Care of Clients with Enteral Feedings & NG Tubes

1. Care of Clients with Enteral Feedings & NG Tubes Cathy Gibbs BSN, RN

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Types of Tubes? • Depends on • Purpose or needs • Length of time • Dietary needs • Rate

10. 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

11. 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

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

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

14. 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