Tubes and Drains Lecture Powerpoint COPY

Question 1

Nasogastric (NG) tubes

Answer 1

PVC, polyurethane, or silicone flexible tube inserted thru the nose with the end terminating at the stomach, a salem sump tube is most commonly used for decompression (additional lumen tube for decompression of the stomach or blowing off the wall)

Question 2

NG tube indications (2)

Answer 2

• treat ileus or small bowel obstruction with decompression (removal of contents of GI which is a good measure of how severe a small bowel obstruction is)
• enteral nutrition and administer medications short term in patients who cannot swallow

Question 3

NG tube contraindications (5)

Answer 3

• esophageal stricture
• esophageal varices or diverticuli
• basilar skull fracture
• prophylactic placement is NOT done (such as after bariatric surgery)
• long term enteral nutrition

Question 4

Placement of an NG tube steps

Answer 4

• gather supplies
• measure estimated length based on zyphoid to earlobe and earlobe to nares
• have patient positioned sitting up chin to chest
• insert tube horizontally
• have patient sip on water as NG tube is advanced
• ensure patient can speak
• tape in place
• connect to suction
• confirm placement thru aspiration of contents/simultaneous auscultation or abdominal x ray

Question 5

NG tube complications (4)

Answer 5

• coiling
• reflux
• cribiform plate perforation
• pneumonia or tracheal perforation

Question 6

Orogastric tube (OG)

Answer 6

Same idea as a nasogastric tube but thru the mouth in intubated patients, eliminates worry for nasal ulcerations, sinusitis, etc

Question 7

When is a post pyloric feeding tube utilized? What 2 complications occur with it?

Answer 7

-When there is concern for aspiration (A simple NG tube can cause reflux into the esophagus), concerns over difficulty in placement and causing “dumping syndrome”

Question 8

Long term enteric feeding options

Answer 8

If greater than 2 weeks, may refer to

-Percuaneous endoscopi gastrostomy/jejunostomy (PEG/PEJ) or a PEG-J which is both

Question 9

What to do if a long term enteric feeding tube falls out

Answer 9

• courtesy call to surgeon who placed it for instruction first and foremost
• if well healed around it (well formed tract) can often just return PEG tube manually, but dangerous if new and cannot replace PEJ manually

Question 10

Venting PEGs

Answer 10

Indications for a PEG tube in palliative care where a patient who has a distal obstruction and is terminal can continue to eat and suck out the contents as needed

Question 11

Indications for a drain

Answer 11

Prevent accumulation of fluid (blood, pus, and infected fluids) as well as air

Question 12

Open drain (penrose)

Answer 12

A type of drain that is open type with passive pressure simply to keep the skin open, drainage usually occurs around the tube not necessarily thru it

Question 13

Closed drain

Answer 13

Can utilize active or passive pressure

Question 14

What to do if a long term enteric feeding tube is clogged?

Answer 14

Flush it, sometimes with coca cola and if that doesn’t work then x ray