GASTRIC TUBES

TYPES:• SALEM (DOUBLE LUMEN GASTRIC) SUMP TUBE• ENTEROFLEX• G-TUBE/PEG TUBE• J TUBE• LEVIN (SINGLE LUMEN TUBE)

Salem (Double Lumen) pump• Most common nasogastric tube• Used for irrigation of stomach

and tube feedings• Sizes 14-18 French• 120 cm long• If suction is needed, connect the

larger bore to suction• Blue vent is always open to air

for continuous atmospheric irrigation

• Prevent reflux by having the blue vent port above patient’s waist

Single Lumen TubesLevin

• Sizes 14-18 French and 125 cm long

• Used for stomach decompressing, withdrawing specimens, washing the stomach free of toxic substances, and irrigating the stomach and treat upper GI bleeds

• Can be used to administer meds and/or feedings

Dual-Purpose TubesMoss Mark IV,

Dobbhoff Nasojejunal• Inserted nasally and ends in the

duodenum or jejunum• Gastric decompression port

connects to suction• Use the smaller, more distal

port, for feedings• Reduces reflux through

removing excess feedings• 3rd port is a retention balloon

Double-Lumen Nasointestinal TubeMiller-Abott Tube

• Rubber balloon tip that should not be inflated until passed through the pylorus

• Peristalsis moves balloon along

• Second port is for suction for sampling

• Label the ports to alleviate confusion

Tubes for Upper GI Bleeding for VaricesSengstaken-Blakemore

• Two lumens inflate the gastric and esophageal balloons

• 3rd lumen reserved for gastric suction or drainage

• Can be inserted orally or nasally

• Compresses esophageal varices or reduce gastrointestinal hemorrhage

Percutaneous Endoscopic Gastrostomy (PEG) Tube

• Procedure for placing a feeding tube directly into the stomach through a small incision in the abdominal wall

• Peg tubes can be temporary or permanent

• Peg tube care should be completed every 8 hours with part hydrogen peroxide part sterile water, then place a drainage sponge around port

J-tube

• Placed in the jejunum• Lasts >= 30 days• Decreases risk for reflux• Decreases risk for

complication in comparison to Peg tube

• Can be a combo of J/G tube

CONTRAINDICATIONS FOR NG TUBE PLACEMENT

• Mid-face trauma• Recent nasal surgery• Esophageal perforation

High Risk• head/brain trauma• Deviated septum

• Esophageal varices/strictures• Recent banding/cautery of varices• Coagulation abnormalities• Alkaline ingestion• Nasal polyps

Questions• You have a patient that needs gastric suctioning

and may need feedings after a few days post-op. Which tube would you most likely use?

Salem sump gastric tube

Can you close the vent, blue, port on a salem sump tube?

No, the ventilation port should not be closed off. To ensure this, you can use an anti reflux valve (seen above) as long as it is positioned correctly to allow air to circulate or a syringe without a plunger to guarantee the ventilation port remains higher than the patients abdomen.

Enteral Nutrition Indications• Patients unable to eat due to surgery, injury,

or disease like mechanical ventilation, comatose, and head and neck surgeries– Post-CABG, MVA head traumas

• Nutritional deficits from reduced food ingestion or malabsorption – Low albumin, decrease appetite

• Impaired gag or swallow reflexes– Stroke, tracheostomy patients

Enteral Feeding Administration and Maintaining Tube Patency

• Initiation after tube feed placement checked– Start at 10-40mLs/hr

• Progression to goal– Increase by 10-20 mLs every 8-12 hrs– Critical care/greatly malnourished

• Increase by 10 mLs every 12-24 hrs

• Flush tube with 20-30mLs every 4 hrs– Before and after intermittent feedings– 10 mLs before and after each medication administration– 30 mLs before and after each residual check

Patient/Family Education for Feedings

• Stay upright if tolerate during and after feedings– Pause if Head of bed is less

than 30 degrees• Fullness, increased gas,

belching, or diarrhea is common

• X-rays will be completed to ensure placement after placement

• Use of a lopez valve or leur-lok system during feedings is preferred

• Absent bowel sounds are not a contraindication to feedings

• Residuals cannot be checked if jejunum or duodenum is accessed by tube

• Immunocompromised or critically ill patients should have sterile water flushes.

Nursing considerations for feeding• Tube feeds should be at

room temperature– Liquids not room temperature

can cause gastric cramping and discomfort

• Shake tube feed well• Gastric residuals greater than

500mls can cause aspiration• Change tubing and tube feed

bags a minimum of every 24hrs

• Blood sugar checks should be a minimum of every 6 hours

• Check gastric residual before each feeding and every 4-6 hours initially for continuous feedings for 24 hours, then every 6-8 hours– Once small bowel feedings

tolerance, there is no benefit to performing residual checks and will clog the tube

– If residual is high, then intestinal tubes may be dislodged

– Enteroflexes are unable to check residuals due to the density of the tube

Parentral Nutrition (TPN)Indications

• Bowel rest• Nonfunctioning GI tract• Severe malnutrition in

which the patient does not eat for 5 days or more

Contraindications

• Treatment of < 5 days without malnutrition

• No IV access• Functioning GI tract

Parentral Nutrition (TPN)• Peripheral Nutrition– 10-14 days without fluid

restriction• Central Nutrition– Long-term, fluid

restriction, poor peripheral access

• Bags last for 24 hours and a new order must be placed by 1800 for pharmacy to have for patient

• Complications– Abnormal labs, fatty liver,

GI atrophy, catheter complications

• Transition slowly to po diets– Decrease TPN volume by

half every 1-2 hours• Maintain TPN– If TPN continuing without

next bag present, start D10 to maintain blood sugar.