Term
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Definition
COLD DAM
C - Compress a bleed
O - Obstruction treatment
L - Lavage the stomach, remove ingested toxins
D - Decompress stomach, remove gas and fluid
D - Diagnose motility disorders
A - Aspirate gastric contents for analysis
M - Meet nutritional needs when oral intake impossible |
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Term
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Definition
Nasogastric
Introduced from the nose to the stomach |
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Term
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Definition
An example of a short tube
Single lumen
Connected to low-intermittent suction (20-80 mmHg)
Clear - NO pigtail
Pull out the contents from the stomach |
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Term
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Definition
An example of a short tube
Double Lumen Catheter
Usually use a 16 French
Decompress the stomach and keep it empty |
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Term
| Function of small, inner tube in a Salem NG tube |
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Definition
This is the blue "pigtail"
It vents the larger suction-drainage tube to the atmosphere via an opening at the distal end of the tube.
It keeps the suction force at the drainage opening less than 25 mmHg to prevent capillary irritation.
Connected to low, continuous suction
Anti-reflux valve - keeps gastric contents out of vent lumen |
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Term
| Instructions for small, inner tube in a Salem NG tube |
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Definition
Vent lumen should be kept ABOVE patient's waist
NO liquids down the blue part!
After suction, lumen is irrigated and air is injected.
This maintains a buffer of air between the gastric contents and the valve. |
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Term
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Definition
Nasoenteric
Used for feeding |
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Term
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Definition
Example of a medium-length tube
Placed in duodenum or jejunum by x-ray or bedside
Verified by x-ray before anything goes down that tube!
May take up to 24 hours for it to pass through the stomach into the intestines.
Place client on the RIGHT side to facilitate passage. |
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Term
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Definition
Nasoenteric tube introduced through the nose and passed through the esophagus and stomach into the intestinal tract.
* Aspirate intestinal contents
* Decompression to prevent obstruction
* Aids in preventing vomiting; reduces tension at incision line and prevents obstruction |
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Term
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Definition
Cantor
Harris
Miller-Abbott |
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Term
NG tube INSERTION
First - Basic Patient Interaction |
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Definition
Check order
ID patient
Provide privacy
Wash hands
Don gloves
Instruct and reassure client |
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Term
NG Tube INSERTION
Second - Patient prep |
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Definition
Determine patency of nares
Determine length to insert
Place client in Fowler's position, head slightly tilted back |
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Term
NG Tube INSERTION
Third - Initial procedure |
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Definition
Lubricate end of tube
Insert tube until resistance is met at the nasopharynx |
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Term
NG Tube INSERTION
Fourth - Continuing procedure after initial resistance is met |
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Definition
Have client tilt head forward until chin is near chest
Ask client to sip water through a straw or ice chips
Instruct client to swallow (This aids in advancing the tube) |
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Term
NG Tube INSERTION
Fifth - Once measured circular mark is reached |
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Definition
Have client open mouth
Inspect the oropharynx to be sure tube is not coiled in back of throat
Secure the GI tube |
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Term
NG Tube INSERTION
Sixth - Securing the GI Tube |
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Definition
Use a skin barrier to prep the skin
Use an NG strip or slit piece of tape under the tube at the nose and secure to the skin.
Place another piece of tape over the first piece.
Secure tube to client's gown using a slip-knot rubberband and safety pin. |
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Term
NG Tube INSERTION
Seventh - Verification of correct placement |
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Definition
Confirm tube placement with x-ray before putting ANY fluid in it.
Also, confirm placement by measuring the pH of aspirate
For an NG or Salem tube, auscultate an injected air bolus over the epigastrum. |
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Term
NG Tube INSERTION
Eighth - DOCUMENT! |
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Definition
Chart:
Tube type and size
Drainage or aspirate (residuals) amount, color, consistency
Irrigation type/amount
Suction type and level
Feeding type and amount
Patient tolerance
Patient/family education and response |
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Term
NG Tube INSERTION
Determining length to insert |
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Definition
1. Measure from tip of nose to earlobe.
2. Measure from earlobe to xiphoid process.
3. Add 6" for NG tube
4. Add 8-10" for intestinal placement |
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Term
NG Suction
What is tube for?
