Tube Team Summary2

8/2/2019 Tube Team Summary2

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Polyurethane is kink resistant, stronger, and provides maximum durability. The

internal lumen is larger in comparison to silicone tubes of the same French size. (1 Fr

= 0.33mm) Corflo feeding tubes are color coded to correspond to the varying lengths

The stylets are braided stainless steel. The stylet lengths are matched to the Corflo

feeding tubes. The flow-through stylets are convenient when flushing, auscultating,

and aspirating during the insertion procedure. The tubes have a water activatedlubricant (C19) on the tip and internal lumen that makes intubation less

uncomfortable for the patient and making the stylet easy to remove. The entire

feeding tube is 100% radiopaque for x-ray confirmation with or without the stylet. The

feeding tubes contain 20% barium sulfate and the tip has 40%. Weighted tubes use

multiple tungsten weights that allow flexibility and greater comfort for the patient

during intubation. These Corflo feeding tubes have a unique dual component,

universal Y adapter that makes flushing easier and simplifies co-administration of

medicines. Touch contamination is also minimized with the closed system, reducingthe infection potential and simplifying feeding protocols.

Enteral nutrition, also known as tube feeding, consists of a nutritionally balanced

liquefied food, delivering nutrients distal to the oral cavity. It may be ordered for a

patient with a functioning GI tract but unable to take any or enough oral nourishment.

This may include patients with anorexia, orofacial fractures, head and neck cancer,

neurologic or psychiatric conditions that prevent oral intake, extensive burns, critical

illness, and those receiving chemotherapy or radiation treatment. Enteral nutrition

provides nutrition by the route of the gastrointestinal tract either alone or as a

supplement to oral or parenteral nutrition. A nasogastric tube is most commonly used

for short term feeding requirements. Transpyloric placement (into jejunum) is used

when physiologic conditions require feeding the patient below the pyloric sphincter.

Placement into the small intestine reduces the risk of regurgitation and aspiration. The

use of a stylet makes it possible to place a feeding tube when the ability to swallow is

compromised.

-3-It is important to explain the procedure to the patient. Position them in a sitting or

Fowlers position. They dont need to lean forward or have the head or neck extended.

Remove the tube and stylet from the package. Close the access port. Seat the stylet

connector firmly into the tube connector. Make sure stylet connector stays firmly

seated during intubation. The stylet is packaged with the tube, but use is optional and

may not be needed in the conscious and cooperative patient. Measure the length of the


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tube to be inserted to assure the tip enters the gastric region. Place exit port of the tube

at the tip of the nose. Extend the tube to the earlobe, then to the xiphoid process. Use

the centimeter marks on the feeding tube as a reference. Premeasuring is essential.

Never insert too much tubing because it may kink, causing an occlusion. Determine

the preferred nostril for insertion. Provide cooperative patient with a glass of water

with a straw. Activate the lubricant on the tip of the tube by dipping into tap water. Ifmore than several minutes elapse before the tube is inserted, additional dipping of the

tip may be needed. Direct the tube posteriorly, aiming the tip parallel to the nasal

septum and the superior surface of the hard palate. Advance on to the nasopharynx,

allowing the tip to seek its own passage. Ask the patient to swallow water while

advancing the tube into the stomach. If the patient coughs, this could be an indicator

the tube is misplaced into the trachea. If this is suspected, remove the tube and begin

the process again when the patient is comfortable. Relaxation is important. Even the

scrunching of the face adds difficulty to successful placement of the feeding tube,causing resistance. If resistance continues to be a problem, contact the doctor.

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Confirmation of the feeding tube position can be done with or without the stylet in

place. Gastric position can be confirmed by aspirating the contents of the stomach and

putting it onto litmus paper. When aspirating, use a 50 milliliters female Luer or cath

tip syringe inserted into the access port. Withdraw the plunger slowly. If it is difficult

to obtain gastric aspirate, the tip may be above the level of fluids in the stomach. Theinternal lubricant of the feeding tube must be activated before removing the stylet.

Open the side arm access port and flush the tube with 10 milliliters of water. Remove

the stylet immediately. It is extremely important that the position of the tube has been

confirmed before flushing with water. If gastric placement is all that is required, tape

the tube securely to the nose and cheek.

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The feeding tube is taped securely to the nose and cheek to prevent dislocation. Thetube team monitors the patients regularly to make sure the tape is secure to prevent

dislocation. If a patient does not want to leave the feeding tube in place and it is

needed or required, a bridle can be placed after the feeding tube has been inserted.

This is placed around the septum with a magnetized kit. The feeding tube is taped to

the bridle. If the patient attempts to tug at the tube it causes discomfort.


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The feeding tube is prone to obstruction if oral medications are not crushed

appropriately and dissolved in water. They can become dislodged by vomiting or

coughing. They can also become knotted or kinked while in the GI tract. Vomiting or

aspiration can happen if there is a delay in gastric emptying, which increases residualvolume. Diarrhea can be a problem that could be caused by several factors such as

feeding too fast, contaminated formula, and some medications. The fluid components

can also be the cause of constipation. Constipation can also be caused by some

medications and deficient intake of fluids. Dehydration may be a problem if there is

excessive diarrhea, vomiting or poor fluid intake.

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As with any procedure, it is important to accurately document the details to paint aclear picture. A thorough understanding of the procedure and the assessment of the

patient is important for the next person and how they interpret and determine the plan

of care for the patient.

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The patient was prepared psychologically by receiving a thorough explanation of

everything that was happening. Every question was answered and the patient was given

choices. The patients LOC was assessed regularly from the moment we walked in theroom. Steve would ask questions that would indicate if the patient was competent

enough to make decisions and know what was really going on during the placement.

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The Tube Team is definitely beneficial to the nursing staff and the hospital. They

provide expert care. Steve informed me of the possibility of nurses becoming

responsible for the placement of the feeding tubes. That procedure can be devastating

to the patient and the hospital when a nurse misplaces a tube into the lung. It becomesa life threat to the patient and unnecessary cost for the hospital.

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I thoroughly enjoyed my day shadowing Steve. He taught me, in comprehensive detail,

the process of placing a feeding tube. There were only two patients needing feeding

tubes placed, but that didnt stop me from understanding everything he was telling me


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about tube placement. The communication Steve provides to others he becomes

involved with while caring for a patient is amazing. He leaves nothing out and makes

sure others are informed completely.

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The first client was an older gentleman, about 73 years old. He had hip replacementsurgery but he fell and dislocated the replacement. He was confused, but not steadily

confused. Based on the simple question of being retired, he struggled with an answer

several times. The orders from the doctor were clear to insert the NG tube. He was

scheduled to have a swallow study at noon. We were in there around 10:00 am. After

inserting the tube, the doctor came into the room yelling out, Halt! Stop the presses!

meaning for Steve to stop with placement. He had just finished checking placement by

aspirating stomach content. The doctor said the tube was not supposed to be placed

until after the swallow study was complete. The nurse from the previous night had amiscommunication and didnt relay the proper information. Steve had to remove the

tube. He made sure the doctor was aware the orders in the computer didnt indicate

waiting for placement of the feeding tube.

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I was very surprised by the number of tubes placed by the Tube Team and by Steve,

alone. Learning there is only four individuals that are on the team was unexpected. I

was able to see different areas of the hospital. I didnt see the need to ask manyquestions simply because the information he was relaying to me was so thorough. He

explained everything so completely.

Documents

Tube Team Summary2