Nasogastric Tubes Flashcards
Nasogastric tube
Pliable
Nasopharynx –> stomach
Removal of gastric secretions and introduction of solutions into stomach
Small or large bore
Uses of NGT
Enteral feed
Meds
Suctioning
Lab analysis
Internal pressure
Why may someone have a NGT
Post-op
Impaired peristalsis
abdominal distention
Critically illness
Client Assessment
Patency of nares
Gag reflex
LOC
Auscultate abodomen
If gastric residual is more than 200-500ml
Withhold feed, notify, semi-fowlers
N/V
Check patency, aspirate, auscultate
How to position pt for insertion
High fowlers
Place pillow behind pts head/shoulders
After tube passes through nasopharynx..
Tilt head forward to prevent opening of epiglottis
How to verify placemenr
Test pH, less than or equal to 5
Must be verified by xray before initiated
Why is it important to ensure placement before initiation?
To prevent aspiration pneumonia
pH of Intestinal fluid
less than/ equal to 6
pH of respiratory fluid
greater than 6
Why clamp tube before removal?
So it does not leak
If bowel sounds absent
Indicate absence of peristalsis, increase risk of aspiration/distention
Used for how long?
Less than 4 weeks
Indication for beyond the stomach
Gastroparesis, esophageal reflux, aspiration, asp. pneumonia
Normal gastric residual
250-500ml Indicates whether gastric emptying is delayed
do not hang formula longer than
4hr
Change bag/tubing every
24hr
Large bore
Decompression
short term
Small bore
Longer term
When is a small tube inserted?
after 24-48 hrs, if large bore was tolerated
When are surgical/endoscopically placed tubes inserted?
When enteral nutrition is needed for more than 4 weeks
Polymeric formula
Milk based, blenderized foods
or commercially prepped nutrient-whole formulas
Whole gastrointestinal tract must be functioning
Modular formula
Single-macronutrient
not nutritionally complete
Added to other foods for meeting individuals needs
Elemental formula
Predigested nutrients that are easier for a dysfunctional GI tract to absorb
Specialty formula
Designed to meet specific nutritional needs
Refeeding syndrome
Metabolic disturbances that occur as a result of reinstitution of nutrition
Parenteral nutrition
Specialized nutrition
Nutrients are provided intravenously
Central access
When may someone require parenteral nutrition?
Pts unable to digest or absorb enteral nutrition
Highly stressed states
Lipid emuslions
Parenteral
Prevent deficiencies of essential fatty acids
Can be separate or part of a mixture
Lipid emulsion - what to look out for
Should not be used if oil droplets are observed on the surface
Lipid emboli
Initiation of TPN
PICC
Verified by chest x-ray/radiographically
Flushed with salin/heparin
If encountering resistance when placing a nasogastric tube…
withdraw the tube
