Gastrointestinal Intubation Flashcards
What is intubation?
Placement of tube into body structure
What is an ostomy?
A surgically created opening
What are the 4 categories of gastrointestinal tubes?
- Orogastric
- Nasogastric
- Nasointestinal
- Transabdomenal
Example of and use of an orgastic tube. Physical characteristics
Ewald- lavage or removal of debris, toxic material in stomach -large diameter/single lumen
Two examples of Nasogastric tubes
Levin tube and Salem sump
Characteristics and use of Levin tube
Single lumen, small diameter, used for decompression, lavage, lavage and diagnostics
Characteristics and use of Salem sump
Double lumen, small radius, used for decompression
What is the purpose of a double lumen?
To prevent stomach adhesion and blockage of drainage ports during suction
What are risks of prolonged use of nasogastric tubes?
Tissue breakdown, dilation of cardiac valve which leads to gastric reflux which leads to aspiration
What are the 6 reasons for intubation?
- Gavage 2. Lavage 3. Gastric residual for diagnostics 4. Decompression 5. Compression/Tamponade 6. med administration
What is Tamponade?
Controlling of gastric bleeding via compression
Two functions for nasointestinal tubes
- gavage 2. decompression
Two types of nasointestinal tubes
- Keofeed 2. Maxter
Use and characteristics of Keofeed
Gavage, small diameter with weighted tip
Use and characteristics of Maxter
Decompression, double lumen with tungsten weighted tip
Typical duration of Keofeed?
4 weeks or longer
Advantages to keofeed?
Reduce gastric reflux, able to stay in place for long durations
disadvantages of keofeed
Long and thing so they curl easily
How is a Maxter tube placement monitored and what aids its placement?
radiopaque tip via x-ray and via peristalisis
Two types of transabdominal tubes
- Gastrostomy tube
2. Jejunostomy tube
What does PEG tube stand for?
Percutaneous endoscopic gastrostomy tube
How is a PEJ tube inserted?
Through a PEG tube
When are transabdominal tubes preferred?
When alternative to oral feeding is required for more than 1 month
3 major functions of the nurse in tube management
- insertion of tube
- Maintain patentcy
- removal of tube
How can the nurse calm an anxious client prior to tube insertion?
Have client establish hand signal to indicate a pause to facilitate some form of control
What are the 7 aspects of the Preintubation assessment?
- level of consciousness
- weight
- bowel sounds
- abdominal distention
- integrity of nasal and oral mucosa
- ability to swallow, cough and gag
- nausea and vomiting
What do assessment serve as?
A baseline for future comparisons
Related to the nose, a major goal of the preintubation assessment is?
To establish which nostril is better suited for insertion
What excludes a nostril from being used?
Deviated septum, nasal polyps or narrow nasal passage
How does a nurse perform tube measurement?
NEX
NEX stands for
Nose. Earlobe. Xiphoid
What are 3 methods for assessing stomach placement?
- Fluid aspiration
- Auscultating the abdomen
- PH Testing of aspirated liquid
Which colors should aspirated gastric fluid be?
Yellow, green, brown
What is auscultation of the abdomen?
Instilling 10ml of air into tube, placement of bell over stomach to listen for swoosh sound
What is an indicator that tube-end might be in the esophagus?
Belching
What are the two types of performed suction?
- continuous
2. Intermittent
Low pressure suction values are usually between?
40 to 60 mm Hg
How can a nurse promote tube patentcy on a client that is NPO?
Providing ice chips or sips of water
What is the potential disadvantage of ice chips/ water administration when trying to maintain tube patency?
Water is hypotonic so to much which will draw electrolytes into gastric secretions to be suctioned out
Can a nurse perform a tube irrigation?
Not without a medical order
Unobstructed larger diameter tubes are usually removed and changed every
2-4 weeks
Unobstructed smaller diameter tubes are usually removed and changed every
1-3 months
How does the NEX measurement of a nasointestinal tube differ to a nasogastric?
