Week 1- NG and penrose drain Flashcards
A nasogastric (NG) tube is a ________inserted from _____ into _________
flexible
nostril
stomach or upper part of the SI
pediatric and adult size of NG
5-12 fr
12-18 Fr
some tubes may have a
hydrophilic coating that needs to be soaked for 5-10 mins to activate it
Indications for NG tube (5)
Gain access to GI tract
Decompress stomach (air, toxins, GI contents)
Lavage (wash if there has been a poisoning or oral drug overdose)
Enteral feeding
Instilling medications
contraindications of NG tubes
(2)
Should not be performed in facial, head and neck or throat trauma
Should have a gag reflex (or airway needs to be protected with an artificial airway) gagging closes the epiglottis
might be put on suction when have
a small bowel obstruction
large bore NG tube
hard bore
Salem sump
Larger tube
double lumen (main tube/smaller air vent lumen)
With holes near the tip
large bore may also be used for
suction as the smaller vent lumen allows for an inflow of air which prevents a vacuum if the tube adheres to the stomach wall.
Decreases tissue damage (blue pigtail section
soft bore NG
Levin
Single lumen, softer, more flexible
Often used with anti-reflux valve
Most common for enteral feeding in IH
Usually 6 -12 FR diameter
eg. silastic 8 FR
Smaller, more flexible, less irritating
May have weighted tip
Have stylet to assist insertion
Need to be changed monthly
More often used to put fluids into stomach
anti-reflux valve with a
Large bore NG
anti- reflux valve
- prevents
- allows
- when stomach pressure exceeds
- attach ends ___ to ____
prevents gastricrefluxor leakage through the vent lumen of a double-lumennasogastric tube
thevalveallows the passage of air into the vent lumen when atmospheric pressure exceeds stomach pressure
when stomach pressure exceeds atmospheric pressure thevalveprevents flow of fluids through the tube
Attach ends BLUE to BLUE
Indications for an enteral feeding
- Need a functioning and accessible GI tract
- Malnourished or at risk of malnutrition
- To supplement food intake when it is insufficient to meet daily needs
- Unable to ingest oral foods (eg. surgery, head/neck trauma)
- Unwilling to take oral feeds (eg. prolonged anorexia)
- Upper GI tract is impaired (eg. esophageal cancer)
- Dysphagia (eg. CVA, multiple sclerosis, ALS)
- Critical illness (eg. severe burns)
- Malabsorption disorders (eg. crohn’s disease)
- Decreased LOC, coma
complications of enteral feeding
*Refeeding syndrome
*Aspiration
- Metabolic problems (eg. deficiency or excess of electrolytes, vitamins, trace elements, and water)
- Over-hydration
- Hypo/hypernatremia
- Tube dislodgement
- Infection
- GI side effects (nausea, abdominal bloating, cramps, regurgitation, diarrhea, constipation)
re-feeding syndrome occurs in
previously malnourished patients who are fed with high carbohydrate loads.
carbs in feeds can cause
a large increase in the circulating insulin level. This results in a rapid and dramatic fall in phosphate, potassium and magnesium - with an increasing extracellular fluid (ECF) volume.
as the body tries to switch from
from catabolic (starvation mode) to using exogenous fuel sources, there is an increase in oxygen consumption, increased respiratory and cardiac workload. Demand for nutrients and oxygen may outstrip supply. Both of the above can lead to multiple organ failure; respiratory and/or cardiac failure, arrhythmias, rhabdomyolysis, seizures or coma, red cell and/or leukocyte dysfunction.
return of enteral feeding in the gut can
be intolerance to the feed, with nausea and diarrhea.
