Exam 2: Chapter 44 - GI Intubation and Feeding Flashcards
What is GI Intubation?
The insertion of a flexible tube into the stomach, or beyond the pylorus into the duodenum or the jejunum
Why might a GI Intubation be performed?
Decompress the stomach and remove gas and fluid Lavage Diagnose GI Disorders Administer Tube Feedings Compress Bleeding Site
What are NG Tubes, and used for?
Introduced through the nose into the stomach, often before or during surgery, to remove fluid and gas from the upper GI tract by the process known as decompression
Commonly used gastric tubes?
Levin and the Salen Sump tube
What is a Levin tube?
Single lumen (channel within a tube or catheter) and is made of plastic or rubber
Why is a Levin tube used?
Connected to low intermittent suction (30-40 mmHg) to avoid erosion or tearing of the stomach lining
Why is a Salem Sump used
Tube is radiopaque, is clear plastic, double-lumen gastric tube
Inner, smaller lumen (blue port) vents the larger suction-drainage tube to the atmosphere by means of an opening at distal end.
seen on Xray. Kept at 25 mmHg to protect fragile mucosa
Salen Sump:Where should the blue lumen be placed?
It should be kept above the patients waist to prevent reflux of gastric contents.
One-way antireflux valve seated in blue pigtail can prevent reflux of gastric conents out of the vent lumen
Where are gastric tubes that are used for decompression and drainage mounted? And what care should the nurse make?
Connected to a wall mounted suction regulator and canister or to a suction machine.
Suction should be set at right pressure and drainage assessed. Ensure that oral and nasal hygiene maintained.
A short term orally or nasally placed feeding tube should stay in place for no longer than
Four weeks before being replaced with a new tube
Why are gastric or enteric feeding tubes used?
Used for patients who have the ability to receive and process nutrition, fluids, and medications adequately by the gastric route
A pt with gastroparesis (reduced stomach motility), severe Gastroesophageal reflux disease, impaired glottic closure, or undergone partial or total gastrectomy or otherwise at risk for aspiration use what type of tube?
Nasoenteric Tube (In nose into small intestine) or oroenteric tube (from mouth to small intestine) for feeding can be used
What are nasoduodenal tubes?
Enteric tubes placed in the duodenum via the nares
What are nasojejunal tubes?
Enteric tubes placed in the jeunum via the nareas
Why may nasally inserted feeding tubes kink?
Because they are soft and pliable. They may kink when a stylet ( a stiff wire placed in a catheter or other tube that allows it to maintain its ahep) is not used during insertion
Enteric tubes are never inserted in those with?
Basilar skull fracatures, or those with maxillofacial surgery or facial trauma
What can be done if tube becomes obstructed?
warm water irrigation, milking the tube, infusing digestive enzymes, and employing mechanical declogging devices
Tubes used for enteral nutrition are attached to
Enteral delivery tubing or a syringe that contains the feeding formula. Can be connected continuously for pump feedings or intermittnetly so that end of tube may be capped between feedings
To maintain patency, tube is irrigated with water after every
feeding and medication delivery, and every 4-6 hours during continuous feedings or if the tube is set to gravity drainage or suction
How often should nasal tape be changed?
Every 3 days and as needed
What should you do if the nasal and pharyngeal mucosae are excesively dry?
Steam or cool vapor inhalations
Symptoms of fluid volume deficit in patients receiving enteral nutrition?
Dry skin and mucous membranes, decreased urinary output, lethargy, lightheadedness, hypotension, and increased heart rate
Assessment for patient recieving enternal nutiriton?
Accurate record of intake and output
This includes measuring fluid from intake from tube feeding and flushes , oral liquids, and IV fluids.
Aspiration pneumonia occurs when
regurgitated stomach contents or enteral feedings from an imporperly positioned feeding tube are instilled into the pharynx or the trachea
Those at risk are those older than 70, unable to protect airways, AMS, or other neurologic deficits
Head should always be elevaed 30-45 degrees. Position maintained for one hour afterwards
Signs and symptoms of pulmonary complications include
Coughing during administration of foods or medications
Difficulty clearing the airway
Tachypnea and Fever
Advantage of tube feedings over PN?
They are lower in cost, safer, usually well tolerated by patient and easier to use in extended-care facilities
Nasoduodenal or nasojejunal feeding is indicated when
When the esophagus and stomach need to be bypassed or when the patient is at risk for aspiration
What tubes are preferred for administration of medications or nutrition longer than 4 weeks?
Gastrostomy or jejunostomy tubes
What happens when a concentrated solution of high osmolality enters the intestine?
Water moves rapidly into the intestinal lumen from fluid surrounding the organs and vascular component.
Pt hasnt feelings of fullness, nausea, cramping, dizziness, diaphoresis, and osmotic diarrhea (dumping syndrome).
What is the dumping syndrome?
Physiologic response to rapid emptying of gastric contents into the small intestine, manifested by nausea, weakness, sweating, palpitations, syncope, and possibly diarrhea
What can dumping syndrome lead to
dehydration, hypotension, and tachycardia
Purpose of Enteral Feeding
Meets nutritional requirements when oral intake is inadequate or not possible, and the GI tract is functioning
Enteral Formulas contain how much water and more information about it
Contain 70-85% free water and are not designed to meet total fluid needs
What are Polymeric Formulas?
