Enteral tubes

Question 1

What are 2 Enteral tubes we see in skills 2?

Answer 1

1. GT (gastrostomy tubes)
2. NG (Nasal-gastro)

Question 2

What are the 3 types of GT tubes?

Answer 2

1.Percutaneous endoscopic gastrostomy or jejunostomy (PEG or J-PEG)
2. Balloon gastrostomy
3. Jejunostomy tube

Question 3

Which tube is used for long term feeding needs like >4 weeks?

Answer 3

GT

Question 4

How is GT tube inserted?

Answer 4

surgically

Question 5

Which tube is used for shorter term feeding like <4 weeks ?

Answer 5

NG

Question 6

How is NG tube inserted?

Answer 6

nurse at bedside

Question 7

Why are Enteral tubes sometimes indicated?

Answer 7

1. Abdominal decompression (temporary)
2. Enteral feeding/nutrition

Question 8

What are examples of Abdominal decompression?

Answer 8

1. drug overdose
2. GI bleed lavage (test to see if they have a GI bleed)

Question 9

What diagnoses may require enteral feeding/nutrition?

Answer 9

1. cancer (head and neck)
2. critical illness
3. stroke
4. dementia
5. pancreatitis
6. anorexia

Question 10

What are the 3 checks before starting Enteral nutrition ?

Answer 10

1. Nutritional assessment consult with RD
2. a medical order
3. contraindications awareness

Question 11

What 4 things does an RD do in the nutritional assessment consult?

Answer 11

1. initial nutritional assessment
2. enteral formula recommendations
3. goal rate of feeding
4. ongoing monitoring of nutritional status

Question 12

What is required in the medical order for enteral nutrition?

Answer 12

1. the type of formula requested
2. Initial flow rate
3. Progression rate
4. Goal rate
5. Route (NG, GT, etc)
6. volume and frequency of free water flushes per 24 hrs

Question 13

What are 4 examples of contraindications to Enteral feeding

Answer 13

1. perforation of GI tract
2. Gastrointestinal ischemia (hemodynamically unstable)
3. Bowel obstruction
4. inability to access GI tract

Question 14

When is continuous administration indicated?

Answer 14

When the goal is to catch the person up with nutrition (starting out)

Question 15

Which method of administration is used for small bowel feeds?

Answer 15

continuous (b/c need smaller amounts and consistent amounts)

Question 16

Which method of administration has a low risk for abdominal distension, aspiration?

Answer 16

Continuous

Question 17

Which is the highest risk for abdominal distention, aspiration?

Answer 17

Bolus

Question 18

Which method of administration is delivered by pump?

Answer 18

continuous

Question 19

Which method of administration is pump OR gravity?

Answer 19

intermittent

Question 20

Which method of administration is delivered by syringe?

Answer 20

Bolus

Question 21

What is GRV?

Answer 21

Gastric residual volumes

Question 22

When do we stop feeding immediately?

Answer 22

overt regurgitation
suspect aspiration

Question 23

How far should we put an NG tube?

Answer 23

nare to the end of the purple port

Question 24

How far should the GT be?

Answer 24

bolster to end of feeding port

Question 25

What kind of tubes should we not be aspirating ?

Answer 25

small bowel feeding tubes

Question 26

How many hours before eating is pH of gastric contents valid?

Answer 26

4-6 hours prior

Question 27

What 2 things make gastric pH readings invalid?

Answer 27

1. food 2. antacids

Question 28

how does tube occulsion occur?

Answer 28

med admin with crushed medsho

Question 29

What are ways to identify tube occlusion and how do we fix it?

Answer 29

1. you can't get liquid in (tube occluded) - -viokase + bicarb solution - replace tube 2. tube displacement - get a longer tube 3. decreased LOC, delayed gastric emptying, HOB not elevated for feeds >30 degrees, vitals show signs of aspiration, infection -stop immediately -notify MD -monitor vitals, RR, sputum etc - reassess tube placement 4. Diarrhea - feed intolerance - notify MD and dietician - maybe change formula or rate - monitor perineal skin integrity - fluid status/electrolytes

Question 30

Why are low profile devices (Mic-Key) helpful?

Answer 30

1. good for kids/people who pull it out 2. decreases likelihood of pyloric obstruction from inward migration of the tube 3. anti-reflux valve 4. ca be replacement device after stoma tract has healed 5. uses "key" as an extension to help with feeds

Question 31

Steps to feeding

Answer 31

1. prepare food 2. measure external tube 3. assess skin around bolster 4. pH strips (if continuous or often then maybe pH will be thrown off) 5. HOB 30-45 degrees - 90 degrees is best 6. water (usually tap water) for pre/post feed (dietition tells us) 7. patients tolerance for the feed - bowel sounds, distention, aspiration (SOB/RR/cough/ etc) - GRV site specific 8. GRV check q4 hrs (continuous) < or = 200ml gr can be refed - monitor again in 4 hrs. if >200ml discard and stop TF 9. gloves

Question 32

pump feed steps

Answer 32

1.prime the tube 2.drip chamber should be ½ - 1/3 full 3. towel/blue pad 4.set pump rate – like 20ml/hr – VTBD 80ml/4 hrs 5. set the tube and open the chamber 6.gloves 7. kink tube and attach to port then hit start 8. monitor discomfort, distention, vomiting, aspiration etc.

Question 33

water flush measurments pre and post meds

Answer 33

15-30 mL of warm water before administering meds 5-10 mL between meds 15-30 mL water after last medication

Question 34

what size syringe do we use and why?

Answer 34

60mL min. to avoid too much pressure and tube rupture