enteral tubes Flashcards
enteral tubes
aka gastric tubes
tubes that can be placed in the GI tract when a patient is unable to ingest food, but is still able to digest food and absorb nutrients.
parental nutrition vs enteral tubes
with parental nutrition the patient is unable to ingest, digest, and absorb nutrients.
why would we insert an enteral tube?
- gavage
- decompression
- compression
- lavage
- diagnostic
Gavage
- giving food or medications through a tube when a patient cannot swallow but they have normal bowel fxn.
- preferred over perantal nutrition because is utilizes bowel fxn.
- the tube allows for administration of medication and nutrients throught the GI tract.
Decompression
- the means to remove gas (air), acidic secretions or other substances through the stomach by a prescribed amount of suction applied to the tube.
- relives nausea and vomiting, gaseous abd distention, and helps prevent aspiration.
- indications: an intestinal obstruction (illeus) a temporarilly paralyzed section of the bowel; a cancerous tumor which is ong term
- a person who has undergone surgery and anesthesia and their bowel has not yet recovered (paralytic illeus)
- -
- places pt at risk for electrolyte depletion
compression
- pressure applied by a nasal gastric tube and an inflated balloon to stop bleeding in the esophageal or gastric area
- esophageal varacies (large bleeding pockets of tissue or ulcers)
- ice saline and pressure is applied with a memometer
adds pressure to stop bleeding
lavage
- to wash out stomach contents
- bolus of normal saline that is later suctioned back out
- indication ( ingestion of a posionus substance) to help with the acidity and the erosion it may cause within the GI tract.
diagnostic
evaluate a patients swallowing or gastric ph
gastric tube locations
- nasogastric (NG tube)
- nasoduodenal
- jejunostomy (J tube)
- gastrostomy tube (PEG tube or G tube)
nasogastric (NG tube)
- enters the nose and passes down until the stomach
nasoduodenal
- enters the nose and passes the stomach into the intestine until the duodenum
nasointestinal tube
enters through the nose and teminates down in the intestine
- pnemonia patients, gerd, copd, asthma, breathing diffulculties, or regurgetates a lot
orogastrict tube
enteres through the mouth and terminates in the stomach
- for patients with a contraindication of a tube entering through the nasal cavity
- if they have had nasal or facial trauma
jejunostomy ( J tube)
surgical incision made into the intestine
- used for long term feedings
Gastrostomy tube (PEG tube) (G tube)
surgically making an incision at the stomach to insert a tube
- used for long term feedings
contraindications of tubes
absolute
- facial trauma:
- esophageal trauma
- cranial trauma: thin fragile bones = high risk for bleeding
- birth defects = cleft lip/palate (pediatrics)
- surgery: dont want to compramise a pts airway and to risk the tube percing the thin fragile bones of the face or the cranial cavity
relative
- coagulation abnormalities: pts on heparin or warfarin (PT or pTT is elevated) monitor coagulation panels, platelets, CBC before insertion
- esophageal varices or strictures: depending on severity
- ingestion of alkaline substances:
inserting a tube can cause bleeding as it enters into sensitive, thin tissue cavites and can cause abrasions and scarring
when inserting an NG tube it inhibits the cardio esophageal sphinchter from closing completely and cause reflux of the alaline substance
the three major tubes
- salem sump
- levine
- dobhoff
nasogastric tube (NGT, NG Tube)
- Measured by French System: A system used to indicate the outer diameter of catheters (small number = small diameter)
- 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)
**
- short term use: 1-2 weeks; 14 days maximum
- use the smallest tube intended for the purpose
salem sump
- double lumen large bore tube
main lumen: containe islets that allows the contents in and out - air vent: (blue pigtail) prevents the suctioning of gastric mucousa from entering into the islets by letting in atmospheric pressure to prevent the adherence of the tube to the gastric wall.
- when connected to suction (80-120 mmHg) the airvent allows for free flowing continous drainage of secretions
- never irrigate the pigtail, insert fluids other than air
- air (20 mL) may only be inserted into the pigtail to irrigate and check patency
- keep the (blue pigtail) above the abdomen at all times to prevent reflux of gastric secretions or contents
- uses: decompression, feeding, lavage, medication administration
- pt may experience burning sensation as it is inserted as the tube is large and rigid
- check patients nares daily q shift for inflamation, blistering - monitor patient for electrolyte depletion because when removing gastric secretions you remove everything
- s/s or electrolyte depletion: hypokalemia, hypomagnesia, hyponatremia
levine
- single lumen tube
- uses: short-term feeding (1-14 days), medication administration
- wall suction: 40-80 mmHg
- flush: warm water
- high risk for migration and cause aspiration; monitor for s/s of migration
dobhoff
- small bore tube
- uses: short-term feeding (1-14 days), liquid medication administration
- tube is to small for medication administration that needs to be crushed because it will clog, need liquid form of medication for tube
- guidewire: aids in insertion, after x-ray confirmation it is removed and is never reinserted. (high risk for pulmonary and/or esophageal punture)
- tungsten weighted
- flush: warm water
- intestine placed: physican using xray
- stomach: nurse or physician
nasointestinal, post pyloris
non-nasogastric tubes
Gastrostomy Tube (PEG Tube, G-Tube)
- placed in the stomach
Jejunostomy Tube
- placed in the intestines
- long tem use (greater than 4 weeks)
uses: long term bowel rest, tube feeding, med administrations, pts who had a stroke
placed using light source during surgery
contraindications: pt with facial trauma fragmentation, trauma to the skull, swallowing issues (high risk for pulmonary aspiration)
monitor the skin: keep clean and dry
small amount of bleeding is normal right after insertion
clean with warm, soapy water and cover it with gauze