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*N126-U4-I. NG*
Dobrisky-U4-Nasogastric Intubation
| Question | Answer |
|---|---|
| Name the 4 purposes for nasogastric tubes | enteral feedings, decompression, lavage, compression |
| name the type of tubes used for enteral feedings | duo, dobhoff, levin |
| to instill liquid feedings & meds for a patient who can't swallow without aspirating or can't eat by mouth which kind of tube is needed? | enteral feeding tube |
| for the removal of secretions & gaseous substances from the GI tract or relief of abdominal distention which type of tube is used? | decompression |
| what are the names of common decompression tubes? | salem sump, levin, miller-abbott |
| A dobhoff is what type of tube? | enteral feeding tube |
| a Levin is what type of tube? | decompression, enteral feedings or lavage |
| the tube used for irrigation of the stomach in cases of active bleeding or poisoning is | lavage |
| an Ewald is what type of tube? | lavage |
| for internal application of pressure by means of inflated balloon to prevent internal esophageal or GI hemorrhage what type of tube is used? | compression |
| name a compression tube | sengstaken-blakemore |
| a miller-abbot is what type of tube? | decompression |
| a salem sump is what kind of tube? | decompression or lavage |
| which tube is used for "gastric gavage"? | enteral feeding tube |
| in case of poisoning which type of tube would be used? | lavage |
| which type of tube uses a ballon to preven hemorrhage? | compression |
| describe how to determine the length needed for a nasogastric tube? | measure ear to tip of nose to xyphoid process |
| what is the best way to check placement of a nasogastric tube? | xray |
| large bore tubes are how big in diameter? | >12 French |
| large bore tubes are used most for what? | suctioning/decompression |
| a large bore levin tube can be used for what? | suctioning or feeding |
| this large bore tube is flexible, rubber or plastic, single lumen tube with holes near the tip | levin tube |
| this tube is not common due to the large size and the irritation it causes to the mucousa | levin tube |
| a salem sump-double lumen tube is used for | decompression |
| the salem sump-double lumen tube has a | smaller lumen and a larger lumen |
| the smaller lumen of the salem sump is what color? | blue |
| what is the blue end used for? | air |
| can you put feedings through a salem sump? | no |
| the blue lumen is open to air to allow for what? | equalization of pressure |
| equalization of pressure will help avoid what? | irritation of gastric mucosa |
| the larger lumen of a sale sump is used for what? | it drains gastric contents |
| the air vent should be positioned where? | above the patient's midline |
| the drainage receptacle should be positioned where? | below the patient's midline |
| what type of valve is used on salem sumps? | anti-reflux valve |
| the blue end of the anti-reflux valve fits into which port of the salem sump tube? | the blue air port |
| what suction pressure is used mostly for levin tubes? | 80-100mm Hg |
| what is the range for low suction pressure | 80-100mm Hg |
| what is considered high suction pressure | 100-120mm Hg |
| which type of suction is used to protect the mucus membrane lining near the tip of the suction tube? | intermittent suction |
| small bore tubes are pliable and used for? | feeding purposes and medication administration |
| small bore tubes have what tool to help pass the tube into the stomach? | a stylet |
| describe the stylet of a small bore tube | it is hollow to allow air to be injected thru it to check for placement |
| when is a stylet removed? | when placement has been confirmed |
| some feeding tubes are weighted with what to promote passage of the tube into the small intestine? | tungstun |
| nasoenteric feedings are used for | short term nutritional support |
| how long is short term nutritional support | 6 weeks or less |
| prolonged intubation of a nasoenteric feeding tube could cause what complications? | sinusitis, erosion of the nasal septum or esophagus or distal esophageal strictures |
| what are three ways tube feedings are administered? | bolus amount via gravity, intermittently gravity drip or continuous drip by infusion pump |
| how often are tube feedings administered by a bolus | several times per day |
| what type of syringe is used for bolus feedings? | large bore syringe |
| for what reasons should a weighted tube be used? | when the stomach must be bypassed due to injury or disease or when the patient's condition prohibits elevation of the head |
| describe the process of advance a tube into the duodenum | position the patient on right side, allow gravity to assist passage of the tube through the pyloric sphincter |
| how long may it take for a tube to pass through the pyloric sphi9ncter on its own? | up to 24 hours |
| what does AAA of ng tube placement verification mean? | assess, air, aspirate |
