Term
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Definition
| Position patient should be in when giving a NG tube |
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Term
1) Check color of aspirate (Tell me what color you would expect to see as you do this.)
2) Check pH of aspirate (Tell me what pH you would expect to see on the paper as you do the test.)
3) Inject air and auscultate.
(Any order is acceptable.) |
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Definition
| Three ways to check if an NG tube is in the right position |
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Term
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Definition
•Compression
•Lavage
–Used to have something leave the patient
•Decompression
•Feeding (Gavage)
–Give food/meds to the pt |
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Term
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Definition
•Used for:
–Bleeding Esophageal varices, usually secondary to portal hypertension due to liver cirrhosis |
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Term
Types of tubing used for Compression
(NG tubes) |
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Definition
–Blakemore tube
–Minnesota tube
–Tube with a balloon that is placed orally. The balloon is inflated to compress the vessels in the esophagus to control bleeding. |
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Term
Lavage used for irrigation
(NG Tubes) |
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Definition
•Used for:
–Upper GI Bleeding: gastritis, bleeding ulcers; iced NS is lavaged through an NGT or oral tube to control the bleeding in the stomach
–Poisoning: Used to pump out someone’s stomach if they have ingested poisons or drugs (OD). |
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Term
Used for lavage
(NG tubes) |
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Definition
•Type of tube:
–Ewald tube
–Salem sump Tube |
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Term
| Reasons for using decompression |
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Definition
–Whenever the GI tract has decreased motility
–Protection of anastomosis (Post GI surg)
–Whenever accumulation of fluids & air is causing distension (SBO)
–Whenever absolute NPO status is indicated (pancreatitis) |
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Term
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Definition
•Used:
–Post-op GI Surgery
–Small bowel obstruction (SBO) |
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Term
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Definition
•Types of tubes used:
–Salem Sump: Standard size is 14-16 French
–Anderson Tube |
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Term
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Definition
•Salem Sump Tube has a double lumen
•One lumen for gastric secretions
•One lumen allows air/gas out of the stomach |
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Term
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Definition
•Used for Enteral Nutrition
–Patient can not swallow correctly
–Malnourished / pt who can not eat enough (preterm infants)
–Pts who repeatedly aspirate when eating
–Birth defects of the mouth, esophagus or stomach (esophageal atresia or tracheal esophageal fistula) |
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Term
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Definition
•Types of tubes used:
–Small-bore feeding tubes
–PEG tube (Percutaneous endoscopic gastrostomy)
–PEJ tube (PE jejunostomy) |
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Term
| Knowing which types of feeding tubes to use |
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Definition
•Know the end-point of each type of tube. Is it in the stomach (pre-pyloric) or is it in the jejunum (post-pyloric), in the small intestine?
•Where is each of these tubes located (end-point)? NGT, NJT, PEG, PEJ, GT, JT
•Standard size is < 12 French |
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Term
| Aspirations (greatest risk) |
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Definition
–Tube dislodged
–Too much volume
–Pt lying flat
–Pt with decreased LOC
–Pt with a trach |
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Term
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Definition
–Displacement
–Gastric residual
–Intestinal motility change |
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Term
| Assess with feeding tubes |
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Definition
–Placement of tube
–Bowel Sounds
–Food Allergies |
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Term
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Definition
•Intermittent
•Bolus
•Continuous
–Pump
–Gravity |
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Term
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Definition
• Type tubes are typically used for 4 weeks or less
•If longer nutritional support is needed, pt will have tube placed that will not be routed through the nose: G tube, J tube, PEG, PEJ |
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Term
| Complications of feeding tubes |
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Definition
•Aspiration
•Fluid & Electrolyte Imbalances
–Inadequate water intake esp. if hypertonic liquid
–Hyperglycemia
–If Pt has diarrhea
•Skin Integrity
–Insertion site of tube
–Excoriation of skin
•Infection (food is growth medium) |
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Term
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Definition
•GI Problems
–Diarrhea, constipation, abd cramps, N/V, Motility problems
•Displacement
–Always check placement before using, or @ q 8 hr when continuous infusion
•Occlusion |
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Term
| Taking care of a pt with tube or tube feedings |
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Definition
•Comfort
•NPO status usually
•Oral/Nasal/Skin care/Skin integrity assessment
•Maintain tube patency
•Maintain/Assure Placement
•Assessment of GI function: Do Abd assessment
•Assessment of F & E status I/O, Labs, wt, |
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Term
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Definition
•Empty suction cannisters
•Record I & O
•Verify placement before inserting anything through the tube
•Med administration: Know which meds you can put down a tube, which are contraindicated, crush well so the tube is not clogged
•Verify Placement
•Prevent spoilage of formula
•Prevent clogging of tube
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Term
| How to verify if NG is placed correctly |
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Definition
•Chest x-ray is the best, 100% accuracy
•Aspirate for gastric contents
•Aspirate and check pH of fluid: Gastric 1-4, Intestinal 6-7; meds & food can alter the pH
•Measure length of tube once verified by x-ray
•Injecting air and auscultating over stomach
–? Reliability; depends on institution |
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Term
| How to Minimize Risk for Aspiration |
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Definition
•HOB elevated 30-40 degrees during feeding and keep elevated 30 min after intermittent fdgs
•Check residuals; if large amt (100-200-check policy), hold feeding until residual decreases (Residual is returned to the pt to prevent F & E imbalance)
•Be aware of meds which reduce patient cognition or sedate them |
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Term
| If at High Risk for Aspiration |
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Definition
•Can place blue food coloring in food, thus sputum or ET suctioning would have blue color also, confirming aspiration has occurred
•Watch for S/S of pneumonia
•N/V can displace tube |
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Term
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Definition
| isotonic, hypertonic;pt needs more water with hypertonic, risk for dehydration if not provided |
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Term
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Definition
| Cramps, flatus, diarrhea, distention, residual amount increasing, |
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Term
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Definition
•Hydration status
•I & O
•Monitor glucose levels initially, not as large of a problem as TPN
•Advance rate of infusion
–Start with 30-50cc per hour, increase 12-20cc to target rate |
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Term
| Do not insert NG tube if patient has |
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Definition
– Esophageal varices
–Gastric surgery
–Nasal surgery
–Neck surgery |
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Term
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Definition
•Disconnect Suction
•Verify Placement
•Flush NGT (@30cc)
•Give crushed/diluted meds (tap water)
•Each med is to be given separately unless you verify with pharmacy about chemical stability
•Flush after giving each medication (@5cc)
•After last med, flush with @ 30cc
•Keep tube clamped for at least 30 minutes |
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Term
| Meds through a GT or JT, PEG, or PEJ |
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Definition
•Same procedure with the following exceptions:
–Suction will not be connected to this tube, the tube will be capped off.
–Verify by checking for correct placement at abdominal insertion point.
Coordinate meds with feedings as appropriate |
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