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Introduction
Gastrointestinal intubation is
Types of Tubes
Short- Nasogastric tube
Introduced from the nose to the stomach
Levin and Gastric (Salem) Sump
Used to remove gas and fluid from the
Levin Tube
Single Lumen (hollow part of tube)
Size 14-18 French
Made of plastic or rubber with opening near
tip
It is 125 cm long
Circular markings on the tube serve as
insertion guides
.Medium tubes
Medium length- nasoenteric used for feeding.
Example- Dobhoff
Placed in the duodenum or jejunum by fluoroscopy
(x-ray dept) or at clients bedside.
Verified by x-ray before feedings
begin. May take up to 24 hrs.
to pass through the stomach
into the intestines.
Place client on right side
to facilitate passage
rubber tube
one lumen used for aspiration and
other for Introduce with mercury,
water, or saline
Procedure of Inserting
nasogastric tube
Definition
Tube inserted through the nose into
stomach
:Purposes
To administer tube feedings and medications
Purposes
To drain fluid or air from the
stomach.
To promote healing after bowel
surgery.
To monitor bleeding in the
gastrointestinal (GI) tract.
To help treat an intestinal
obstruction.
procedure
Check physician's order for insertion of
NG tube.
Explain procedure to patient.
Assist the patient to high Fowler's
position.
Drape chest with disposable pad
flashlight
Observe ( intactness of tissue nostrils
including any irritation or abrasion )
Examine the patients nostril for septal
deviation. To determine which nostril is
more patent, ask the patient to occlude each
nostril and breathe through the other
Patency of nares & intactness of nasal tissue
( note especially history of nasal surgery or
deviated septum )
If plastic tube
Used place it in warm water until tube
Nasogastric tube
Adult
- 16-18F
Viscous lidocaine 2%
Oral analgesic spray (Benzocaine spray or
other)
Oral syringe, 12 mL
Glass of water with a straw
Water-based lubricant
:Equipments
Non allergenic adhesive Tape 2,5 cm wide
Emesis basin or plastic bag
Wall suction, set to low intermittent suction
Suction tubing and container
Flashlight .
Stethoscope.
Toomey syringe (20 to 50 ml) .
Tissues
Disposable pad & gloves . .
Tongue blade .
Normal saline solution (for irrigation only).
: Procedure
Note
A nasogastric (NG) tube is used for
,,Cont
If client gag when tube reaches
Patient flexing
his neck and
drinking water
while a
nasogastric
tube is
.inserted
Confirming Placement
Tube placement is confirmed prior to any use
Document
Document: Tube type and size
Drainage or aspirate (residuals)
NG Suction
Tube for decompression will be attached
,,,Conte
Remove disposable gloves.
Wash hands.
Remove all equipment.
Keep the client at comfortable
position.
Assist with or provide oral hygiene at
regular intervals.
Complications
The main complications of NG tube
Contraindications
Absolute contraindications
Relative contraindications
Coagulation abnormality
Esophageal varicose or stricture
Alkaline ingestion
Procedure of Administering a
.Tube
Feeding
Tube Feedings
Meet nutritional needs when oral
Assessment
Before a nasogastric or orogastric feeding
:Purposes
To restore or maintain nutritional
status.
To administer medications.
:Equipments
Feeding container.
Large syringe with plunger or calibrated
: Procedure
:Preparation
Explain procedure to client.
Prepare equipment.
Check amount, concentration, type,
Procedure
Use stethoscope to assess bowel
sounds.
Wash hands.
Wear disposable gloves.
Position client with head of bed
elevated at least 30 degrees or as near
normal position for eating as
possible. Fowlers position
:Performance
Check to see that the NG tube is properly
high.
Syringe feeding
Add 30 to 60 ml of water for irrigation to syringe when
:Documentation
:Purposes
To clears the tube of feeding or
debris.
To prevent the spread of
microorganisms in the tube of
feeding.
:Equipments
Normal saline solution or water for
irrigation.
Disposable gloves.
Stethoscope.
Toomey syringe.
Container.
Disposable pad.
: Procedure
:Preparation
Check physician's order for irrigation.
Explain procedure to client.
Prepare necessary equipment.
Check expiration dates on irrigating solution.
Wash hands.
Wear disposable gloves.
Assist client to semi-Fowler's position.
Check placement of NG tube.
Pour irrigating solution into container.
Draw up 30 ml of saline solution.
Place tip of syringe in tube.
:Documentation
Record irrigation procedure,
Procedure of Removing a
Nasogastric Tube
Purposes:
The
:Equipments
Tissues.
50-ml syringe (optional).
Disposable gloves.
Disposable plastic bag.
Disposable pad.
Normal saline solution or water for
irrigation (optional).
Emesis basin.
: Procedure
:Preparation
Check physician's order for removal of NG
tube.
Explain procedure to client.
Assist to semi- Fowler's position.
Prepare equipment.
Wash hands.
Wear clean disposable gloves.
Place disposable pad across client's chest.
Give emesis basin and tissues to client.
Attach syringe and flush with 10 ml of water or
normal saline solution.
nose.
Instruct client to take a deep breath and hold it.
Clamp tube with fingers by doubling tube on
itself.
Quickly and carefully remove tube while client
holds breath.
Dispose of tube.
Remove gloves and place in bag.
Clean and dry face, nose and mouth.
Remove all equipment and dispose of according
to agency policy.& Wash hands.
tract
TPN therapy is expected to be less than 5
days
Prognosis does not warrant aggressive
nutrition support
Source of Nutrition
Eternal nutrition
Parenteral nutrition
Central
: Short-term
NG, ND,NJ
Parenteral Nutrition
:Long-term
Gastrostomy Jejunostomy
GI function
Intact
Nutrients
Adequate
NO
Functional GI Tract
Defined
Formula
Inadequate Adequate
PN
Oral Feeding
PPN
TPN
GI function return
YES
NO
Components of TPN
Carbohydrate, Amino acid, Fat,
Amino acid
Electrolyte (Na, K, Cl, Mg, Ca, P)
Vitamin (A, B1, B2, Niacin, B6,
Panthothenic acid, C, D, E, Zn, Cu, Mn, Cr)
Lipid emulsion
TPN
Protein--------------------------Amino Acids
Carbohydrates------------------Dextrose
Fat--------------------------------Lipid Emulsion
Vitamins--------------------Multivitamin Infusion
Minerals------------------------Electrolytes
and Trace Elements
complication
Mechanical: thrombosis, embolism,
skin slough
Infectious: particularly staph
epidermidis, Candida
Metabolic: hypoglycaemia,
hyperglycaemia,
cholestasis