Gastrointestinal Intubation - PowerPoint PPT Presentation

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Title:

Gastrointestinal Intubation

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Vent lumen kept above the client's waist. ... prevents the reflux of gastric contents out of the vent lumen. After suction lumen is irrigated, air is injected. ... – PowerPoint PPT presentation

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Title: Gastrointestinal Intubation


1
Gastrointestinal Intubation
2
Purposes of GI tubes
  • To decompress the stomach, remove gas and fluid
  • To lavage the stomach, remove ingested toxins
  • To diagnosis disorders of GI motility
  • To treat an obstruction
  • To compress a bleeding site
  • To aspirate gastric contents for analysis

3
Examples of Clients with GI tubes
  • Disorders of the Esophagus- cancer, surgery
  • Neck Dissection
  • Post surgical gastric surgeries

4
Types of Tubes
  • Short- Nasogastric tube
  • Introduced from the nose to the stomach
  • Levin and Gastric (Salem) Sump
  • Used to remove gas and fluid from the upper GI
    tract or to obtain a specimen of gastric contents
  • Sometimes used for meds or feedings

5
Levin Tube
  • Single Lumen (hollow part of tube)
  • Size 14-18 French
  • Made of plastic or rubber
  • Circular markings on the tube serve as insertion
    guides
  • Connected to low intermittent suction (20 to 80
    mm Hg)

6
Gastric (Salem) Sump
  • Double lumen catheter
  • Plastic, 12-18 FR.
  • Used to decompress the stomach, keeps it empty
  • Smaller, inner tube (blue pigtail) vents the
    larger suction-drainage tube to the atmosphere by
    way of an opening at the distal end of the tube.

7
Sump cont.
  • Keeps the suction force at the drainage openings
    at less that 25 mm Hg to prevent capillary
    irritation.
  • Connected to low continuous suction.
  • Vent lumen kept above the clients waist.
  • Anti-reflux valve- prevents the reflux of gastric
    contents out of the vent lumen.
  • After suction lumen is irrigated, air is
    injected. Reestablishes a buffer of air between
    the gastric contents and the valve.

8
Types cont.
  • Medium length- nasoenteric used for feeding.
    Example- Dobhoff
  • Placed in the duodenum or jejunum by fluoroscopy
    (x-ray dept) or at clients bedside.
  • Verified by x-ray before feedings begin.
  • May take up to 24 hrs. to pass through the
    stomach into the intestines.
  • Place client on right side to facilitate passage

9
Types cont.
  • Long- nasoenteric tubes introduced through the
    nose and passed through the esophagus and stomach
    into the intestinal tract.
  • Used to aspirate intestinal contents-ie. gas and
    fluid (Decompression) to prevent intestinal
    obstruction.
  • Due to ? peristalsis, prevents vomiting, reduces
    tension at the incision line and prevents
    obstruction.

10
Types cont.
  • Examples of long tubes
  • Miller- Abbott- used for aspiration and
  • weighted with mercury, water, or saline
  • Harris- used for suction and irrigation
  • mercury-weighted.
  • Cantor- has a large balloon at distal end of
  • tube. Filled with 4- 5 ml of mercury, water
  • or saline to weight the tube.

11
Inserting an NG Tube
  • Provide privacy, wash hands, wear gloves
  • Instruct and reassure client.
  • Determine nares patency and length to insert.
  • Measure from tip of nose to earlobe, earlobe to
    xiphoid process. Add 6 in. for NG, 8-10 in. for
    intestinal placement.
  • Place client in Fowlers position,head tilted
    back slightly.
  • Lubricate end of tube and insert until resistance
    is met at nasopharynx.

12
Inserting cont.
  • Have client tilt head forward until chin is near
    chest and ask client to sip water or ice chips
    and swallow. Aids in advancing the tube.
  • Advance tube to measured circular mark.
  • Have client open mouth and inspect orophayrnx to
    be sure tube is not coiled in back of throat.

13
Confirming Placement
  • Tube placement is confirmed prior to any use of
    the tube for suction, irrigation, medication
    admin. or feedings.
  • Initially, an x-ray should be ordered to confirm
    placement of weighted feeding tubes (Dobhoff).
  • Verify NG or Salem Sump tubes by auscultation of
    an injected air bolus over the epigastrium or
    aspirate stomach contents.
  • Measurement of tube length and visual inspection
    of aspirate is also recommended.

14
Securing the GI tube
  • Use a skin barrier to prep the skin
  • Use NG strip or place a piece of tape under the
    tube at the nose and secure to the skin, place
    another piece of tape over the first piece.
  • Secure tube to clients gown with a safety pin.

15
Documentation
  • Tube type and size
  • Drainage or aspirate (residuals) amount, color
    and consistency
  • Irrigation type and amount
  • Suction- type and level (i.e. low intermittent)
  • Feeding- type and amount
  • Patient tolerance
  • Patient/ Family education and response

16
NG Suction
  • Tube for decompression will be attached to
    Intermittent Suction.
  • Keep suction setting between 20-80mm Hg.
  • Continuous suction greater than 25mm Hg can cause
    damage to the gastric mucosa.
  • Do not clamp or plug the vent lumen.
  • A soft hissing sound will be heard from the vent
    lumen if its patent.
  • Empty cannister q shift- record amt. on IO
  • Change cannister if needed, tubing q 48 hrs.

17
NG Irrigation
  • Obtain solution ordered by MD , water or saline.
  • Wear gloves.
  • Obtain irrigation set- 60cc syringe with tray and
    equipment to confirm placement of tube.
  • Unclamp tube or disconnect from suction/ feeding.
  • Check amount of residual if tube not connected to
    suction.

18
Irrig. Cont.
  • Draw up irrigation fluid in syringe (50-100ml).
  • Connect to tube and gently instill irrigation
    fluid. DO NOT FORCE IRRIGANT.
  • Instill air into vent lumen (15-20 cc for adult).
  • Re-establish suction or feeding as indicated.
  • Document irrigation type and amount suction
    type drainage amount and color and, how client
    tolerated the procedure.

19
Medication Administration into an NG Tube
  • Check MD order
  • Check to be sure medications can be crushed or
    given through a tube (ie.enteric coated is never
    crushed).
  • Follow 5 rights of Med. Admin.
  • Disconnect tube from suction or feeding.
  • Aspirate stomach contents- if less than 100cc of
    contents, reinstill back to client.

20
Med. Admin. cont.
  • Irrigate tube with 30-50 ml of irrigation fluid
    prior to med. administration.
  • Mix with water or apple juice in med cup to
    dissolve.
  • Use syringe to flow into tube by gravity or use
    bulb. Give each med separately.
  • Irrigate tube with 30-50 ml of irrigation fluid
    after med. administration.
  • Re-connect to suction or feeding.
  • Document med. admin., client tolerance.

21
Nursing Management for clients with GI tubes
  • Instruct client re purpose and procedure for
    inserting/assisting and advancing the tube.
  • Confirm the NG placement.
  • Advance the nasoenteric tube- Use CAUTION
  • Gastric Surg. pts.- Do not reinsert!!! Call MD
  • Monitoring the client, maintaining tube
    function/patency.

22
Nurs. mgmt. cont.
  • Provide oral and nasal hygiene and care
  • Monitor for complications- aspiration,
    constipation, N V, occlusion
  • Check for placement even with continuous feedings
  • Change feeding bag and contents according to
    procedure
  • Tube removal
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