1. Care of Clients with Enteral Feedings & NG Tubes Cathy Gibbs BSN, RN

2. GI Tubes  Placed in the GI tract for therapeutic or diagnostic purposes  Nasogastric or nasointestinal tube Placed through nares and into the stomach or intestine Usually for short term and temporary use  Esophagostomy, gastrostomy, or jejunostomy tubes These are generally for longer term nutrition

3. GI Tubes  Reasons for insertion Remove gas or fluids from stomach or intestines (decompression) Diagnose GI motility Obtain gastric secretions for analysis Relieve and treat obstructions or bleeding in GI tract Provide means for nutrition, hydration, and medications Allow for healing after esophageal, gastric, or intestinal surgery Remove toxic substances from the stomach

4. Decompression  When stomach or small intestine fills with air or fluid  Accumulation leads to distention and pain  May be after GI surgery  NGT may be to suction  NGT uncomfortable (firmer)  Keep in place till full peristaltic activity returns

5. Tubes for Nourishment  Patients cannot recover without nourishment Total or supplemental Short term or permanent  Inability to swallow  Chewing problems  Severe burns or trauma  Careful with skull fractures or facial trauma (orogastric tube)  Mental retardation or disability

6. GI Feeding Formulas  Based on patient’s nutritional needs  Size and location of tube  The method of delivery  Provide protein, carbohydrates and fats  Need to monitor H 2 O needs  Include in I & O’s

7. Methods of Delivery  Gravity Dripped in by gravity slowly or as a bolus feeding over a few minutes  Pump Programmed amount and rate Change tubing out every 24 hours

8. Feeding Schedule  Continuous Specified rate for 24 hours Usually a smaller amount given at one time  Intermittent Given during day and D/C’d at night Volume of feeding over 20-30 minutes

9. Types of Tubes?  Depends on Purpose or needs Length of time Dietary needs Rate

10. Type of Tube  Levine tube Single lumen, used for gastric decompression, irrigations and lavages Use with intermittent suction to prevent stomach lining injury  Salem sump Double lumen, has a vent for air and prevents excess suction, used for decompression Can be used for continuous suction

11. Types of Tubes  Miller-Abbott tube Double lumen tube used to drain and decompress the small intestine Rubber balloon at the end of one tube, tube passed through the pylorus and balloon is inflated, then tube is advanced through peristalsis, then suction happens in intestines  Cantor tube Single lumen with bag on the end, bag is mercury filled, weighted mercury helps move tube through GI tract Used for intestinal decompression, stretches intestine as bag moves through to allow for suctioning to occur

12. Complications  Aspiration and regurgitation  Clogging  Nasal damage  Diarrhea  Nausea & Vomiting  Abdominal distention  Tissue trauma

13. Complications  Dehydration or over hydration  Hyper/hypokalemia  Hyper/hyponatremia  Dislodging of tube  Infection  Comfort

14. Insertion of Tube  Gather supplies  Explain to patient  High Fowler’s leaning forward  Choose nare  Measure tube & mark  Lubricate and insert tube  Verify placement  Secure tube  Suction  Document