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Nasogastrictubes*(*)
nasogastric tubes
| Question | Answer |
|---|---|
| Intubation | the placement of a tube by nose or mouth into a body structure like stomach or intestine |
| Orgogastric intubation or orogastric tube | the insertion of a tube through the mouth into the stomach |
| Nasogastric intubation | the insertion of a tube through the nose into the stomach |
| Nasointestinal intubation | the insertion of a tube through the nose to the intestine |
| Orogastric, nasogastric and nasointestinal intubation are used to? | remove gas or fluids and to administer liquid nourishment |
| Ostomy | a surgically created opening |
| What are some reasons in which gastric or intestinal tubes are used? | perform lavage or gavage, administer oral meds which clients can't swallow, obtain sample of secretions for testing, promote decrompression, control gastric bleeding |
| Gavage | to provide nourishment |
| Lavage | to remove substances from the stomach |
| Decrompression | to remove gas and liquid contents from the stomach or bowel |
| Tamponade | pressure |
| What does each number on the French sacle equal? | 0.33 mm |
| What is the type of orogastric tube? | Ewald tube |
| What is the purpose of the Ewald tube? | lavage |
| Which type of tube is used in an emergency to remove toxic substances that has been ingested? | orogastric tube or Ewald tube |
| What are the characteristics of an Ewald tube? | large diameter, single lumen, and multiple distal openings for drainage |
| Nasogastric tube | a tube placed through the nose and advanced to the stomach |
| Lumen | channel |
| What are the types of nasogastric tubes? | Levin, Salem sump, and sengstaken-Blakemore |
| What is the purpose of the Levin tube? | lavage, gavage, decompression, or diagnostics |
| What are the characteristics of the levin tube? | usual adult size is 14-18 F, single lumen, 42-50 in long, and has multiple drain openings |
| Sump tubes | double lumen tubes |
| What is the purpose of sump tubes? | decompression |
| What are the characteristics of the salem sump tube? | same diameter as levin tube, double lumen, pigtail vent, 48 in long, marked at increments to indicate depth of insertion, and radiopague |
| What is the purpose of Sengstaken-Blakemore tube? | compression or drainage |
| What may clients complain of with nasogastric tubes? | nose and throat discomfort |
| What may occur if the tubes diameter is too large or pressure from the tube is prolonged? | tissue irritation or breakdown |
| Gastric tubes tend to dilate the esophageal sphincter which may lead to? | gastric reflux |
| Gastric reflux | the reverse flow of gastric contents |
| Nasointestinal tubes | tubes inserted through the nose for distal placement below the stomach |
| What does the added length permit of a nasointestinal tube? | the tube to be placed in the small bowel |
| What are the types of nasointestinal tubes? | Keofeed and maxter tubes |
| What is the purpose of a Keofeed tube? | gavage |
| What are the characteristics of the keofeed tube? | small diameter 8F and 36 in long, polyurethane or silicone, weighted tip, flexible, radiopague, and bonded lubricant becomes activated with moisture |
| How long may keofeed tubes be left in place? | 4 weeks or longer |
| What do keofeed nasointestinal tubes reduce the potential for and why? | gastric reflux; they deliver liquid nutrition beyond the stomach |
| What is the purpose of the maxter tube? | intestinal decompression |
| What are the characteristics of the maxter tube? | usual size 18 F, 100 in, double lumen, weighted tip, and graduated markes every 10 in |
| Stylet | metal guidewire |
| Intestinal decompression | the removal of gas and intestinal contents |
| Transabdominal tubes | tubes placed through the abdominal wall |
| What are the types of transabdominal tubes? | gastrostomy and jejunostomy |
| Gastrostomy tube | a transabdominal tube located within the stomach |
| What is the purpose of a gastrostomy tube? | gavage; can be used for decrompression while client is fed through jejunostomy tube |
| What are the characteristics of the gastrostomy tube? | size 12-24 for adults, rubber or silicone, may have additional side ports for balloon inflation to maintain placement, may be capped or plugged between feedings, and radiopague |
| Jejunostomy tube | a trasabdominal tube that leads to the jejunum of the small intestine |
