Term
| What is the purpose of enteral tubes |
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Definition
Lavage (flushing) stomach of contents, blood, poisons or drug overdose.
Establish a means of suctioning stomach contents to prevent gastric distention
Provide access for feedings, fluids, and medications |
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Term
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Definition
| This is done when it is important to remove things quickly, such as poisoning. Done when gastric hemorrhage happens to remove blood from the stomach. Clean technique, although solution is usually sterile. |
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Term
| What kind of suction is used for enteral tubes usually? |
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Definition
| Low suction due to the liquid form of the stomach contents because they haven't been eating solid foods |
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Term
| What is needed before suctioning |
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Definition
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Term
| When can you not use NG tubes? |
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Definition
| After nasal/craniofacial surgery, if facial trauma is present, if there is no gag reflex/cough reflex |
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Term
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Definition
| Tissue irritation, fluid/electrolyte imbalance, aspiration, infection, tracheal intubation/damage |
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Term
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Definition
| Nasogastric, nasoduodenal, nasojejunal |
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Term
| Nasogastric suction tubes |
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Definition
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Term
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Definition
| Miller-abbott, cantor, Johnston, baker |
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Term
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Definition
| J-tubes, T-tubes, Peg tubes |
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Term
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Definition
| First where they enter, then where they end up. |
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Term
| How do we choose which tube to use? |
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Definition
| Based on tube feeding needs and duration |
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Term
| What are intestinal tubes used for? |
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Definition
| Provide decompression above a bowel obstruction and can prevent distention. Placed by using a weight and allowing normal peristalsis to bring it where it needs to go |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| Primary suction and drainage lumen, small vent lumen which forms as a vacuum which avoids gastric damage. Keep the blue tail above the gastric hole, and if fluid appears, flush it with 10ml of air and place an anti-reflux valve in the blue lumen immediately. Used to deliver or remove fluid to the stomach. |
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Term
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Definition
| One lumen with multiple distal perforations. Used for aspirating gastric content or delivering medication |
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Term
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Definition
Decompression and drainage of stomach
Allow GI system to rest and heal
Measure and monitor gastric bleeding
Larger bore tubes such as Salem sump or Levine are used |
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Term
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Definition
| Used for longer term (greater than 6 weeks) nutritional. Surgically placed. |
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Term
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Definition
| Gastric tube placed in intestinal area |
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Term
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Definition
| Adequate gastric emptying, bowel motility and cough and gag reflex. Only use for 6 weeks! |
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Term
| Percutaneous enteral tubes |
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Definition
| PEG (percutaneous endoscopic gastrostomy) or PEJ. Generally do not require anesthesia to insert. Done with endoscopy. Can be used for pt who cannot tolerate NG feeding tubes |
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Term
| How do you initially verify enteral tube placement |
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Definition
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Term
| Ongoing placement verification: pH |
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Definition
pH: more reliable. Determine pH less than or equal to 5.
Respriatory system: greater than or equal to 6.
Keep in mind that respirations might be more acidic if they have an infection, or other issues. Stomach pH can be more alkaline if you are in the small bowel or if the pt doesn’t produce any stomach acid.
PH will temporarily be higher if they are receiving a tube feeding in progress or are on an acidity inhibitor. If the pH is greater than 5, there needs to be other placement verifications. |
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Term
| Ongoing placement verification: Auscultation/Length |
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Definition
| Woosh cannot differentiate between stomach or bronchial lung/tree. Not recommended. Length is marked at initial placement. Check to see if it moved |
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Term
| Placement Auscultation steps |
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Definition
| Place stethoscope over LUQ, inject 30-50cc of air with 50cc syringe (different for peds client or client with gastric surgery) assess for resistance, listen for whooshing or gurgling sounds as air enters stomach |
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Term
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Definition
| Flush with 30mL air using 60mL syringe. Aspirate 5-10mL of GI contents, gently mix. check it, return contents |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| NG tube holder or statlock, or tape. Wipe nose off first and allow to dry |
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Term
| Nursing assessments associated with enteral tubes |
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Definition
Assess for bowel sounds
Verify tube placement
Verify tube patency
Assess for residuals if administering feeding or meds
Assess for gastric distress (nausea, cramping, diarrhea)
Assess I&O
Assess skin integrity (nares, surgical site) |
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Term
| Checking Residuals Bolus Feeding |
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Definition
gastric contents should be suctioned out and returned to the stomach before a new feeding is administered to ensure that minimal residue remains from the previous feeding.
