imbalance (prolonged drainage)
• Tube migration/dislodgement

Care of NG Tube

• Keep nostrils clean and moisturized
• Check tube placement regularly (before each feed)
• Maintain oral hygiene (mouth care every 4-6 hours)
• Flush tube with 30ml water before/after feeding/meds
• Secure properly to prevent dislodgement
• Monitor for signs of complications
• Document tube length at nostril daily

Definition & Types

Definition: Insertion of a hollow, flexible tube into the bladder to drain urine.

Indications & Procedure

Indications

• Relief of urinary retention
• Accurate urine output measurement
• Bladder irrigation (clot removal)
• Urinary incontinence management
• During certain surgeries
• Urine specimen collection

General Procedure Steps

1. Explain procedure, maintain privacy
2. Wash hands, wear sterile gloves
3. Clean genital area with antiseptic
4. Lubricate catheter tip
5. Insert catheter gently into urethra
6. Inflate balloon with sterile water
7. Connect to drainage bag, secure
8. Document procedure

👨 Male Catheterization

• Penis held at 60-90° angle
• Longer urethra (18-20 cm)
• Advance 15-20 cm until urine flows
• Risk of false passage creation
• More care needed for prostate enlargement
• Secure to abdomen or thigh

👩 Female Catheterization

• Shorter urethra (4-5 cm)
• Advance 5-7 cm until urine flows
• Identify urethral opening clearly
• Risk of vaginal misplacement
• Labia must be separated throughout
• Secure to inner thigh

UTI
Most common complication

Trauma/bleeding
False passage creation

Urethral stricture
Long-term in males

Bladder spasms
Painful contractions

Blockage/leakage
Sediment or kinking

Catheter-associated pain
Discomfort during insertion/removal

Definition & Types

Definition: Introduction of fluid into rectum and colon via anus.

Types of Enema

• Evacuant/Cleansing: Relieve constipation, bowel prep
• Retention: Medication administration (steroids for colitis)
• Carminative: Relieve flatulence
• Anthelmintic: Treat parasitic infections
• Nutritive: Provide nutrition (rare)

Indications

• Relieve constipation
• Bowel preparation before surgery/colonoscopy
• Administer medications
• Soften fecal impaction
• Reduce body temperature (rare)
• Diagnostic procedures

Procedure Steps (Evacuant Enema)

1. Prepare: Explain, privacy, left lateral position
2. Prepare Solution: Warm to 37°C (500-1000ml)
3. Hang Container: 45-60 cm above rectum
4. Lubricate & Insert: Lubricate 3-5 cm of tube
5. Insert Tube: 7-10 cm into rectum
6. Administer: Open clamp, allow slow flow
7. Retain & Expel: Retain 5-10 minutes, then expel
8. Clean & Document: Clean patient, document output

Local Method Preparation

When commercial kits unavailable in peripheral settings:

Equipment Needed

• Clean bucket/vessel
• Rubber/silicone tubing
• Funnel or clamp
• Soap, clean water, salt

Solution Preparation

• Soap Water: 1L warm water + 5-10ml mild soap
• Normal Saline: 1L boiled water + 9g salt (0.9%)

Sterilize equipment by boiling if possible. Emphasis on cleanliness to prevent infection.

Complications of Enema

Universal Principles

• Always obtain informed consent
• Maintain strict aseptic technique
• Ensure adequate patient preparation
• Provide privacy and dignity
• Document everything thoroughly

Patient Comfort

• Use distraction techniques
• Apply local anesthetic when possible
• Maintain clear communication
• Monitor for pain/discomfort
• Provide aftercare instructions

Safety Measures

• Double-check equipment functionality
• Have emergency equipment available
• Follow sharps safety protocols
• Monitor for complications
• Know when to seek assistance