| What is the purpose of a jejunostomy tube? | gavage |
| What are the characteristics of a jejunostomy tube? | size 5-14 F for adults, silicone or polyurethane and radiopague |
| Percutaneus endoscopic gastrostomy tube (PEG tube) | a transabdominal tube inserted under endoscopic guidance |
| Percutaneous endoscopic jejunostomy tube (PEJ tube) | tube thats passed through a PEG tube into the jejunum |
| What type of tube is used instead when clients require an alternative to oral feeding for more than 1 month? | transabdominal tubes |
| What are some ways to reduce anxiety when having to place an NG tube down a client? | tell client the diameter of tube is smaller than most pieces of food, explain procedure, allow client to assist while tube is being placed, establish a signal for if client needs to pause, give client some form of control |
| Before NG tube insertion, the nurse conducts a focused assessment. What does this assessment include? | loc, weight, bowel sounds, abdominal distention, integrity of nasal mucosa, ability to swallow cough or gag, and any nausea or vomiting |
| What is a major goal of the assessment before inserting the NG tube? | to determine which nostril is best to use and the length of tube placement |
| When inspecting the nasal area, what things excludes a nostril for tube insertion? | presence of nasal polyps, deviated septum, and narror nasal passage |
| NEX measurement | length from nose to earlobe to the xiphoid process |
| What is the first mark that is made prior to NG tube insertion? What does this indicate? | from nose to earlobe; distance to nasal pharynx or tip at back of throat above gag reflex |
| What is the second mark made prior to NG tube insertion? | from earlobe to xiphoid process |
| What are the nurses primary concerns when inserting a nasogastric tube? | to cause as little discomfort as possible, to preserve the integrity of nasal tissue, to locate the tube within the stomach not in respiratory passages |
| What are some ways to verify the locations of the NG tube placment? | aspirate fluid, asucultate abdomen, test pH, and x ray |
| What color should the aspirated fluid be if proper placement of NG tube? | clear, brownish yellow, or green |
| When checking placement of NG tube, how do you auscultate the abdomen? | while listening with stethoscope over abdomen, instill 10 mL of air or more. If swooshing sound is heard, tube is in stomach |
| When belching is occuring, with a client that has just had an NG tube placed, what has likely happened? | the tip of the tube is in esophagus |
| What confirms the acidic gastric contents of NG tube placement? | testing the pH |
| What are the most accurate ways to check NG tube placement? | x ray and pH test of gastric contents |
| What is the pH of stomach contents? | 1-3 (acidic) |
| What does a pH of 7 or more indicate in regards to aspiration of gastric contents? | tube is in respiratory tract |
| What can continuous suctioning with an unvented tube cause? | the tube to adhere to the stomach mucosa which results in localized irritation and interferes with drainage |
| The suctioning setting is prescribed by the physican. What is the normal pressure setting for NG tube? | 40-60 mm Hg |
| When does the NG tubes need to be clamped or plugged | if client is ambulating or after instilling medications |
| How does the nurse assess for NG tube patency? | monitors volume and characteristics, signs and/or symptoms of an obstruction |
| What are some signs/symptoms of possible obstruction within the tube? | nausea, vomiting, abdominal distention |
| What must the nurse obtain before attempting an irrigation? | a medical order |
| In an NG tube, if the drainage holes are adhering to the gastric mucosal wall, what can the nurse do? | turn off suction momentarily and change client's position |
| In an NG tube, if a tube is displaced above the esophageal sphincter, what can the nurse do? | if measured mark is not at tip of nose, remove tape, advance tube, check placement and resecure |
| In an NG tube, if the drainage container is filled beyond capacity, what can the nurse do? | empty and record amount of drainage in suction container |
| In an NG tube, if the vent is acting as a siphon, what can the nurse do? | instill a bolus of air into the vent and restore patency |
| In an NG tube, if the vent is capped or plugged, what can the nurse do? | remove cap and restore the port to an atmospheric pressure |
