GI - NG Tubes Flashcards
Aspirate
to remove fluids or gases by suction
Bolus
- a one time large dose
- meds, food
Carina
point at which trachea divides into right and left bronchi
What do you do if someone starts to cough and turn blue while you are inserting NG tube?
pull out and start over
What precaution do you take for someone that is in coma?
- check placement of tube
- make sure it is not in lungs
Cachexia
- a state of ill health, malnutrition and protein wasting
- eating own muscle
Decompression
- to decrease pressure
- remove contents in stomach
Dumping syndrome
- symptoms due to rapid entry of undigested food into jejunum
- diabetes or ng tube too long
How long can you leave a NG tube in?
7 to 10 days
Dysphagia
difficulty swallowing
Emesis
vomiting
Enterostomy
opening into stomach or jejunum through which a feeding tube is inserted
Why do stroke patients have an NG tube?
dysphagia, aspiration issues
Enteral
- within the intestines-gastro intestinal tract
- something into GI tract
Eructation
producing gas from the stomach, belching
Flatus
gas from the intestine
Gastrostomy
surgical creation of a gastric fistula
Gavage
introduction of nourishment into the GI tract by mechanical means
Intermittent
coming and going, suspending activity at intervals
Ileus
obstruction of intestine caused by paralysis of intestinal muscles
Nasogastric
tube that is passed through the nose into the stomach
Lumen
inner open space of a tube
Jejunostomy
surgical creating of an opening into the jejunum
Kwashiorkor
extreme malnutrition from severe protein insufficiency
Lavage
- washing out of a cavity, irrigate
- stomach - taken overdose of medicine and need to get it out
Parenteral
outside of the intestines
Patent
wide open, accessible
PEG
percutaneous endoscopic gastrostomy, type of NG tube
Regurgitation
return to the mouth from the stomach
Residual
what is left over
Salem Sump
- double lumen radiopaque gastric tube with blue pigtail
- one lumen for meds
- second lumen - safety valve
Reasons for NG intubation
- decompress
- instill medicine
- irrigate
- feed
Why would you use gravity drainage?
- sometimes for people who have fragile suture line
- suction would create bleeding
- below the bed on a hanger
Why would you use a NG tube to decompress?
- major GI surgery, no collection of acids, secretions in stomach
- vomit blood - need to get blood out of stomach
intermittent suction
on and off
continuous suction
on all the time
Why would you use a NG tube to instill medicine?
- run out of veins, rectal
- must always flush with water both before and after giving a medication
Why would you use a NG tube to irrigate?
- to maintain patency
- to wash out (lavage)
- GI bleed, suction out, put in ice saline to try to create vasoconstriction, last ditch approach
Why would you use a NG tube to feed?
- Only 7 to 10 days
- Stroke, neuromuscular disorder
- Gavage
- Bolus
- Continuous/intermittent feeding
What size does an NG tube come in?
- 12 to 18 French
- average is 14 french
How do you decide where to place NG tube?
- check nostrils for patency
- do they breathe better in one over the other
- polyps, trauma, etc…
When not to insert a NG tube…
- The patient is recovering from gastric, nasal, craniofacial or hypophysectomy (removal of the pituitary gland) surgery or brain/facial injuries
- If it gets pulled out do not put back in until you speak with the surgeon
- The patient may return from the OR with a NG tube in place but always check with the MD before inserting a new tube on a new GI surgical.
What should you elevate head of bed to when inserting NG tube?
at least 45 degrees
What type of lubrication do you use for NG tube insertions?
water based
How do you measure the length of NG tube?
- Measure from the tip of the nose to the earlobe, to the xyphoid process.
- Mark the tube before insertion.
Why do you set up a signal for the patient?
so they can let you know if they are having a bad time
How much of the NG tube do you lubricate?
first 4 inches
What position is the patient’s head in when you first start the NG tube insertion?
the patient’s head is slightly up
What position is the patient’s head in when you pass the gag reflex?
chin toward chest
What can a patient do to help you advance the NG tube?
take sips of water
How do you check for placement of NG tube?
- use pen light to look at back of throat
- aspirate stomach contents
- hear air at end of tube
- x-ray
What is the pH of stomach?
- 1 to 4 but as high as 5.5
- question under 1 and over 5.5
What do you expect if patient is coughing after insertion of NG tube?
tube could be in trachea
How often should the NG tube be repositioned?
- at least once a shift
- inspected for skin or mucous membrane irritation
- loosen tape, rotate tube, look for skin irritation
What should you do with end of tube after insertion?
attach tube for suction or plug it
What do you do with tube when not feeding?
plug it
How do you test position of NG tube with air?
insert 10-15 mL of air and listen for it come through the tube in the stomach
NG tube - single lumen
must be attached to low (30-40 mm Hg) intermittent suction
NG tube - double lumen
- May be attached to intermittent high (120 mm Hg) suction or continuous low suction
- Stabilize blue tube above level of stomach and insert blue to blue anti-reflux valve
NG tube - triple lumen
- Usually used for irrigation and suction simultaneously, such as a GI bleed
Why provide oral care for patient with NG tube?