| when do you assess, air and aspirate? | while waiting for xray |
| what is the best way to confirm placement of an ng tube? | xray |
| when assessing for placement you should | inspect, auscultate and palpate the abdomen for abnormalities |
| what should you inspect in addition to the abdomen when checking placement? | back of mouth for coiled tube |
| "air" is the 2nd verification...how does it work? | inject 30 mls of air into the tube via syringe |
| when injecting air what is the most important thing a nurse should know? | the reason for the tube, air may be harmful to the patient |
| what size syringe should be used when injecting air into an ng tube? | 60ml syringe |
| what is the purpose of injecting air? | helps return of aspirate by flushing out formula, medications or flush solutions |
| aspirate is | pulling back a small amount (10-15ml) of gastric contents to check for ph and to observe it's color and consistency. |
| gastric tube aspirate should have a pH of | 5.5 or less |
| a gastric tube aspirate ph of 6 or more indicates | misplacement into the respiratory tract |
| during insertion of an ng tube what position should the patient be in? | fowlers with chin down |
| in order to obtain accurate pH results | no meds, feedings with in last hour, no antacids or acid inhibitors |
| if a patient has gastric reflux, pernicious anemia or visceral neuropathy will a pH reading of gastric juices be accurate? | no |
| what do you do before laying a patient flat that is receiving feedings? | turn off the feeding |
| what is the key to feeding tube clogs? | prevention |
| flushing should be done | immediately before & after feedings |
| flushing before & after feedings should be done with how much fluid? | 30 mls |
| what type of fluid is used to flush a feeding tube? | tap water |
| can meds be mixed with tube feeding? | not unless ordered by the MD |
| how much water should be used to flush the tube between medications? | atleast 5mls |
| if giving six medications when should you flush? | before and after each medication |
| if the tube is clogged what can you have the patient do to help clear it? | reposition the patient |
| if the tube is clogged how do you flush? | don't force, gently & firmly push and ppull the plunger back and forth |
| after pushing warm water in to a tube that is clogged what do you do? | clamp and wait a few minutes to allow the water to "soak" |
| medications for flushing the tube | must be ordered by an MD (if not listed as a PRN med) |
| name a few clog buster medications | Viokase powder, Clog Zapper CORPAK, Bard PEG cleaning Brush, Bionix DeCloggers |
| how often should gastric residual be checked | before each feeding or every 4-6 hours during continous feedings |
| when should continuous feedings be checked for residual? | every 4-6 hours (depends on institution) |
| what complication is assessed for when checking gastric residual? | delayed gastric emptying |
| to check residual what type of syringe is used? | 60ml |
| what should be known by the nurse before returning aspirate to the stomach? | what the dr has ordered as acceptable residual amounts |
| if the order states to return if under 200mls what do you do with excess? | call the dr to report the excess and to receive instruction on what to do with excess |
| after aspirating and returning stomach contents what should be done next | flush the tube with 30mls of water |
| do you flush with water if you return aspirate? | yes always |
| aspirate should be | placed in a graduate and measured before being returned to the stomach |
| a patient receiving tube feedings should be elevated | at least 30 degrees |
| what must you plan for when before placing a patient flat? | stop feeding 30-60 minutes before to prevent aspiration |
| to prevent rupturing the tube you should always use a | 30-60ml syringe |
| what type of care should always be given for a patient with a tube in place? | frequent nose and mouth care |
| what type of fluid do you use to irrigate an ng tube used for decompression? | normal saline |
| why is normal saline used to irrigate an ng tube used for decompression? | to prevent alteration of the sodium balance |
| if an ng tube is used for feedings what type of fluid is used to irrigate? | warm tap water |
| when should sterile water be used to irrigate a feeding tube? | when a patient is critically ill or immunocompromised |
| how often should placement of a tube be assessed? | at the beginning of each shift and before flushing, feeding or administering meds |
| what is the first step you should take when assessing at the beginning of your shift? | turn off the pump/suction in order to auscultate the abdomen |
| besides the abdomen what else should be checked? | the nares for irritation |
| a salem sump tube should be flushed with saline to avoid what condition? | hypokalemia |
Created by:
Lori Dobrisky
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