Enteral Access and Nutrition Flashcards
Where can Enteral Access Devices (EAD) be inserted?
-nasally
-orally
-percutaneously through the abdomen
What are the types of EAD?
-nasogastric tube (nose to stomach)
-orogastric tube (mouth to stomach)
-gastrostomy (tube in abdomen exiting from stomach)
-jejunostomy (tube in abdomen exiting from small bowel)
Purposes of EAD?
-decompression/removal of gastric contents
-nutrition (gavage)
-medication administration
-GI lavage
-specimen collection
-compression
Describe GI lavage
fluid is instilled through an NG tube then aspirated or suctioned out to wash out the stomach contents; it’s an uncommon procedure
How long is the PVC NG tube good for?
max of 5 days– but ones made of silicone can stay in the body for up to 30 days
In what cases are oropharynx’s (OGs) used?
ICU, ER, OR, NICU
What is important to know about a single lumen tube?
-also called a Levin
-if using suction, use the suction intermittently as constant suction can cause mucosal trauma/ulcers
What is important to know about double lumen tubes?
-also called a salem sump (brand name)
-can use continuous suction because the double has a small second vent lumen
-has an anti-reflux valve attached to the end of the vent lumen; the valve makes a quiet whistle
-the vent lumen should be kept above the level of the stomach, or it can act as a siphon and it should NOT be used for suction, med admin or irrigation and NEVER clamp it off
What are the contraindications to NG/OG tube insertion?
-esophageal varices (dilated, enlarged vessels in distal esophagus that rupture and bleed)
-recent ENT or gastric surgery
-nasal or skull fractures
-CA of head, neck or esophagus (cancer)
-sinusitis
-epistaxis (nosebleed)
-coagulation disorder (ex. high INR)
How many attempts are allowed per person to insert a tube?
2 tries per person
What test is considered the gold standard for confirming tip placement?
x-ray
How often should you check tip placement for a tube?
every 8 hours
When should you check tip placement?
-q8h
-prior to instilling anything into the tube
-after any episode of coughing/retching/gagging/vomiting
-if there is any evidence of tube dislodgement
-presence of new/unexplained respiratory symptoms
-when in doubt
How often should an NG tube be irrigated?
q4h with small amounts of water (30mL)– may also want to irrigate the BG tube if there is a new onset of increased abdominal distention, pain, nausea, decreased or no output to determine if the NG tube is patent
if using a Salem Sump with ARV, after irrigating remove ARV and inject 10-20 mL of air into sump vent lumen and replace ARV (this maintains patency, irrigation of suction lumen may cause contents to backflow into sump vent lumen)
How should you measure a tube for insertion?
measure from nose to ear to xiphoid and then add 10cm for the tip to be in the stomach
What are the indications for enteral nutrition?
-cancer of the head, neck or upper GI tract
-critically ill
-neuromuscular disorders
-GI disorders
-eating disorder
-mental health disorder
What are the contraindications for enteral nutrition?
-intestinal obstruction
-paralytic ileus
-severe diarrhea
-high output enterocutaneous fistula
-shock
-prognosis does not warrant aggressive nutritional support
How should formula be given?
given at room temperature, shaken well, and not expired
How long can formula sit for?
a max of 4 hours– so only pour 4 hours worth of feed into the feeding bag
How often should equipment be replaced?
every 24 hours– includes feeding bag, syringe, grad used for water, etc. except in home care setting where equipment may be rinsed out/kept in fridge
How do you confirm placement of tube before accessing tube?
-measure external length
-gastric aspirate and check pH
-check for clinical signs of tube dislodgement (changes in respiratory status)
What are the complications of enteral access devices (EAD)?
-aspiration
-aspiration pneumonia
-clogged tube
-irritation of nares or skin around tube exit site
-refeeding syndrome
What is refeeding syndrome?
-metabolic disturbance that occurs as a result of reinstituting nutrition (happens when pt hasn’t eaten in >10 days)
-pt in catabolic state which means they can develop a fluid/electrolyte disorder when nutrition is reintroduced
-blood work needs to be closely monitored
-those that are receiving chemo, malnourished, elderly, those with alcoholism and anorexia are the more at risk
