Caring for the client with gastric or intestinal tubesWhy Insert an NG Tube?Decompression: Removal of stomach contents by way of SUCTION; prevention of N/V and gastric distention when motility is slow or absent.? Intestinal obstruction? Post-op ileus? Gastric or intestinal surgery? Pancreatitis? Purposes:? Allows the bowel to rest? Relieves N/V and distention? Prevents aspirationGavage:Giving food or meds through the tube when the patient cannot swallow but has normal bowel functionVocabulary Lavage:The washing out of stomach contents.Repeated washings with NS. Maybe done for the ingestion of poison. Decompression:The removal of stomach contents: gas or air or other substances for the purpose of relieving distention.Usually done with suction. Gavage:Feeding.Done with a feeding tube. Compression:Pressure applied to stop bleeding.Done with a nasogastric tube and inflated balloon.Used in bleeding varices, ulcers.Iced saline is often used.Pressure is applied with a manometer. Normal Saline:0.9% Normal Saline.Physiologically compatible with blood. French:A system used to indicate the outer diameter of catheters.Each unit is approx. 1/3mm.Normal for NGT is 12-20 Fr.Types of Tubes? NG tube: nasogastric tube can be a feeding tube or a tube used for suction? Salem sump: ?Most often used for suction.? Double lumen (blue pig-tail)? Keep above midline to prevent leakage of stomach contents? Dont irrigate pig-tail unless secretions are present? Dobhoff: ?Most often used for feeding? Radioopaque stylet? Tungsten weighted end for easier mobility? Goes into small intestine? Levin:Rubber or plastic, used for suction, single lumen? Ewald:26-30 French. For patients who have ingested poison. Inserted through mouth.? Miller-Abbott:Long, double lumen.Balloon end with Hg, air or fluid. Rubber. Used for suction or irrigation? Sengstaken-Blakemore:Triple lumen. Esophageal tamponade. Balloon in stomach and esophagus.Non-NG tubes? Gastrostomy:? A tube going directly through the skin into the stomach.Used for feeding.When endoscopy is used, its called a PEG.Used for long-term feeding.? Jejunostomy:? A tube going directly through the skin into the jejunum, bypassing the stomach.Used for long-term feeding.Used if patient has GERD, risk for aspiration, or gastritis.More vocabulary? Large/Small bore:Relating to the inner diameter of a catheter or tube.G-tubes are large bore while J-tubes are generally small bore.? Similarly, tubes used for decompression are generally large-bore while feeding tubes are smaller bore.Small bore tubes? Generally clog easier with feeding or medicines.? Best way to unclog them is the flush with warm water.? Coke vs. cranberry juice vs. water? Will migrate more easily up in to esophagus and lungsLarge bore tubes? Generally are for a shorter term? Cause more irritation to the nose, mouth, throat and esophagusPrinciples? NGTs are easily dislodged.Be aware of your environment when working close your patients.? Suction is set up from 80-120mg Hg.Any more than that can cause bleeding.? When inserting a feeding tube, always listen for bowel sounds first.Why?? Always listen to lung sounds at least once a shift.Why?? Tape tubes to nose to minimize irritationPrinciples? Always keep accurate I & O.Its easy to lose track of irrigants.? Suction may be continuous or intermittent.The physician will specify this.? Always keep HOB above 30 degrees.Why?? Describe suction drainage as it is going into the cannister, not when it is already there.What could go wrong with NG insertion?? Tube comes out mouth? Tube is in lungs:coughing, gagging. Aspiration pneumonia.VERY SERIOUS!? Nares are irritated: Frequent oral and nasal care? Tube stops draining: Check if tube is patent.Irrigate with NS or air. Check equipment.Irrigation? The NG tube will need to be irrigated at least once a shift and prn.? Turn off the suction and use 30-60 cc NS.? Irrigate if tube is no longer draining or gastric distention occurs.? Patient may complain of nausea if tube is not patentReview questions? What is the purpose of assessing bowel sounds?? Your patient is NPO after gall bladder surgery and has an NGT to LWS.You observe no drainage after 3 hours and the pt complains of nausea.What should you do?? What do you do if the gag reflex is triggered when inserting an NGT?? Please practice inserting a Salem sump tube as well as a Dobhoff and note any differences.