| In an NG tube, if the suction is inadequate what can the nurse do? | check that the pressure is 40-60 mmHg |
| In an NG tube, if the cover of the suction container is loose what can the nurse do? | resecure lid to container |
| In an NG tube, if a solid particle or thick mucus obstructs the lumen what can the nurse do? | increase suction pressure for a moment and obtain and implement a medical order for irrigation |
| Enteral nutrition | nourishment provided through the stomach or small intestine rather than by the oral route |
| When do nurses remove a nasogastric tube? | when a client's condition improves, when tube becomes obstructed and not able to clear obstruction, and according to agency's policy |
| How often are unobstructed larger diameter NG tubes usually removed or changed? | at least every 2 to 4 weeks for adults |
| How often are small diameter flexible NG tubes removed or changed? | every 4 weeks to 3 months depending on agencys policy |
| How do you estimate the length of a nasointestinal tube? | determine the NEX measurement then add 9 in |
| After insertion of a nasointestinal tube, an X ray is taken to confirm placement. HOw do nurses check placement after that x ray? | using a 50 mL syringe and obtain sample of fluid |
| Who inserts transabdominal tubes | physician |
| Why is care so important with transabdominal tubes, especially G tubes? | G tubes can leak which leads to skin breakdown |
| What are some causes of gastrostomy leaks? | disconnection between feeding delivery tube and G tube, clamped G tube while tube feeding is infusing, mismatch in size of G tube and stoma, increased abdominal pressure, underinflation of balloon |
| In which clients are tube feedings used? | clients with intact stomach or intestinal function but unconscious, extensive mouth surgery, difficulty swallowing, or esophagel or gastric disorders |
| Nasointestinal tubes reduce the potential for what? | enteritis or inflammation of intestines |
| Nasointestinal tubes increase the potential for what? | gastric reflux |
| What type of tube may cause dumping syndrome? | a nasointestinal tube |
| Dumping syndrome | a cluster of symptoms from the rapid deposition of calorie dense nourishment into the small intestine |
| What are the symptoms of dumping syndrome? | weakness, dizziness, sweating, nausea, low blood glucose, diarrhea |
| In dumping syndrome,what can cause the weakness, dizziness, sweating and nausea? | when fluid shifts from the circulating blood to the intestine |
| In dumping syndrome, why may diarrhea occur? | when hypertonic formula is administered |
| What factors are considered on determining the type of formula needed? | weight, nutritional status, concurrent medical conditions, projected length of therapy, and feeding schedule |
| What type of formula would benefit clients with or who are at risk for pressure ulcers? | formulas fortified with additional zinc, protein, and other nutrients |
| What are the types of tube feeding formulas? | standard (isotonic), high calorie, high protein, fiber containing, and partially hydrolyzed |
| Which type tube feeding are routine formulas for clients with normal digestion and absorption, don't alter H2O distribution and provide about 1.0cal/mL? | standard(isotonic): osmolite, isocal, nutren 1.0 |
| Which type of tube feeding provides up to double the amount of calories of standard formulas for client who require a fluid restriction or have high calorie needs? | high calorie: comply, nutren 1.5, nutren 2.0 or deliver 2.0 |
| What type tube feeding, provides up to double the amount of protein of standard formulas? | high protein: promote, isocal HN,or ultracal HN plus |
| Which type of tube feeding provides fiber to normalize bowel function in clients with diarrhea or constipation? | Fiber containing: jevity, compleat, ultracal |
| What type of tube feeding, provides nutrients in simple form requiring little or no digestion for clients with impaired digestion or absorption? | partially hydrolyzed: criticare HN, optimental, or vivonex TEN |
| How often can tube feedings be administered? | bolus, intermittent, cyclic or continuous |
| Bolus feeding | the instillation of liquid nourishment in less than 30 minutes 4-6 times a day |
| What is the usual amount given in a bolus feeding? | 250-400 mL of formula per administration |
| The bolus feeding schedule is the least desirable. Why? | it distends the stomach rapidly causing gastric discomfort and increased risk for reflux |
