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