Gastrointestinal Intubation Nasogastricgoes to stomach for either suction

Gastrointestinal Intubation • Nasogastric—goes to stomach for either suction or feeding • Nasoenteric—goes to duodenum or jejunum for either suction or feeding

Types of Tubes • Suction tubes—Levin (NG), Salem Sump (NG), Cantor (NE) • Feeding tubes—Levin (NE), Dobbhoff (NE), gastrostomy (PEG), jejunostomy (both open to abd wall)

Suction Tubes: Indications • Decompression to relieve intestinal obstruction • Lavage to control bleeding • Confirm diagnosis by aspirating stomach contents

Feeding Tubes: Indications • Supplementation--Short term medication and nutritional management via NG or NE tube. Usually given by intermittent bolus. • Risk for aspiration--Provides long term medication and nutritional management via ostomy. Usually given by pump.

Formula • MD will decide type based on status of GI tract, nutritional needs of pt, and presence of disease • Most are started in diluted state • Pt will need water supplement

Complications from Tube Feedings • Aspiration • Tube dislodgement • Tube clogging • Bacterial contamination • Dehydration • Diarrhea • Hyperglycemia

Nursing Responsibilities • Assess nutrition & fluid balance • Know policies re: hanging time and tube changes • Monitor pt tolerance/complications • Check for residual (usually ordered) • HOB up • Emotional support

Home Care • Initiated in hospital; F/U by home health nurse • Family education: – – – Check for placement Monitor feedings/change bags and tubes Do site care Do oral hygiene Monitor for complications Call MD or nurse for questions or concerns

Insertion Technique for NG and NE tubes • Insertion is thru nose • Use NEX measurement + 6 inches for NG and 8 inches for NE • Technique: See Fundamentals skills and watch video

Checking for Placement • Listen with stethoscope • Put tube in glass of water • Aspirate contents (preferred) • X-ray (confirmation)

Securing Tube • NG tubes can be taped to nose and cheek right away after placement is determined • NE tubes are taped to forehead or cheek with plenty of slack to allow for advancement of 2 -3 inches every hour. Change positions q 2 h.

Nursing Responsibilities • • Check for placement Check suction settings Monitor feedings (continuous or bolus) I&O Hygiene Irrigation (if ordered) Clamping tubes Monitor for complications

Removal • • Clear line with air before removing Have pt hold breath Remove NG smoothly and quickly Remove NE at intervals q 10 min until it reaches esophagus • Conceal in towel • Provide oral hygiene