Enteral Tubes and Gastric Tube Locations

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Questions and Answers

What are the potential minor complications associated with the insertion of a nasogastric tube?

Tracheobronchial aspiration

Pneumothorax

Intracranial Intubation

Epistaxis (correct)

Which of the following steps is NOT part of the proper insertion process for a nasogastric tube?

Inspect oropharynx

Educate the patient

Position the patient in High Fowlers

Secure the tube with a clamp (correct)

What is the correct method to verify the placement of a nasogastric tube?

Measure the length of the tube outside the esophagus

Auscultate bowel sounds

Send for X-ray confirmation (correct)

Perform a visual inspection

During the assessment prior to nasogastric tube insertion, which item should NOT be assessed?

Patient's past medical history Signup and view all the answers

What kind of gastric content would indicate a proper placement of a nasogastric tube?

pH of 1-3 Signup and view all the answers

Which piece of equipment is necessary to secure a nasogastric tube after insertion?

Tape Signup and view all the answers

Which of the following can skew the pH levels of gastric content tests?

The presence of enteral feedings Signup and view all the answers

What major complication can arise from incorrect placement of a nasogastric tube?

Pneumonia Signup and view all the answers

What is the main purpose of a Salem Sump tube?

Decompression of the stomach Signup and view all the answers

Which of the following is a contraindication for placing a nasogastric tube?

Facial trauma Signup and view all the answers

Which tube is ideal for short-term feeding lasting up to 4 weeks?

Levine Tube Signup and view all the answers

What is a critical risk when suctioning with a Salem Sump tube?

Electrolyte imbalances Signup and view all the answers

What measurement system is used to indicate the diameter of nasogastric tubes?

French System Signup and view all the answers

What should be monitored when using a Salem Sump tube on suction?

Electrolytes and signs of bleeding Signup and view all the answers

Which type of enteral tube is primarily used to remove gaseous air or other substances from the stomach?

Salem Sump Tube Signup and view all the answers

What complication is associated with nasoduodenal tube placement?

Increased risk of aspiration Signup and view all the answers

Why is it important to keep the blue pigtail of the Salem Sump tube above the abdomen?

To prevent reflux of gastric contents Signup and view all the answers

What is the main reason for using enteral tubes over Total Parenteral Nutrition (TPN)?

Better nutrient absorption Signup and view all the answers

Study Notes

Enteral Tubes

Enteral tubes: Tubes placed in the GI tract for various purposes.
Reasons for inserting enteral tubes:
- Gavage: Delivering food or medication through the tube, bypassing the mouth. Requires normal bowel functioning and swallowing issues.
- Decompression: Removing air or other substances from the stomach.
- Compression: Used for controlling GI bleeding or esophageal varices.
- Lavage: Washing out stomach contents, helpful in cases of overdose or poison ingestion.
- Diagnostic: For examining stomach contents.

Gastric Tube Locations

Nasogastric (NG tube): Placed in the stomach area, usually through the nose.
Nasoduodenal: Tube passes through the pylorus, into the duodenum.
Jejunostomy (J tube): Tube inserted into the jejunum, a part of the small intestine.
Gastrostomy tube (PEG tube or G tube): A tube surgically placed into the stomach.
Orogastric: Tube placed through the mouth, ideal for patients with facial trauma or skull fractures.

Contraindications

Absolute Contraindications:
- Facial trauma: Avoid NG tubes due to the risk of skull puncture.
- Esophageal trauma: Putting tube in the esophagus can cause damage.
- Cranial trauma: Tube insertion can risk brain injury.
- Birth defects involving cleft lip or palate (pediatrics): Uncertain tube placement.
Relative Contraindications:
- Coagulation abnormalities: Monitor PTT, PT/INR, H&H, CBC, and platelet count.
- Esophageal varices or strictures: Use caution and confirm placement with radiographs.
- Ingestion of alkaline substances: Avoid NG tubes as the substance can be regurgitated, causing further damage.

Three Major NG Tubes

Salem Sump: A large-bore tube used primarily for decompression.
Levine: A tube mainly used for short-term feeding.
Dobhoff: A smaller-bore tube suitable for long-term feeding.

Nasogastric Tube (NGT, NG Tube)

Measured by French System: A system used to indicate the outer diameter of catheters (smaller number = smaller diameter).
Short-term use for feeding, decompression, or lavage.
Size varies based on age:
- Neonates: 4-8 Fr
- Pediatrics: 6-14 Fr
- Adults: 12-18 Fr

Salem Sump Tube

Thick, rigid tube, potentially uncomfortable.
Ideal for Decompression: Removes air, distension, or fluids.
Blue Pigtail: Allows air in to prevent a vacuum.
Keep above the abdomen or heart to prevent reflux.
Two lumens:
- One for air intake.
- One for suction.
Continuous low wall suction usually set at 80-120 mmHg.

Levine Tube

Ideal for Short-term Feeding: Up to 4 weeks.
Routinely flush with 30 mL of sterile tap water every 4 hours.
Includes a bumper to prevent skin irritation.

Principles for Practice

Placement depends on:
- Purpose of the tube.
- Duration of use.
- Patient condition: Assess respiratory issues, facial trauma, coag panels, aspiration risk, GERD.

Complications

Minor:
- Nasal irritation.
- Epistaxis (nosebleeds).
- Sinusitis (risk increases with time and tube size).
Major:
- Pneumothorax (from incorrect placement).
- Tracheobronchial aspiration (from incorrect placement).
- Pneumonia (from incorrect placement).
- Intracranial intubation.
- Trauma (to nares, larynx, esophagus, mucosal lining).
- Death.

Inserting a Nasogastric Tube

Required:
- Provider order.
- Labs: Coag panel and electrolytes.
- Patient assessment: Check mouth, nose patency, abdominal issues, bowel sounds.
- Education: Explain procedure, potential sensations.
- Equipment: Gloves, Salem sump tube, penlight, tape, marker, piston syringe, Emesis basin, lubricant, pH strips, tincture of benzoin, water.
Position Patient: High Fowler's position.
Measurement: Mark the stopping point on the tube.
- Adult: Tip of nose to earlobe, down to xiphoid process.
- Neonate: Tip of nose to earlobe, down to the umbilicus.
Equipment Preparation: Lubricate the tube.
Insert the Tube: Slowly and gently, keep patient comfortable and safe.
Secure the Tube: Secure with tape.
Assess PH Confirmation: Use a piston syringe to inject 20 mL air, aspirate gastric content, and check pH.
Send for X-ray Confirmation: The gold standard for placement verification.

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Description

This quiz covers the various types of enteral tubes used in medical settings, including their purposes and insertion sites. Topics include gastric tube locations such as nasogastric, nasoduodenal, and gastrostomy tubes, along with their functions in patient care. Test your knowledge on enteral feeding techniques and tube management.