Term
| How does the efficacy of Clog Zapper compare to pancreatic enzyme solutions in terms of clearing occluded tubes? |
|
Definition
| Clog Zapper has a lower success rate when compared to pancreatic enzyme solutions |
|
|
Term
| What is the recommended method for clearing an occluded feeding tube? |
|
Definition
| Administer a mixture of pancreatic enzymes and bicarbonate solution, allow to sit for 1-2 hours, and then flush with warm water |
|
|
Term
| What should be done if a patient with a permanent feeding tube gains or loses weight? |
|
Definition
| They should be re-evaluated in order to make sure that their feeding tube still fits (particularly if they have gained weight) |
|
|
Term
| What factors should be assessed when considering long-term enteral access? |
|
Definition
- Condition of the external abdominal wall
- Ability to correct coagulopathies
- Patient tolerance to anesthesia
|
|
|
Term
| What types of anesthesia can be used for long-term enteral access placement? |
|
Definition
| Long-term enteral access can be placed with local or general anesthesia |
|
|
Term
| What abdominal wall factors should be considered when considering long-term enteral access in a patient? |
|
Definition
- Open wounds or fistulas
- Presence or future requirement of ostomy
- Percutaneous or intra-abdominal infusion devices
- PD catheters
|
|
|
Term
| Which types of patients are appropriate for long-term gastric feeds? |
|
Definition
| Those with normal gastric emptying and a low risk of aspiration |
|
|
Term
| For which types of patients is small bowel feeding preferred when considering long-term enteral access? |
|
Definition
- Gastric outlet obstruction
- Gastroparesis
- Patients at increased risk of aspiration
- Pancreatitis
|
|
|
Term
| Which types of patients are appropriate for G-J systems in which the stomach is decompressed while the small bowel is fed? |
|
Definition
- Gastric outlet obstruction
- Severe GERD
- Gastroparesis
- Early postoperative feeding
|
|
|
Term
| How does the construction of NG/NJ tubes differ from PEG/PEJ tubes? |
|
Definition
| Most NG/NJ tubes are made of polyurethane (thinner), while PEG/PEJ tubes are made of silicone (more comfortable and last longer) |
|
|
Term
| What is the advantage of dual port feeding tubes? |
|
Definition
| They allow for concomitant feeding and medication administration and/or irrigation |
|
|
Term
| What should be done when administering medication through a dual-port tube while feeds are running, and why? |
|
Definition
| Medications should be administered only after enteral feeds are held and the tube is flushed in order to prevent clogging |
|
|
Term
| What is the difference in usage between solid and balloon-type bolsters for percutaneous feeding tubes? |
|
Definition
| Solid type bolsters are more commonly used with initial placement due to ease in placement. Balloon-type bolsters are more commonly used in replacement tubes due to ease in placement |
|
|
Term
| What is the typical lifespan of a balloon-type bolster for enterostomy tube placement? |
|
Definition
| They generally only have a lifespan of 3-6 months |
|
|
Term
| Can permanent enterostomy feeding tubes have multiple ports? |
|
Definition
| Yes, plus an additional port for inflating the balloon (if necessary) |
|
|
Term
| What are the surgical type options for placing gastrojejunal feeding tubes? |
|
Definition
| They can be placed using percutaneous, open, and laparascopic techniques |
|
|
Term
| What are the contraindications to NG/NJ tube placement? |
|
Definition
- Obstructing head, neck, or esophageal pathology
- Injury preventing safe insertion
|
|
|
Term
| What should occur after feeding tube placement occurs before feedings are initiated? |
|
Definition
| Confirmation of proper position should be obtained before feedings are administered |
|
|
Term
| How should NG/NJ tube placement be confirmed before initiation of feeds? |
|
Definition
| Radiography (best) or electromagnetic imaging technology |
|
|
Term
| How should methods such as aspiration of gastric contents, auscultation of insufflated air over the stomach, and absence of patient choking or coughing be used when confirming tube placement? |
|
Definition
| They are useful to suggest correct placement, but radiographic evidence must be obtained |
|
|
Term
| Where are nasoenteric and nasojejunal feeding tubes placed relative to GI anatomy? |
|
Definition
- Nasoenteric: anywhere distal to the pylorus
- Nasojejunal: distal to the ligament of Treitz
|
|
|
Term
| How can nasoenteric tubes be placed? |
|
Definition
| Nasoenteric tubes can be placed at bedside, endoscopically, or flouroscopically |
|
|
Term
| How should coagulation parameters and platelets be evaluated when considering enterostomy tube placement? |
|
Definition
| Routine pre-procedural testing of coagulation parameters and platelets is not recommended, but they should be considered if there is concern for abnormal coagulation due to anticoagulant medication, medical history of excessive bleeding, or recent antibiotic use |
|
|
Term
| What are relative contra-indications to PEG placement? |
|
Definition
- Ascites
- Coagulopathy
- Gastric varices
- Active head and neck cancers
- Morbid obesity
- Neoplastic, infiltrative, or inflammatory disease of the gastric or abdominal wall
|
|
|
Term
| When are gastrojejunal tubes indicated? |
|
Definition
- Impaired gastric motility
- Pancreatitis
- Pancreatic surgery
- When feeding into the small bowel with simultaneous decompression of the stomach
|
|
|
Term
| What types of skin care/tube maintenance should be done with patients with nasal tubes? |
|
Definition
| They benefit from skin care to nasal area due to prolonged exposure to tape and adhesive products. Additionally, repositioning the nasal tube and avoiding pressure to the nares is important to prevent pressure necrosis. |
|
|
Term
| How should the stoma site for percutaneous tubes be cleaned? |
|
Definition
|
|
Term
| What are common causes of enteral tube clogging? |
|
Definition
- Suboptimal flushing
- Not flushing between each medication administration
- Accumulation of pill fragments
- Frequent checking of residuals
- Administration of high-protein, high-fiber formulas
|
|
|
Term
| When can enterostomy tubes be safely removed? |
|
Definition
- After the stoma tract has matured, usually >2 weeks after insertion
- Waiting 4 to 6 weeks is advised in patients who are immunosuppressed, obese, or otherwise suspected of poor wound healing
|
|
|
Term
| What is the risk of removing an enterostomy tube too early? |
|
Definition
| Removing an enterostomy tube before the stoma tract has matured may result in the stomach falling away from the abdominal wall, allowing gastric contents to leak into the peritoneum |
|
|
Term
| How does replacement of enterostomy tubes differ for stoma tracts which have matured vs those that have not? |
|
Definition
- If tube replacement occurs before stoma tract maturation, replacement with the assistance of endoscopy, interventional radiology, or surgery is required
- If tube replacement occurs after stoma tract maturation, a replacement tube can be placed at bed side without endoscopy or fluoroscopy
|
|
|
Term
| What is the test of choice if peritonitis is suspected after placement of enterostomy tube? |
|
Definition
| Infusion of water-soluble contrast with fluoroscopic imaging |
|
|
Term
| What is the most common complication of gastrostomy placement? |
|
Definition
|
|
Term
| What are risk factors for leakage around the gastrostomy site? |
|
Definition
- Infection
- Excessive cleaning with irritant solutions
- Excessive tension and side torsion on the external portion of the feeding tube
|
|
|
Term
| What should be done to fix leakage around the gastrostomy site? |
|
Definition
- Prompt treatment of infection
- Good ostomy skin care
- Loosening of the outer bumper
- Stabilizing of the fastrostomy tube to prevent tension torsion
|
|
|
