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Clinical Topic # 5

Gastric Tubes Student Guide

Objectives: Students will: Describe the procedure for initiating and maintaining tube feedings. Describe methods to avoid complications of tube feedings. Describe methods to avoid complications of parenteral nutrition Demonstrate insertion, placement, confirmation, and documentation of NGT Demonstrate preparation and administration of medication and nutrition via gastric tubes. Differentiate between various types of gastric tubes and tube feedings. Supplies to Bring: None. We will have supplies in the lab to utili e. Supplemental Activities: !iew "Taylor#s !ideo Guide to $linical Nursing S%ills& '() Nutrition Nursing Diagnosis: *mbalanced Nutrition: less than body re+uirements, -is% for .spiration Discussion uestions: (. What is /nteral Nutrition and when is its use indicated0 1/N2 o /nteral nutrition provides nutrients into the GI tract. It is the preferred method of meeting nutritional needs if a patient is unable to swallow or take in nutrients orally yet has a functioning GI tract. 3. Discuss advantages and disadvantages of various enteral feeding routes 1ie NGT, GT, and 4T2. Nasograstric tubes are used to give postpyloric feeding because the formula is placed directly into the small intestine. 5ne disadvantage of using nasogastric tubes is that gastric ileus prevents feedings from being given. Gastric Tubes are an invasive feeding route. They are inserted through a small incision in the abdomen into the stomach. . benefit of this %ind of feeding tube is that it can be useful where it is difficult for a patient to swallow, such as after a stro%e. 4e6unal tubes are used to give postpyloric feedings because it is put directly into the 6e6unum. *t is also preferred if there is a ris% of gastric reflu7, which could lead to aspiration. 8. Discuss advantages and disadvantages of bolus9intermittent9continuous feeding. Some of the advantages of bolus feeding is that it is more physiological, and enteral pump is not re+uired, they are ine7pensive, and easy to administer. 5n the other end of the spectrum, there is an increased ris% of aspiration with bolus feeding. $ontinuous feeding can improve tolerance, reduce the ris% of aspiration, and it increases the time for nutrient absorption. They are more e7pensive for home support though, and my restrict ambulation. :all 3)((

*ntermittent feedings allow for greater mobility and may be better tolerated than bolus. *t does increase the ris% of aspiration, gastric distention, and delayed gastric emptying. ;. Describe the different types of /nteral feedings <olus feedings are infusions of up to =))ml of enteral formula into the stomach over =>3) minutes, usually by gravity or with a large>bore syringe. $ontinuous feedings are a form of enteral formula administration into the gastrointestinal tract via pump or gravity, usually over ?>3; hours a day. *ntermittent feedings are administered at specified times throughout the day, in smaller volumes and at a slower rate than bolus feedings. They are usually given in 3))ml>8))ml over 8)>@) minutes. =. Aow do you assess a patient#s tolerance to gastric feedings0 . nurse will assess the patient#s gastric residual volumes in order to determine how they are tolerating gastric feedings. @. What are the steps and rationales for chec%ing for residual volume0 Draw up () to 8) mB of air into syringe. $onnect to end of feeding tube. :lush tube with air. Cull bac% slowly to aspirate total amount of gastric contents 1see illustration2.

Return aspirated contents to stomach unless volume exceeds 250 m ! then check agency policy. "ome #uestions exist regarding the safety of returning high volumes of fluid into the stomach $o not administer feeding when a single GR% exceeds 500 m or when two consecutive measurements &taken ' hour apart( each exceed 250 m

Return of aspirate prevents fluid and electrolyte imbalance

"ome controversy exists regarding the ability of elevated GR%s to identify risk for pulmonary aspiration. )owever! fre#uent interruptions of feeding based on GR% levels is a well* recogni+ed reason for failure to meet nutritional goals

D. Describe procedure for nasogastric tube insertion and removal. !nsertion - Wash hands - Dip tube with lube into glass of water - *nsert tube through nostril to bac% of throat. - Aave patient fle7 head toward chest - /ncourage patient to swallow - /mphasi e the need for mouth breathing through the process - Bisten for air e7change at the end of the tube when the tip reaches the carnia - .dvance length of tube as patient swallows until desired length is reached :all 3)((

- anchor tube to nose and avoid pressure on nares - :asten end of nasogastric tube to patients gown - :or intestinal placement, place patient on right side until location is verified - 5btain 7>ray film of chest9abdomen - Don clean gloves and administer oral hygiene - -emove gloves and dispose of e+uipment "emoval E Cerform hand hygiene. Don clean disposable gloves. E Clace towel or disposable pad across patient#s chest. Give tissues to patient. E Discontinue suction and separate tube from suction. Fnpin tube from patient#s gown and carefully remove adhesive tape from patient#s nose. E *nstruct patient to ta%e a deep breath and hold it. E $lamp tube with fingers by doubling tube on itself. Guic%ly and carefully remove tube while patient holds breath. E Clace tube in disposable plastic bag. -emove gloves and place in bag. E 5ffer mouth care to patient and facial tissues to blow nose. E Heasure nasogastric drainage. -emove all e+uipment and dispose according to agency policy. Cerform hand hygiene. , Record removal of tube! patient-s response! and measure of drainage. .ontinue to monitor patient for 2 to / hours after tube removal for gastric distention! nausea! or vomiting. ?. What documentation needs to be included for a patient with a gastric tube of any %ind0 -ecord and report type and si e of tube placed, location of distal tip of tube, patient#s tolerance of procedure, pA value, and confirmation of tube position by 7>ray film e7amination. I. Discuss factors to consider when administering medications through gastric tubes. Catients who have a nasogastric tube in place are commonly given medications through the tube. *f a medication is not available in li+uid form, you must first crush it or open the capsule and empty the powder or granules and then dissolve the medication in a facility> approved>fluid. *n general, do not administer sustained>release, chewable, long>acting, or enteric>coated tablets and capsules through an NG tube. *f unsure about whether or not you can safely crush a tablet or open a capsule, consult a drug guide or a pharmacist.

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