(use a 60 mL syringe) |
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Term
| Checking residuals Continuous feeding |
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Definition
| should be checked every 4-6 hours when feeding is by continuous drip. Excess residual volume (>100-200 mL depending on facility policy) may indicate an obstruction or some other problem that must be corrected before feeding can be continued. |
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Term
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Definition
| Maintain tube patency and clear accumulated solids and secretions. Frequency depends on policy, patient condition, and purpose of tube |
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Term
| When is irrigation most important |
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Definition
| when slow feeding with a small diameter tube. Clogging can be due to improper med admin |
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Term
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Definition
| Semi-Fowler's position, disconnect suction, assess tube placement, kink feeding tube, gently instill 20-30mL normal saline for adults, 3-5 mL for peds. restart feeding/suction after you are done |
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Term
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Definition
Flush feeding tubes with 30mL of water every 4 hours during continuous and before and after intermittent on adults.
Flush tube w/ 30mL of water after residual volume check
Use administration pump with neonatals |
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Term
| Which is preferred, enteral or parenteral nutrition? |
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Definition
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Term
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Definition
4-8x a day each feeding 15-30 min. More similar to a normal feeding, less expensive, more convenient, allow more patient freedom so they aren’t tethered to a feeding bay. Important: bag/syringe is not more than 18 inches above stomach/feeding tube because it will cause rapid absorption which causes cramping and diarrhea
Disadvantages: aspirated more easily, cause bloating cramping N/D |
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Term
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Definition
without interruption for unlimited amount of time per day. However we usually limit it to about 18 hours or less. Around the clock elevates insulin levels and limits mobility.
-Usually done 8-10 hours at night.
-given by gravity drip or infusion pump (preferred). Gravity is inconsistent and needs to be checked frequently.
-Disadvantage: more expensive, limits mobility.
-Have to stop feeding to give meds |
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Term
| Continuous feeding guidelines |
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Definition
| Head of bed elevated all the time, residuals checked per policy or order |
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Term
| Intermittent/bolus feedings |
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Definition
| Check residuals before initiating, head of bed elevated for 1-2 hours after feeding, limit hang time of solution to 8 hours if gravity bag or open system and 24 hours if closed system |
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Term
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Definition
Product is poured into an enteral feeding bag or syringe
Allows additives such as protein and fiber to be added to feeding formulas
Less waste in unstable patients (maybe)
Shortens hang time
Increases nursing time
Increased risk of contamination |
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Term
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Definition
Containers sterile until spiked for hanging
Can be used for continuous or bolus delivery
No flexibility in formula additives
Requires less nursing time
Increases safe hang time
Less risk of contamination
More expensive than canned formula |
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Term
| Guidelines for enteral medication |
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Definition
| Do not add meds to enteral feedings. Do not crush two or more meds at the same time. Mix meds with 30mL of water. Do not give enteric coated, oily meds, or sustained release. Each med goes in separately. always use sterile water in pts under 2 and immunocompromised |
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Term
| Med administration enteral tube process |
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Definition
| 5 R's +2x3, crush to fine powder, mix each pill with 30mL sterile water, abdominal assessment, place in fowler's position, turn off tube feed, disconnect tubing and place a cap on end of tubing not being used to admin meds. Assess placement, measure residual (feeding tubes only), return residual, pinch tube, flush tube, admin meds, final flush |
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Term
| How long to clamp after tube feeding or if attached to suction? |
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Definition
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Term
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Definition
| Procedure and purpose, type, size, location of tube, verification of placement, solution (amnt, continuous or intermittent) client toleration, lavage, irrigation, med admin, amnt flushed, pt assessments |
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Term
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Definition
*CHECK ORDER*
clean gloves, clamp or plug tube, unpin, loosen tape, inject with 30mL of air, pinch tube and remove with steady pull, provide nasal and oral hygiene |
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