What level is appropriate? |
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Definition
Tube for decompression.
Will be attached to intermittent suction.
Keep suction level between 20-80 mmHg |
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Term
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Definition
CONTINUOUS suction at greater than 25mmHg can cause damage to the gastric mucosa.
Do NOT clamp or plug the vent lumen: KEEP IT OPEN!
You should hear a soft hissing sound indicating lumen is patent. |
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Term
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Definition
| Record amount of aspirate on I&O |
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Term
NG Suction
Recommendations for hygiene |
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Definition
Change cannister PRN
Change the suction tubing q 48 hours
IF family is coming to visit, go ahead and change things out so all is clean. |
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Term
NG Irrigation
Who orders?
What will be ordered? |
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Definition
The doctor orders irrigation solution.
It will be water or normal saline. |
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Term
NG Irrigation
Procedure prep |
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Definition
Wear gloves
Get an irrigation set:
- 60cc syringe with tray and equipment to confirm correct placement of tube. |
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Term
NG Irrigation
Actual procedure |
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Definition
Unclamp tube or disconnect from suction/feeding.
Check amount of residual if the tube is NOT connected to suction.
Draw up fluid in syringe (50-100 ml)
Connect to tube and gently instill irrigation fluid. NEVER force the fluid.
Instill air into the vent lumen (15-20 cc)
Re-establish suction or feeding as indicated. |
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Term
NG Irrigation
Documentation |
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Definition
Chart:
* What you used (Irrigation type)
* How much you used (Amount)
* How your patient tolerated it
Suction type
Drainage amount and color |
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Term
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Definition
Is your patient complaining of nausea?
Is there not much coming out upon aspiration?
IRRIGATE!
Get a new irrigation set every single day at 0800. Date it! |
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Term
Tube Feedings
Why we might do this: |
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Definition
1. Meet nutritional needs when oral intake isn't possible
2. Better than TPN
3. GI integrity is preserved
4. Normal insulin/glucagon ratios are preserved
5. Can be intermittent, bolus or continuous |
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Term
Tube Feedings
Procedural tips |
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Definition
Check residual before feeding
Flush before and after every feeding
Doctor will order feedings based on calories and/or glucose
Administer feedings at room temperature
Continuous feedings in bottle: change every 24 hours
Pitch bottle bags at the start of each shift
Lots of glucose in feedings so watch for infection
Be alert to irritation between the nares |
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Term
Tube Feedings
High residual before feeding? |
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Definition
IF the residual is over 100 (certainly over 125-150) things are not moving and patient will probably have N/V/D.
There is an absorption issue.
Patient will probably go NPO to rest the gut.
Never continue a tube feeding if there is a lot of distention. |
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Term
Medication Administration into an Enteral Tube
Precautions |
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Definition
1. Check MD order
2. Can this medicine be crushed or given through a tube?
3. Follow 5 medication administration rights
4. Disconnect tube from suction/feeding
5. Aspirate stomach contents.
**IF less than 125 mL, re-instill
**IF greater than 125 mL, return and hold feeding X 1 hr, then aspirate again. May need to call MD. Do not give a medicine if gut is not moving. |
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Term
Medication Administration into an Enteral Tube
Procedure |
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Definition
1. Irrigate tube with 30-50 mL of irrigation fluid prior to medication administration.
2. Mix medicine with water or apple juice to dissolve.
3. Use syringe to flow into tube by gravity or use bulb.
4. Do NOT need to give each medication separately IF patient tolerate all his/her meds well and there is not negative interaction between medications.
5. Irrigate tube with 30-50 mL of irrigation fluid after medication administration.
6. Re-connect to suction/feeding
7. Document |
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Term
| Nursing Management for Patients with GI Tubes |
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Definition
Monitor client.
Keep head of bed between 30-45 degrees to maintain the tube function/patency.
Provide oral and nasal hygiene and care. |
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Term
| For a gastric surgical patient whose tube was placed during surgery: |
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Definition
Do NOT replace the tube if it comes out.
Call the MD! |
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Term
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Definition
It is much easier coming out than going in~
Good signs:
Patient says, "I am getting hungry." "I feel full." |
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