Addition of 9 inches (23 cm)
During nasointestinal tube insertion, which syringe is used to aspirate fluid?
50-mL syringe
Durring nasointestinal tube insertion, when does the nurse tape the tube to the nose?
When the third mark on the tube is reached
Why is a larger syringe perfered to a smaller one for fluid aspiration?
Larger one produces less negative pressure during aspiration and this provides more fluid for testing
What are 4 causes for gastrostomy leaks?
- Clamped G-tube while tube feeding is infusing
- Mismatch between stoma and G-tube
- Increased abdominal pressure from formula accumulation, sneezing, coughing
- Underinflation of balloon beneath the skin
Benefit to instilling nutrients into the stomach
Reduction of enteritis (inflammation of intestines) since gastric juices destroys microorgansims
Disadvantage to instilling nutrients into the stomach
Increased risk of gastric reflux ( increased volume within stomach)
Advantage to intestinally placed tube
Reduced risk of gastric reflux
Disadvantage to intestinally placed tube
Dumping syndrome
What is Dumping syndrome?
When calorically dense content is placed into intestines, low blood glucose arise because of insulin surge
Symptoms of dumping syndrome
Naseua, sweating, weakness, dizziness
List 4 activities with gastrostomy management
- Daily inspection of skin around tube
- Making sure sutures are in tact
- Apply skin barrier ointment (zinc oxide)
- Rotate bumper 90 degrees once a day
What are the 4 feeding schedules?
- Bolus feeding
- Intermittent feeding
- Cyclic feeding
- Continous feeding
Describe bolus feeding
liquid infusion less than 30 minutes of 250-400 mL per administration 4-6 times a day.
Disadvantage of bolus feeding
Causes abdominal distention, high risk for gastric reflux and aspiration
Describe intermittent feeding
Liquid infusion 4-6 times a day of 250-400 mL per administration for 30-60 mL
What is a key requirement of intermittent feeding?
Container and feeding tube needs to be flushed throughly after each feeding to reduce microorganism growth
How often are feeding tube sets replaced
Every 24 hours
Describe Cyclic feeding
infusion for 8-12 hours followed by 12-16 hour pause
When is cyclic feeding usually used and what time is it given?
To wean clients off of tube feeding and late evening and sleeping
Describe installation rate of continuous feeding
1.5 mL/minute
Continuous feeding is fed into where?
The small intestine
Benefit of continuos feeding
Reduces risk of gastric reflux since formula is fed directly into intestine
What are key aspects of the daily nursing assessment following tube insertion?
- Weight
- Condition of nasal oral mucosa
- Fluid intake and output
- Bowel sounds
- Lung sounds
- Vomiting naseua
- Bowel patterns
- Abdominal distention
- Skin around ostomy
What is a mandatory requirement of the nurse to obtain once feeding schedule has started?
Gastric residual
Purpose of obtaining gastric residual
To determine wether fluid intake exceeds client’s physiological capacity
What is the rule of thumb of obtaining gastric residual?
Should be no more than 100 ml or 20% of the last hours feeding volume
What action is performed if gastric residual is higher than normal?
STOP feeding, recheck residual every 30 minutes until normal volume
What is the best way to maintain tube patency?
Flush tube with 30-60 mL of water prior and after feeding (every 4 hours if on continuous feed)
What liquid can be used to flush a tube other than water?
Cranberry juice
What are two ways to clear tube obstruction and what is required from both of them?
- Meat tenderizer
- Pancreatic enzymes
Both require medical order
How much water does an adult client require?
30 mL of water per kg of bodyweight
Steps to clearing obstructed tube
- Choose 50 mL syringe
- Wash hands
- Don gloves
- Aspirate as much as possible from tube
- Instill 5 mL solution
- Clamp tube and wait 15 minutes
- Aspirate and flush with water
When, why and how long do we ambulate the patient on which side?
After assessing that the nasointestinal tube is in the stomach, to aid the weighted tip in traveling through the pyloric valve and for 1 hour on the right side
