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Gastro-Intestinal Tubes

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Gastro-Intestinal Tubes & Enteral Nutrition NURS 108 Majuvy L.Sulse MSN, CCRN Enteral Feeding Nutrients given via the GI tract Easier to give especially for home care ... – PowerPoint PPT presentation

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Title: Gastro-Intestinal Tubes


1
Gastro-Intestinal Tubes Enteral Nutrition
  • NURS 108
  • Majuvy L.Sulse MSN, CCRN

2
Enteral Feeding
  • Nutrients given via the GI tract
  • Easier to give especially for home care
  • Types
  • Polymeric-1 to 2kcal/ml-milk based blenderized
    foods prepared by the dietary or at home
  • Modular-3.8 to 4kcal/ml-single and incomplete
    formulas
  • Elemental-1 to 3kcla/ml predigested nutrient
    formulas for a partially functional GI to absorb
  • Specialty formulas-1 to 2 kcal/ml-formulas
    designed to meet specific needs in certain
    illness.

3
Feeding Tubes
  • Nasoenteric tubes (NET)- usually for short term
    lt4 weeks
  • Nasogastric (NGT)-
  • Nasointestinal-doudenal or jejunal (NDT/NJT)
  • Surgically placed (enterostomal) gastrostomy
    Jejunostomy tubes-long term use
  • Endoscopic
  • gastrostomy (PEG)
  • Jejunostomy (PEJ)-bypass stomach in presence of
    gastric disease, UGI obstruction, abnormal
    gastric or doudenal emptying

4
Feeding Tubes
  • Nasointestinal tubes are longer than NG tubes and
    are indicated to medically treat an obstruction
    of the small intestine in someone who's a very
    poor surgical risk. They rely on a weighted
    distal end and peristalsis to advance the tube
    along the intestinal tract in an attempt to
    relieve the obstruction

5
Feeding tubes
6
Indications for Enteral feedings
  • Inadequate oral intake
  • Continuous feedings
  • CVA
  • Difficulty swallowing-absence of gag reflex
  • Anorexia Nervosa
  • Severe depression
  • Local trauma or critical illness
  • Prolonged intubation
  • Gastrointestinal disorders
  • Fistulas, IBD, mild pancreatitis

7
Indications for Enteral feedings
  • Neurological and mascular disorders
  • Brain neoplasm
  • CVA
  • Dementia
  • Myopathy
  • Parkinsons disease
  • Cancer
  • Upper GI
  • Head Neck

8
Nursing Management
  • Patient position
  • HOB 30-45 degrees
  • Patency of tube
  • Irrigate with water before and after each feeding
    (if intermittent) or medication administration
  • Tube position
  • Check tube placement before each feeding and drug
    administration
  • Xray most accurate assessment of placement
  • Aspirate gastric contents
  • Check pH contents-less than 5 indicative of
    stomach contents
  • Check every 4-8 hours with continuous feedings
  • Check for bowel sounds

9
Nursing Management
  • Formula
  • Given at room temperature
  • Amount in bag should not exceed 4 hours or per
    policy
  • Labeled with date and time initially used
  • Aspirate contents measure amount-if volume is
    gt200 ml with signs of intolerance, hold feeding
    for an hour and recheck residual volume. Aspirate
    should be re-instilled.

10
Nursing Management
  • Feeding administration-rate volume increased
    gradually to minimize side effect as nausea
    diarrhea. Water flushes or boluses given
  • Feeding pump-continuous
  • Gravity method-intermittent-volume is usually
    200-500/feeding
  • Nursing care
  • Daily weights or as per policy
  • I/O
  • Blood glucose
  • Oral care

11
Complications related to Tube Feedings
  • Vomiting or aspiration
  • Improper tube placement
  • Delayed gastric emptying
  • Contamination of formula
  • Diarrhea
  • Feeding too fast, hypertonic formula, medications
  • Lactose intolerance
  • Contamination of formula
  • Low fiber formula

12
Complications related to Tube Feedings
  • Constipation
  • Formula components
  • Poor fluid intake
  • Drugs
  • Impaction
  • Dehydration
  • Excessive diarrhea
  • Poor fluid intake
  • Hyperosmotic diuresis
  • High protein formula

13
Nursing diagnosis
  • Imbalance nutrition less than body requirements
  • Weight monitoring to make caloric adjustment
  • Progress slowly to avoid gastric distention
  • Gradually add high calorie foods to maintain
    weight
  • Impaired skin integrity related to enzymatic
    action of gastric juices
  • Assess skin daily for signs symptoms of
    irritation
  • Apply protective skin barrier
  • Strict handwashing
  • Patient family teaching

14
Nursing diagnosis
  • Risk for aspiration
  • Positioning
  • Aspirate gastric contents before feeding
  • Disturbed body image related to presence of
    feeding tube
  • Encourage expression of feelings
  • Acknowledge patient fears
  • Provide correct information

15
Nursing diagnosis
  • Risk for deficient fluid volume/volume overload
  • Monitor mucous membranes skin turgor, VS, I/O
  • Provide adequate fluid intake
  • Reinstill gastric contents to prevent electrolyte
    losses
  • Ineffective therapeutic regimen management
  • Give detailed information and return
    demonstration techniques to validate learning

16
Legal Ethical Issues
  • Withholding food fluids-what happens if clients
    are not able to make decisions or make their
    wishes known????
  • Review what is known about tube feedings
    especially risks benefits
  • Review medical facts about the client
  • Obtain the opinion of all stakeholders in this
    situation
  • Delay any action until consensus is achieved

17
Decompression Tubes
  • Occasionally, a tube can be used for acute
    treatment of active bleeding from esophageal or
    gastric varices. Two types are most common
  • The Sengstaken-Blakemore tube has a large
    balloon to compress the esophagus and a smaller
    one to anchor the tube and exert pressure against
    varices in the distal esophagus and the cardia of
    the stomach. It has three lumens-one each to
    inflate the balloons and one attached to suction
    to aspirate gastric contents. To suction
    secretions above the esophageal balloon, an
    additional tube, such as a Salem sump tube, is
    placed in the proximal esophagus.
  • The Minnesota tube is similar to the
    Sengstaken-- Blakemore tube, but it also has an
    esophageal aspiration lumen that eliminates the
    need for an additional drainage tube.

18
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19
Decompression Tubes
  • Gastric tubes-commonly used NG tubes that are
    placed for GI decompression or drainage..
  • Salem sump- The Salem sump has two lumens, one
    for drainage and one for air. The drainage lumen
    is usually connected to low continuous suction.
    At times, however, higher levels may be needed.
    The air vent keeps the tube away from the stomach
    wall to prevent damage to the mucosa
  • The single-lumen Levin tube is typically
    connected to intermittent low suction for the
    same purpose.

20
Decompression Tubes
  • Intestinal Tubes mercury-filled balloon at the
    distal end. These tubes are rarely used today
    because the balloon could rupture and leak
    mercury. The newer Andersen tube, with a
    pre-weighted tungsten tip, is a safer option
  • Miller Abbot tube-A long 10 (3 m) double-channel
    intestinal tube. Inserted through a nostril, the
    tube is passed through the stomach into the small
    intestine. Used for sampling gastrointestinal
    fluid or for therapeutic aspiration to relieve
    intestinal distension.
  • Cantor tube- 10 single-lumen tube with a suction
    port in the lumen to aspirate contents
  • Harris Tube- short around 6single lumen also to
    relieve distention, Y end allows lavage of
    intestinal tract
  • Dennis tube-10 3 lumen irrigation, drainage
    balloon inflation

21
Andersen tubes
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