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8/9/2019 NGT & GASTROSTOMY
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INSERTION & TUBE FEEDING
By: Rochelle Joy T. Ramos
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ENTERAL FEEDING
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Levin tube
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Salemsump
tube
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Gastrostomy tube
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PURPOSE/INDICATION
S
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CONTRAINDICATIONS
ENTERAL
GI obstructionProlonged ileusSevere diarrhea &vomiting
Intercutaneousfistula
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CONTRAINDICATIONS
NGTHead traumaAny presence of skullfractures
Severe facial trauma obstructed esophagusObstructed airwayEsophageal
strictures/varicesAlkali ingestion at riskfor esophagealpenetration
Patients withsuspectedCervicalspine
injury
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CONT AINDICATIONS
Gastrostomy tubeAspirationpneumoniaGros ascites
Blod coagulationdisordersEsophagealvaricesEnlargedliverorspleenHadpreviousgastricsurgery
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ASSESSMENTNGT
MedicalhistoryHistoryofnasalsurgeryordeviatedseptumNutritionalstatus
AnyexistingchronicillnessNares patency/discharge/irritationMentalstatus/abilitytocooperateFluidintakeandoutput
AllergiestoanyfoodPresenceofgagreflexDigestivetractfunctioningKidneyfunction/BUN/electrolytes
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ASSESSMENT
NGT
Hematocrit & urinespecificgravityMedsandtherapiesCorrectplacementoftubeBowelsoundsDiarrhea/constipation/flatulencePresenceofregurgitationandfeelingsoffullnessLackoftoleranceofpreviousfeedingsLactoseintolerant
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ASSESSMENTG-TUBEAbilitytoadjustchangeinbodyimage
Participationinself-carePsychologicalstatusofpt/ & familySkinconditionFluid & nutritionalneeds
SignsofmalnutritionWeight, FluidintakeandoutputUrinespecgravity,acetone & glucoseinurineLactoseintolerant
PropermaintenanceoftubePresenceofbowelsoundsProblemsthatsuggestlackoftoleranceofpreviousfeedings
Regurgitationandfeelingsoffullness
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Insertion ofNGT
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NGT Feeding
y Correct & typeofamountofsolution
y 60mL cathetertipsyringe
y Emesisbasin
y Cleangloves
y pHteststripmeter
y Wateratroomtemperature
y Largesyringe/calibratedplasticfeedingbag withlabel/prefilledbottle withadripchamber
y Measuringcontainer
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Feeding bag
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PROCEDURE &
NURSINGCARE
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NGT insertiony Gatherequipments
y Introduce self,verifyclientsidentity
y Explainpurposeandimportanceofprocedure
yEstablishamethodofcommunication
y Assessnares
y Positionclient,provideprivacy
y Placetowelonchest
y Observeinfectioncontrolmeasures
y Determinesizeoftubebymeasuringlength
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y Weargloves,lubricate 4 inchesofthetipofthetube
y Inserttube,tellpttohyperextendneck,swallow anddrink water
y Iftubemeetsresistance, withdraw andinsertitintoanothernostril. Donotforceagainstresistance. Stopif
ptexperiencerespiratorydistressy Passtubeuntillengthisinserted
y Determinecorrectplacementofthetube
y Foroptional-attachtosuctionasordered
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y Removegloves,disposecontaminatedmaterials
y Washhandsy Ensurecomfortandsafety.Placecalllight withinreach
y Document- typeoftubeinserted,dateandtimeinserted,colorandamountofgastriccontents,client
tolerance.
y Providedailynasogastric care
y Evaluateclientcomfortandtolerance
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Administering NGT Feedingy Checkexpirationdateoffeeding. Feedingformulain
roomtemperature.y Assess properplacementoftube
y Assessresidualfeedingsandreinstill gastriccontentsback
y Cleantopoffeedingy Connectsyringetoaclampedtube.
y Addfeedingtothesyringebarrel
y Allow feedingtoflow inslowly
y Ensureclientcomfortandsafety
y Askclienttoremainsittingforatleast 30min.
y Disposeequipmentor washreusable. Change
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Gastrostomy Tube Insertion & Feeding
y Gatherequipments
y Introduceself,verifyclient,explainprocedureanditsimportance
y Provideprivacy,observeinfectioncontrolmeasures
y
Insertion:y Weargloves,removedressing
y Discarddressing & gloves,applynew gloves
y Lubricateendoftube
y Insertitintotheostomy openingy Checklocationandpatencyofthetube
y Assessresidual
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y Holdbarrelofsyringe 3-6in.aboveostomy opening
y
Slowlypoursolutionintothesyringe,allow toflow bygravity
y Add 30mL ofwatertoflushtube
y Ensurecomfortandsafetyofclient
y Asktoremainsittingatleast 30min.y Assessstatusofperistomal skin
y Checkordersaboutcleaningtheperistomal skin
y Observeforcomplications
y Whenappropriate,teachclienthow toadministerfeedingsand whentonotifyhcp
y Evaluateeffectivenessoffeeding
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COMPLICATIONS
NosebleedSinusitissorethroat
EsophagealerosionPulmonaryaspirationCollapsedlung
Intracranialplacementthetube
DiarrheaConstipationNauseaandvomiting
Gas/bloating/cramping/Dumpingsyndrome
AspirationpneumoniaTubedisplacement
TubeobstructionNasopharyngealirritationHyperglycemiaDehydration,azotemia
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