Enteral Tubing and Nutrition Flashcards
Tubing based on destinations
Nares to Stomach
Nasogastric (NG) tube
Dobhoff (NG) tube = difficult too small liquid
Tubing based on destinations
Nares to Small Intestine
Nasoduodenal tube
Nasojejunal tube
Surgical operation
with Tubes and Destinations
Gastrostomy (PEG) - stomach
Jejunostomy (J)tube - small intestines
PEG full name
Percutaneous Endoscopic Gastrostomy
PEG
-Long lasting
dysphagia
cancer/radiation affecting GI Tract
neurological deficit
bowel disease/dysfunction
cranio-facial abnormalities, trauma
malnutrition concerns
Tube vs. Button
Tube= abdomen and PEG showing catheter fixation
Button= abdomen and balloon fixation of low profile gastrostomy device
Once a tube has been placed, what is critical
confirmation
How do you confirm tube placement?
Xray is gold standard for initial confirmation
Always access placement by
measurement of tube
How long does it take to insert a NG tube
20-30 mins
Deviations of Tubing Length
(increases / decreases)
increase in length possibilities
-from intestines into stomach
-stomach into esophagus
-into lung
decrease in length possible
-stomach into intestines
What do you do before administering ANY meds or feedings
Qualified Nursing Actions
S/S of intolerance
Document findings
Follow agency policy
PEG value is aka
Lopez valve
Enteral Meds must be in
liquid or powder form via pill crusher
DO NOT CRUSH PO
EC
SR/SA/TR/CR/XL/XR
SL
Bucc
Preparation Rules
Know meds
-correct part of delivery to GI tract
Ask allergies
FINE Powder if need to crush (15-15-30)
How to give Enteral Meds
1)In med room, prepare each crushed/liquid medications in their individual label
2)Take med sleeves and pill packaging with you for verifying and scanning
3)At the bedside, mix each med individually with 15 mL sterile water
4)Confirm tube patency by gently flushing the gastric tube with 15 mL of sterile water
5)Pinch/Clamp proximal end of gastric tube each time to prevent air from entering the stomach
6)Attach syringe to the feeding tube
7)Pour dissolved meds and allow for gravity to flow through tube
8)Flush with 10 mL between each medication to prevent drug interactions
9)After administering final meds, flush with 30 mL of sterile water
10)Leave HOB elevated for 30 minutes
Before Proceeding Assess the pt’s GI system
bowel sounds
location of enteral tube
feeding in progress and hold
Prevent Infection
initially thin gauze btw Gtube or Jtube external disk
clean site regularly
monitor skin for breakdown, drainage, yeast infection, replace bumper
Closed system
Ready Made
nutrition solution added during manufacturing
-can’t be opened
-safely hang for 24-36 hours
more common
Open system
Rehab long term
nutrition solution prepared by urse at bedside
Both open and closed systems are administered via
enternal pump
Continuous infusions
administered over 24 hours periods using enteral pump
-initial dose full strength at slow rate and increase 8-12 hours until goal reached
HOB elevated at all time 30 degrees
Cyclic Nutrition
continous in less than 24 hours
often at night
may eat during the day
flush with 30 mL of sterile water when finished
HOB at 30 degrees
Intermittent
feedings usually begin full strength at specified vol
5-8 times per day
Administered over at least 30 mins via pump or syringe
provides needed cal and vol in 4-6 times a day
Elevate HOB at least 1 hour after feeding
Bolus
syringe used to deliver formula into stomach by gravity
raising and lowering syringe regulated flow
delivered more rapidly than intermittent
HOB up at least 1 hour
flush 30 mL of sterile water
High Risk
diarrhea
nausea/vomiting
gas/bloating/cramping
constipation
dehydration
hyperglycemia
aspiration
Biggest Risk of Enteral Nutrition
Aspiration
Signs and Symptoms of Aspirations
cough
SOB
Gurgling
rapsy voice
What to do if suspect aspiration
stop feeding
elevate bed
turn on the right side
notify physician
check placement based on order
what to do for Adult tube feeding intolerance
stop feeding
check constipation
notify physician
Adult tube feeding intolerance
Abdomenal signs ( distension, firm, tense, guarding, discomfort)
nausea (common)
-atiemetics, minimal narcotics, check for constipation
Emesis
hold feedings
check for constipation
notify
Gastric Residual Checks (20 mins on right side)
critical ill surgery/trauma pt, head injury, post-op abdomenal surgery, obtunded/vegetative state
When do you discontinue order for GRV checks
48-72 hours or if less than 500 mL and no abdominal signs present
Before proceeding with a feeding
access pt’s GI system (bowel sounds, location of tube)
HOB at 30 degrees
room temp feedings
primed tubing
Check placement
verify by Xray
aspirate to assess patency and gastric contents ig symptomatic
-Exception not jejunostomy tibe or Levine/dobhoff tube
measure contents and return
flush with 30mL sterile water
document findings
When do you STOP and don’t proceed, if giving enteral medications or feedings?
If greater than 500 mL residual
-return and flush with 30 mL
recheck in 4 hours
-if the same stop feeding and notify
Gravity feedings
HOB 30
connect device and administer via gravity flow slowly
flush with 30 mL
HOB up for 1 hr
Pump feedings
HOB 30
connect primed pump tubing
ensure pump rate as ordered
open clamp and start infusion
monitor gastric residual every 4 hours
flush per protocol
Metaclopramide/Reglan
gastroparesis, GERD, nausea, vomit
Ondansetron/Zofran
nausea and vomit
Nursing Interventions/Care
monitor constantly for intolerance signs
I&O
daily weight
oral care
monitor accu-checks carefully
always access tubes for correct placement and proper labeling
change prepared to feed every 8 hours and closed enteral feedings every 24 or when empty
Never let tubing go dry
aware of tubing when transferring or changing pt position
Skin irritation and infection prevention
thin gauze or external disk (bumper)
clean site regularly
monitor skin for breakdown, drainage, yeast infection, replacemtn
