Gastrointestinal System and Nasogastric Tube Feeding

Gastrointestinal System

• Provides the body with water, electrolytes, and other nutrients used by cells
• Functions to break down ingested food, propel food through the GI tract, absorb nutrients, absorb water and salts, and eliminate waste

Nasogastric Tube

• A gastrointestinal tube inserted into the stomach, duodenum, or intestine
• Indications: decompress the stomach and remove gas and fluid, lavage the stomach, diagnose disorders of GI motility, administer medications and feedings, treat an obstruction, compress a bleeding site, and aspirate gastric contents for analysis
• Contraindications: diffuse peritonitis, severe pancreatitis, intestinal obstruction, severe diarrhea and vomiting, and paralytic ileus

Enteral Nutrition

• Administration of nutrients directly into the GI tract
• Most desirable and appropriate method of providing nutrition is the oral route, but this is not always possible
• Nasogastric feeding is the most common route
• Contraindications: diffuse peritonitis, severe pancreatitis, intestinal obstruction, severe diarrhea and vomiting, and paralytic ileus

Types of Tubes

• Short tubes: passed through the nose into the stomach
• Medium tubes: passed through the nose to the duodenum and jejunum, used for feeding
• Long tubes: passed through the nose, through the esophagus and stomach into the intestines, used for decompression of the intestines

Equipment

• NGT (8-12 Fr)
• 60 ml syringe
• Tape
• Cup of water with straw
• Emesis basin
• Water-soluble lubricant
• Normal saline solution (for irrigation only)
• Safety pin
• Gloves
• Suction equipment
• Pen light
• Tongue blade
• Stethoscope
• Towel
• Gel

Procedure

• Assess the patient's need for NGT
• Get the patient's consent
• Assess the patient's nares, esophagus, and abdomen
• Check the gag reflex and mental status
• Gather equipment and wash hands
• Position the patient at 45°, or drape chest with towel or disposable pad
• Assess abdominal examination
• Determine the length of the tube to be inserted
• Lubricate the tube with water-based lubrication
• Insert the tube, encouraging the patient to swallow and advancing the tube downward and backward
• Check placement by asking the patient to talk, checking the mouth with a light and tongue blade, and securing the tube

Risks of Displacement

• Due to vomiting, suctioning, severe coughing, and moving/transferring

Removal

• Check the discharge order
• Instruct the patient to hold their breath
• Gently and smoothly remove the tube
• Document the removal

Foley Catheter Placement

• Indications: retention of urine, obstruction of the urethra, urine output monitoring, collection of a sterile urine specimen, nerve-related bladder dysfunction, and imaging study of the lower urinary tract
• Contraindications: use cautiously in patients with a history of pelvic or perineal trauma associated with perineal bruising and swelling and/or blood at the meatus, and urethral strictures or anatomically false passages

Risks

• The balloon can break while the catheter is being inserted
• Urine flow is blocked
• Infection in the urine increases with the number of days the catheter is in place