| Intermittent feeding | the gradual instillation of liquid nourishment 4-6 times a day |
| How much is usually administered with intermittent tube feedings? | 250-400 mL per administration |
| How long are intermittent tube feedings usually administered over? | 30-60 minutes |
| How are intermittent feedings generally administered? | by gravity drip or feeding pump |
| With intermittent feeding, what is required to reduce the growth of microorganisms? | thorough flushing after each feeding |
| How often are tube feeding administration sets replaced with intermittent feedings? | every 24 hours |
| Cyclic feeding | the continuous instillation of liquid nourishment for 8-12 hours followed by a 16-12 hour pause |
| Which time schedule of tube feeding is often used to wean clients from tube feedings while maintaining adequate nutrition? | cyclic feedings |
| When are cyclic feedings usually administered? | during late evening and hours of sleep |
| With cyclic feedings, are clients allowed to eat food orally? | yes |
| COntinuous feeding | the instillation of liquid nutrition without interruption |
| When administering continuous feedings, what is the usual rate? | 105 mL/minute |
| What is used to regulate the instillation of continuous tube feedings? | feeding pump |
| What does instilling small amounts of fluid beyond the stomach do? | reduce the risk of vomiting and aspiration |
| What are some standard daily assessments nurses make when a client is on a tube feeding? | weight, I&O, bowel/lung sounds,temperature, breathing pattern, gastric complaints, vomiting, bowel elimination patterns, status of abdominal distention, bowel elimination patterns, condition of nasal & oral mucous membrane, skin condition of tube |
| gastric residual | the volume of liquid within the stomach |
| Why does the nurse measure the gastric residual? | to determine whether the rate or volume of feeding exceeds the clients physiologic capacity |
| In regards to tube feedings, what can overfilling the stomach cause? | gastric reflux, regurgitation, vomiting, aspiration, or pneumonia |
| When checking the gastric residual, there should be no more than how much of the previous hours tube feeding volume? | no more than 100mL or 20% |
| What should the nurse do if the gastric residual is high? | stop feeding and recheck gastric residual every 30 minutes until its within a safe volume for resuming the feeding |
| What are feeding tubes smaller than 12F usually more prone to? | obstruction |
| What is the best way to maintain patency within a feeding tube? | use a 30-60mL of water immediately before and after administering a feeding or medications every 4 hours if continuously fed and after refeeding gastric residual |
| What does the nurse do if an obstruction occurs in a tube feeding? | consult the physician |
| If a tube feeding obstruction can't be cleared, what has to be done? | tube has to be removed and another tube inserted |
| Usually tube feedings are about 80% water but usually clients require additional hydration. How much do adults usually require? | 30mL of water per kilogram of body weight or 1mL/kcal on daily basis |
| How does the nurse determine if a clients hydration needs are being met? | identify the amount of water on the label of formula |
| If an older adult is recieving tube feedings, what things should the nurse look for? | fluid and electrolyte disturbances, capillary blood glucose levels, agitation or confusion or change in mental status |
| Older adults on tube feedings are at risk for fluid and electrolyte disturbances which can lead to what? | hyperglycemia |
| Older adults on tube feedings may experience hyperglycemia. How ofter should capillary blood glucose levels be checked? | every 4 hours for a 48 hour period |
| What is an early sign of fluid and electrolyte imbalance in older adults? | change in mental status |
| If a client goes home on tube feeding, what problems do you need to instruct the client to report? | weight loss, reduced urination, weakness, diarrhea, nausea/vomiting, or breathing difficulties |
| How is a nasointestinal decompression tube removed? | disconnect from suction, remove tape from face, withdraw tube 6-10 in at 10 minute intervals, withdraw last 18 in pulling gently from nose, and provide oral and nasal hygiene |
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