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 |