Tube feeding formula. Most common.
Composed of protien, carbohydrates, and fats in a high-molecular weight form and require that the patient has normal digestive function.
What are chemically defined or “predigested” formulas?
Contain easier-to-absorb nutrients
What are modular products?
A tube feeding formula. Contain only one major nutrient such as protein adn are suually to enhance commerically prepared products
Tube Feeding Administration Methods
Intermittent Bolus Feedings ; Divided into 3-4 feedings daily and can be given as quikcly as patient can tolerate, but are initiated slowly
Intermittent Gravity Drip ; Raising or lowering the syringe above the abdominal wall regulates the rate of flow. Administer feedings over 30 minutes or longer at desingated intervals by a reservoir enteral bag and tubing.
Continuous Infusion Cyclic Feeding; Delivery of feedings by a slow infusion over long periods. Portable lightweight pumps are available
What is cyclic feeding?
Alternative to the continuous infusion method!
Infused feeding is given by an enteral feeding pump over 8-18 hours. May be infused at night . Appropriate for those being weaned form tube feedings to an oral diet.
Whenever water is used to irrigate these tubes, it must be recorded as?
fluid intake.
Gastric Residual Volume exceeding what has thought to indicate feeding intolerance?
250-500 mL
To ensure patency and to decrease the chance of bacterial growth, sludge build-up, or occlusion of the tube, what is done?
At least 30 mL of water is given before and inter intermittent tube feeding and when checking the tubes
Tube Feeding: What is an open system?
Packaged as a liquid or a powder to be mixeed with water that is either poured into a feeding container or given by a large syringe. Feeding container hung on pole and tubing replaced every 24 hours.
Can be used for bolus feedings, intermittent feedings, or continuous drip. CAn be delivered by push, gravity, or pump.
Hang time in bag at room temperature should never exceed 4-8 hours.
Tube Feeding: What is an closed system?
Used a prefilled, sterile container of about 1 L of formula that is spiked with enteral tubing that allows hang time of 24-48 hours at room temperature. Must use pump control.
What do you do if a patient is Hypernutric?
You do not want to give them saline
How to prevent dumping syndrome
Slow the formula instillation rate to provide time for carbohydrtes and electrolytes to be diluted Administer feedings at room temperature Administer feeding by continuous drip REmain in semi-fowler 1 hour after feeding Instill the minimal amount of water needed to be flushed
Maintaining Adequate Hydration: How is this achieved?
Water flushes given every 4 hours and after feedings to prevent hypertonic dehydration.
What is a Gastostomy?
A procedure in which an opening is created into the stomach either for hte purposoe of administering nutrition, fluids, and medications via a feeding tube or for gastric decompression in patietns with gastroparesis, gastroesophageal reflux disease, or intestinal obsturction
Gastrostomy is preferred over a nasally inserted tube to deliver enteral nutrition support longer trhan / also preferred because
4 weeks
Also preferred in those who are comatose because the gastroesophageal sphincter remains intaact, making regurgitation and aspiration less likely
How many Balloon and Non-Balloon Gastrostomy tubes (G Tubes) be placed?
Surgically, endoscopically, or fluroscopically
How is a G Tube placed?
Requires an abdominal incision and either a permanent gastric stoma (an artifically created opening) is created surgically that can be accesed with a feeding tube or a gastric stome is established that remians open as long as it remains intubated
How is a Percutaneous Endoscopic Gastrostomy (PEG) tube inserted?
Lighted endoscope inserted via mouth toward stomach then inflated with air. PEG tube guided down and goes out the stomach through the abdominal incision.
Internal fixaation bolster is pulled snug agianst the stomach wall. An external retention bolster is threaded down the tube and positioned snnug to the skin
Initial G Tube can be replaced after how much time?
Typically 6 weeks to 3 months
Routine replacement is needed how long for balloon G tube?
3-6 months
How long do you need to wait to replace a non-balloon G tube?
6-12 months
How often should the G tube be cleaned?
daily, with soap and water or 2% chlorhexidine gluconate and then dried throughly.
Alternative to G tubes that are bulky?
Low-Profile Gastrostomy Devices (LPGDs). Specific kinds include MIC-KEY or the Bard Button.
When are LPGDs inserted?
6 Weeks to 3 months after initial G tube placement or placed as the initial G tube.
Why are LPGDs used?
they are flush with the skin, eliminate the possibility of inward tube migration, have antireflux valves o prevent gastric leakage, and do not require tape or other securement devices.
Those requiring enteral nutrition are able to conceal feeding tube access site under their clothing. They need a special connection tubing.
What is a jejunostomy?
Surgically placed opening into the jejunum for the purpose of administering nutrition, fluids, and medications.
J Tube is indicated when
the gastric route is not accessible, or to decrease aspiration risk when the stomach is not functioning adequately to process and empty food and fluids
What is another way the small intestine can be acessed?
Placing a jejunal extension tube through an exisitng G tube and manipulating it through the pylorus into the small intestine endoscopically, fluroscopically, or during a surgical procedure.
What is a Orogastric tube??
A large-bore tube inserted through the mouth into the stomach that contains a wide outlet for removal of gastric contents
What tubes are used to treat bleeding esophageal varices?
Sengstaken-Blakemore and Minnesota tube