- Patient only has to mouth breathe
- NG tube will decrease peristalsis, oral care will stimulate this
How often should you offer oral care?
every two hours
What do you document about NG tube insertion?
- How it went
- Return - color and amount
- Toleration - patient is resting, no complaints, watching tv - state of patient when you left the room
- How did procedure go
- Chart - clean and concise, if chart went to trial what would they look for
What solution do you use for irrigation?
- what the dr orders
- can be water or NS
Why would you use NS to irrigate?
prevent electrolyte imbalance
How much solution do you use to irrigate?
30-40 mL
When would you irrigate?
- Lot of return from suction but no longer getting suction
- Patient is nauseous and want to vomit - tube is clogged
How do you put in solution when irrigating?
- Gently
- If fluid doesn’t go in, draw back out, and try again
- If fluid still doesn’t go in may need to replace the NG tube because it is more than likely clogged
What type of patient do you never irrigate a NG tube on?
surgical
What is a gastrostomy tube?
- Usually placed for long term feeding
- Stomach
- Measured in French
When is a jejunostomy tube used?
- May be placed if the stomach needs to be bypassed or if the stomach has been removed, etc.
- Have had gastric bypass
- Tends to be smaller, hard to get meds down
- Measured in French
How is a “G” or “J” tube held in place?
a balloon is often used
How often is site care done for “G” or “J” tubes done?
twice a day
How do you clean a “G” or “J” tube sight?
clean only with water, may need something more, see facility policy
What is proud flesh?
skin that grows around the tube may use nitrate to burn it off
When would you use a dressing for a “G” or “J” tube?
when drainage is present
Do you cut the dressing to fit the site?
- never cut, always fold
- fiber/strings can get into site and cause infection
- fold 2 four by fours and can be taped together
How long should the tube be for a small bore feeding tube?
NEX + 10 inches
What are the checks for small bore feeding?
- Air-30-60 ml then aspirate
- pH>5
- Turn patient to right side
- OBTAIN XRAY Before Starting Feeding
What should you do prior to starting an enteral feeding for the first time?
- xray
- air
- aspirate
What do you do after the first feeding?
aspirate
How much residual should there be prior to enteral feeding?
- no more than 50 mL
- wait and hour and recheck
Do you want to elevate the bed prior to feeding?
yes
Why do you want to check dr orders prior to feeding?
- nephro, diabetics, lactose intolerant, etc…
How long is a closed bag good for?
24 hours
How long is an open bag good for?
4 to 6 hours
intermittent feedings
- Usually delivered via an infusion pump
- Prime tubing so patient doesn’t get a lot of air
- Check expiration date on formula
How long does an intermittent feeding last?
usually given over 60 minutes
How much formula do you give at an intermittent feeding?
not more than 200 - 400 cc’s at one feeding
Continuous feedings
- delivered around the clock
- water flushes given (approx. 50ml) q shift
How much formula is given each hour for continuous feedings?
usually 50 - 100 cc’s per hour
Bolus feeding
- Large volume given at one time
- Delivered via gravity flow
- More for people who don’t want to be tied to a system
How much formula do you give at a bolus feeding?
Usually 250 - 400 ml
What do you do prior to starting a bolus feeding?
- Aspirate - more than 50 ml wait one hour, no gastric contents listen for air
How much water do you flush into a patient prior to/after a bolus feeding?
30 mL
Do you use a luer lock syringe to administer bolus feedings?
no, too much pressure
Do you push fluids with a syringe?
- no because it causes too much pressure
- use gravity flow
How often should the oral cavity be inspected?
once a shift with a flashlight
How often should oral cares be done?
every 2 hours
Medications via enteral tube
- Use liquid form of medication whenever possible
- Never crush medications unless approved by your institution (check policy)
- Always flush tube with H20 before and after giving medications
- Always include the H20 on the intake sheet
- Never mix medications together unless facility policy supports this practice.
Feeding Pump
- Feeding should not hang more than 4-6 hours with an open system
- Use feeding ordered by physician and amount to be administered
- Keep HOB elevated 30-45 degrees
- Flush using side port with 30 ml water every 4-6 hours using a new sterile syringe
- Rinse open system before adding more formula
What do you need to take out a NG tube?
dr orders
What do you do prior to with drawing the NG tube?
Flush with 10-20 ml normal saline or air-to clear tube
What should patient do as you take NG tube out?
hold breath
What should you do with NG tube as you pull it out?
rotate it to loosen tissue that may have grown on it
Can you give a patient something to drink after taking out a NG tube?
If they have orders - give them something to drink, not hot or icy cold, not acidic, encourage them to start with something soft
