Enteral Tubes.pdf

Enteral Tubes What are Enteral Tubes? Placed in the GI tract Why Insert Enteral/Gastric Tube? Preferred over TPN/PPN Gavage: bypass the mouth, giving food or meds through tube, need normal bowel functioning, problem with swallowing Decompression: remove gaseous air or other substa...

Enteral Tubes What are Enteral Tubes? Placed in the GI tract Why Insert Enteral/Gastric Tube? Preferred over TPN/PPN Gavage: bypass the mouth, giving food or meds through tube, need normal bowel functioning, problem with swallowing Decompression: remove gaseous air or other substances from the stomach o They will pump you full of air to displace your organs Compression: GI bleeding, esophageal varices, NG tube manometer that causes pressure Lavage: washing out stomach contents, overdose or poison ingestion Diagnostic Gastric Tubes Locations Bypassed stomach = slow motility, increased risk for aspiration, increased risk for pneumonia, esophageal reflux Nasogastric (NG Tube): in stomach area, surgically place Nasoduodenal: post pyloris Jejunostomy (Jtube) Gastrostomy Tube (PEG Tube or Gtube): in stomach are a, surgically place Orogastric: placed in the mouth, had facial trauma or skull fracture Contraindications Absolute Facial Trauma: No NG tubes b/c thin fragile bones and the risk of brain puncture Esophageal Trauma Cranial Trauma Birth Defects=Cleft lip/Palate (pediatrics): don’t know where the tube will go Relative Coagulation Abnormalities Monitor PTT, PT/INR, H&H, CBC and platelet count Nose is thin, dry and at risk for bleeding Esophageal Varices or Strictures Use caution and look at radiograph studies Ingestion of Alkaline substances No NG tube b/c substance will come back up esophagus THREE MAJOR NG TUBES SALEM SUMP, LEVINE, DOBHOFF Enteral Tubes NASOGASTIC TUBE (NGT, NG TUBE) Measured by French System: A system used to indicate the outer diameter of catheters (small number =small diameter) o Foley is also measured in the French system Short term use (feeding, decompressing or lavage) Neonates: 4-8 Fr Pediatrics: 6-14 Fr (21-39 inches in length) Adults: 12-18 Fr (42-55 inches in length) Want the smallest tube for the intended purpose Salem Sump Tube Large bore tube: thick rigid tube and is uncomfortable o May cause gagging, burning, stinging, coughing during insertion Ideal for Decompression (main purpose): to remove air, distension or fluids Can be used for feeding In and out method Never put anything in the blue pigtail o Allows atmosphere air in to prevent a vacuum Keep it above the abdomen or the heart to prevent reflux of gastric contents 2 lumen o 1 = lets atmosphere air in o 2 = pulls things out o Risk with suction: electrolyte imbalances o Monitor for bleeding/nasal irritation and electrolytes o Hook on suction (80-120): continuous low wall suction Levine Tube Ideal for Short-term Feeding: 4 weeks JEJUNOSTOMY TUBE o In the intestines o Increased risk for aspiration, GI issues and GERD For stroke or brain injury patients Routinely flush with 30 mL of sterile tap water every 4 hours or PRN There is a bumper between the tube and the skin No drainage dressing underneath – this is too much pressure and could cause a fistula Principles for Practice Placement depends on: Purpose Duration: long or short term Patient condition o Do they have respiratory issues or facial trauma? o What are the coag panels? o Are they at risk for aspiration or pneumonia? o Do they have GERD? Nurses preference Complications Minor Nasal Irritation Epistaxis: nasal mucosa is irritated Sinusitis: the risk goes up the longer the tube is placed and also how large the tube is Major Pneumothorax: from wrong placement Tracheobronchial aspiration: from wrong placement Pneumonia: from wrong placement Intracranial Intubation Trauma (Nares, larynx, esophagus, mucosal lining) DEATH!! – lung puncture or go into the brain  Enteral Tubes Properly placed tube inside of the gastric region Malplaced tube into the lung possibly from gagging Inserting a Nasogastric Tube Provider Order Labs: coag panel and electrolytes Patient Assessment: mouth (dentures, loose teeth), nose for patency, abdominal issues, auscultate bowel sounds Education: why and what to expect such as stinging or burning during insertion Proper Equipment CXR post procedure if inserted blindly (at bedside) Equipment needed Gloves Salem sump Penlight for inspection Tape to secure Marker to mark the tube Piston syringe Emesis basin Lubricant pH strips tincture of benzoid to help adhere the tape water Extra Equipment Lopez Valve: stop cock with feedings/ flushing/ manipulating the tube NGT Insertion Steps o Perform Abdominal Assessment o Inspect Nares for patency o Inspect oropharynx o Educate Patient o Gather supplies o Position Patient High Fowlers – if they are comatose or have a decreased LOC 45 degrees will be okay o Measure for NGT insertion length: mark the stopping point o Adult: tip of the nose to the ear lobe/tragus to the xiphoid process o Neonate: tip of the nose to the earlobe and down to the umbilicus o Prepare equipment o Insert tube – lubricate first Enteral Tubes o Secure tube – with tape o Assess PH confirmation o Use a piston syringe and to push in 20 mL of air, pull back (aspirate) for gastric content, put on pH tape o Send for X-ray Confirmation – gold standard Tube feeding will skew pH PPI – decrease gastric acid, sample might not be the best indicator, increase pH Gastric content – pH 1-3 for a fasting patient but definitely