Care of Clients with Enteral Feedings &

NG Tubes

Cathy Gibbs BSN, RN

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

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

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

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

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 H2O needs Include in I & O’s

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

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

Types of Tubes? Depends on

Purpose or needs Length of time Dietary needs Rate

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

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

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

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

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