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Nasogastric Tubes


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What are some reasons that a physician might decide a NG or NI tube is necessary?
Decompression of the stomach, gastric lavage, gavage or medication administration.
What is gastric lavage and when may it be necessary?
Irrigation of the stomach with normal saline and may be needed with GI bleeds.
When may decompression of the stomach be necessary?
When there is an accumulation of gastric contents, fluid, blood, or air in the stomach.
What is gavage?
Introduction of a nutritional supplement into the stomach.
What are Levin tubes?
Single lumen tubes with large lumens and with out venting systems used to quickly remove stomach contents (such as a pt. who has ingested a poison)
Why should contnuous suction never be used with Levin tubes?
Levin tubes have no venting systems. If continuous suction is used and all the stomach contents are removed then the openings on the tube could adhere to the gastric mucosa and damage it.
What are gastric sump or salem sump tubes?
Double lumen tubes with venting systems. A large lumen is used to empty stomach contents while a smaller lumen is used to vent air.
Is continuous suction safe when using a salem sump or gastric sump tube?
yes, because of the venting system the tube won't adher to the stomach mucosa
What are some other uses for gastric sump or salem sump tubes besides suction?
short term gastric feeding or medication administration
What makes nasogastric, nasoduodenal or nasojejunal tubes (feeding tubes) different from other tubes.
They are feeding tubes with smaller single lumens and are more flexible. They are placed with a stylet and may have a weighted tip to help advancement.
What is a PEG tube?
Percutaneous endoscopic gastrostomy. They are inserted by a physician through the skin on the abdomen and into the stomach.
What are some key issues to consider when inserting NG tubes?
1. place pt. in high fowler position
2. remove dentures, bridges, etc.
3. assess each nare for occlusion or deformities and select the more suitable nare
4. measure the tube from the tip of the nose to the ear lobe to the xiphoid process.
5. May be warmed for flexibility
What issues need to be considered when inserting a NI tube?
1. Same issues as for inserting a NG tube
2. risk for aspiration is reduced.
3. tubes have guide wires for rigidity (NEVER reinsert wire after being removed from tube)
4. After reaching the stomach turn pt. to the rt. lateral lying position to advance past pylorus.
5. Prior to insertion pt. may be given peristaltic agent to increase gastric motility.
What is a critical element when inserting a NG or NI tube?
Verifying placement. If tube is inserted into trachea the pt. could receive formula into there lungs and aspirate or develop aspiration pneumonia.
What is the best way to verify correct placement of a NG or NI tube?
Radiographic evaluation (X-ray). Tubes have radiopaque material and can be visualized on film. This is considered the standard of care to confirm placement
What are other ways to confirm placement of NG or NI tubes?
Aspiration of contents or auscultation
What is a normal appearance and pH of stomach contents?
brown or green with a pH ranging from 0-4.0 (however, maybe as high as 6.0 if pt is taking meds to decrease gastric acid)
What is the pH and appearance of lung contents?
6.0 and is normally clear.
What is a normal appearance and pH of intestinal contents?
green with a pH of 7.5-8.0
When is aspiration not reliable to confirm placement of a tube?
When trying to distinguish between lung and intestinal placement or when using small flexible tubes (such as feeding tubes) which may collapse
True or False? Verification of placement only needs to be done once after insertion of a tube.
False. Verification of placement should be monitored routinely at least once per shift and before administration of any meds or feedings
True or Fals? If using a tube for decompression the amount of drainage should be included as part of the output.
What is TPN?
Total Parenteral Nutrition and is given by IV
Why are enteral feeding prefered over parenteral feedings?
Enteral feedings help maintain GI structure and function and stimulates GI immunologic function.
What are the three delivery methods for enteral feedings?
nasogastric, nasointestinal and PEG
What are some of the advantages of a NG tube?
The stomach retains its reservoir function, more naturally regulates movement of the formula into the small intestine (decreasing dumping syndrome) and reduces the risk for infection.
What is a disadvantage of NG tubes?
There is a higher risk for aspiration because the feedings are delivered into the stomach. pts. with a poor gag reflex or those that cannot elevate the head of the bed may not be good candidates for NG feedings.
What are some disadvantages to NI tubes?
a dumping syndrome type problem may occur because the stomach is bypassed.
What is dumping syndrome?
dumping syndrome occurs when a large bolus of "food" rapidly enters the small intestine.
What are some of the early signs and symptoms of dumping syndrome?
vertigo, tachycardia, syncope, diaphoresis, pallor, and palpitations.
What are some of the late signs and symptoms of dumping syndrome?
epigastic fullness, distention, diarrhea, abdominal cramping, nausea, high pitched bowel sounds.
What are some possible problems with PEG tubes?
infection due to precutaneous nature of the method and problems with self-image
True or False? Tube feedings have to be continuous?
False. They can be continuous or intermittent although continuous are usually preferred
True or false? Tube feeding infusions are started at a fast rate.
False. They are started at a slower rate (30-50cc/hr) then increased as pts. tolerance of the feedings dictates.
True or false? Intermittent feedings can be given 5-8 times a day with a volume of less than 250cc over 30 min.
True or false? Tablets cannot be given through tubes.
False. Tablets can be crushed to a fine powder and dissolved in 30cc of water and given with tube feedings.
What are several things a nurse should focus on when caring for a pt. with a NG, NI or PEG tube?
confirmation of placement, assessment of drainage, determination of residuals if on tube feeding, tube patency, assessment of bowl tones, fluid and electrolyte status needs to be monitored, frequent oral care, daily changing of feeding bags and tubing, using meticulous hand washing and gloves.
How often should residuals be checked on a tube feeding?
If the feeding is continuous, residuals should be checked every 4 hrs. and for intermittent feedings it should be assessed prior to feeding.
Rule of thumb, how many cc of residual is it okay to put back into the pt? When should the dr. be called?
If less than 100cc then it is okay to put back into the pt. If over 100cc discard and call the dr. (or if residual is 2x the hourly rate-check with agency policy)
What are some ways to monitor fluid and electrolyte status?
intake and output, skin turgor, mucous membranes, and lab results.
What are the 3 general types of NG/NI tube complications?
Mechanical, metabolic, or gastrointestinal
Mechanical complications (obstruction of tube) of NG/NI tubes include:
inadequate flushing of the tube, a reaction between the formula and medications, inadequately dissolved or crushed medicaitons, or using gravity vs. pump.
What are some ways to prevent obstructions to NG/NI tubes?
appropriate flushing of tube with warm water after medication administration, using push and pull technique of syringe to relieve obstruction, ensuring meds are compatible with the formula and properly crushing and dissolving meds.
What are metabolic complications usually caused by in NG/NI tubes?
Fluid and electrolyte imbalance
What are three examples of a GI complication?
Aspiration, aspiration pneumonia and diarrhea
What are some causes of aspiration and aspiration pneumonia in pts. with NG/NI tube?
Decreased GI motility, decreased acidity (causing increased baterial growth), increased gastric residual vol., nausea/vomiting, not having the HOB raised during feedings, or migrating tubes.
What are some causes of diarrhea in a NG/NI tube feeder?
improper handling of formula, too rapid of a feeding rate, and bacterial infections.

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