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Nasogastric Tubes and Enteral Feeding: Administration, Care, and Documentation, Exams of Nursing

Comprehensive information on nasogastric tubes and enteral feeding, including indications, procedures for insertion and maintenance, and documentation requirements. Topics covered include nasogastric tubes for decompression, lavage, and gavage, double lumen tubes, maintaining suction, and nursing care. The document also includes examples of documentation.

Typology: Exams

Pre 2010

Uploaded on 08/19/2009

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NRAD 201B
Week 12 - Nasogastric tubes, Enteral
feeding 1
Nursing Process: Energy,
Psychomotor
Nasogastric Tubes
Enteral Feeding
Administering Medications via
NGT and PEG
Rationale for Nasogastric Tubes - 1
1. Gastric Emptying (Decompression)
Bowel obstruction
GI Bleed
After GI surger y
Ileus (paralytic ileus)
2. Gastric Lavage Washing out: In & Out
Poisoning – NS in/out to remove poison quickly
Overdose – same
Gastric bleeding – Iced NS can be used
Critical Elements: Correct solution & temperature,
Control rate/volume of introduction/return of fluid.
Rationale for Nasogastric Tubes - 2
3. Gastric Gavage gavage goes in
Pt. cannot eat/swallow safely but has a
functioning GI Tract
Instillation of liquid food
Through an NGT or tube into stomach or
jejunum
Enteral feeding
pf3
pf4
pf5
pf8

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Week 12 - Nasogastric tubes, Enteral

Nursing Process: Energy,

Psychomotor

Nasogastric Tubes

Enteral Feeding

Administering Medications via

NGT and PEG

Rationale for Nasogastric Tubes - 1

• 1. Gastric Emptying (Decompression)

  • Bowel obstruction
  • GI Bleed
  • After GI surgery
  • Ileus (paralytic ileus)

• 2. Gastric Lavage – Washing out: In & Out

  • Poisoning – NS in/out to remove poison quickly
  • Overdose – same
  • Gastric bleeding – Iced NS can be used Critical Elements: Correct solution & temperature, Control rate/volume of introduction/return of fluid.

Rationale for Nasogastric Tubes - 2

3. Gastric Gavage – gavage goes in

– Pt. cannot eat/swallow safely but has a

functioning GI Tract

– Instillation of liquid food

– Through an NGT or tube into stomach or

jejunum

– Enteral feeding

Week 12 - Nasogastric tubes, Enteral

Nasogastric Tubes – double lumen

• Salem Sump Tube

• Normal adult size: 14F to 18F

• 120cm long

• Air vent or “pigtail” open to air

  • Rationale – to prevent adhering to stomach lining
  • Anti-reflux valve usually attached

• Uses: emptying (decompression), lavage,

Occasionally – Gavage (enteral feeding)

Emptying (Decompression)

• Application of negative pressure to

nasogastric tube via wall suction

  • May be continuous or intermittent
  • 20-40 mm/Hg = low suction

• Continuous: Increased risk of gastric mucosal

irritation with continuous suction > 25 mm/Hg

• Equipment required:

  • Suction regulator – wall style or portable
  • Collection canister
  • Connecting tubing.

Week 12 - Nasogastric tubes, Enteral

Documentation - example

• 0730 NGT in place to low intermittent suction.

Placement verified. Draining green fluid. Abdomen soft, hypoactive bowel sounds noted. States has not passed gas but is feeling “better”. M. Bright SN

  • 0930 Vomited 50mL dark brown fluid. NGT in place. Suction off. Placement verified. Abdomen round, tender, firm. Hypoactive bowel sounds. Placed to low intermittent suction with return 200mL dark brown fluid.. M. Bright SN

Nasogastric Tubes – small bore

feeding

• Adult size: 8F to 12F

• Internal stylet and

weighted end to

facilitate insertion

• Designed for enteral

feeding only.

Week 12 - Nasogastric tubes, Enteral

Gastrostomy Tubes

  • Designed as long-term enteral feeding device
  • Surgically or endoscopically placed in the stomach by a physician
  • Larger in diameter than nasogastric feeding tubes
  • PEG – percutaneous endoscopic gastrostomy

Insertion Nasogastric tube

  • Critical elements: Insert, verify placement, secure exterior of tube
  • Explain procedure to client
  • Collect and set-up required equipment
  • Position client: head of bed elevated as much as possible
  • Measure and mark the tube: nose to ear, ear to stomach

Insertion Nasogastric tube

  • Chin up initially until past soft palate & down back of throat
  • Chin down – have pt swallow, may need a sip of water
  • Push tube down smoothly and fairly quickly to mark
  • Stop if resistance encountered
  • Stop for extreme coughing
  • Stop for compromised breathing
  • Verify placement: aspiration, insufflation

Week 12 - Nasogastric tubes, Enteral

Enteral Feeding

• Review facility specific Policy & Procedure

• Review Physicians orders for:

-feeding tube type

-formula: type, strength, additional “free”

water

-feeding schedule

-checking residuals and when to hold or

resume feedings

• Check facility policy for:

-when to change container, tubing

-formula hang time

Nursing Care

  • Feed in semi-fowlers position and maintain position for 2 hours after feeding. - How should the client be positioned if feeding is continuous?
  • Check placement at beginning of shift and before feeding!
  • Check for residual per physician orders or every 4 hrs. if continuous or before feeding if intermittent or bolus.
  • Hold per Physician orders
    • Aspirated residual is returned to the stomach
    • Critical Thinking: how do you assess tolerance to feeding?

Critical Elements: Feeding per NGT

• 1. Assess/reassess for correct placement

• 2. Check residuals q 2-4 hrs and prn

• 3. Secures tube and monitor integrity of

securing mechanism

• 4.Flush tube before/after medication

administration

• 5. Skin care (pressure points where tube

may be pressing): keep clean & dry

Week 12 - Nasogastric tubes, Enteral

Medication Administration via

NGT/PEG

• Assessment - Is the medication appropriate

to crush??

• Medications must be in liquid form or

crushed.

• Dissolve in warm H2O

• Verify placement of NG tube/PEG

1. Flush with H2O (20mL or *per policy)

2. Administer medication – draw up in syringe

3. Flush with another 20mL * H2O, clamp for

30” before returning to suction (if suction

ordered).

Removal of Nasogastric Tube

• Review Physician’s order

• Gather equipment and explain procedure

• Disconnect from suction tubing

• Position the client and remove tape securing

tube

• Remove smoothly and quickly while client holds

breath

• Assist client with nasal care

• Document!!

Documentation - examples

• 1100 Placement feeding tube verified. Abdomen

soft, active bowel sounds noted. Head of bed up

45 degrees. Jevity ½ strength, 50mL/hr started

via feeding pump. M. Bright SN.

• 0800 Abdomen firm, active bowel sounds noted.

PEG placement verified. 20mL residual noted.

Full strength Glucerna @ 50mL/hr via feeding

pump. Denies nausea, cramping. M. Bright SN