
Purposes

To Put Thing In

Feeding

Comatose

Semiconscious

Unable to take in enough _________________

Compression Device
 To Take Things Out

Decompression of gut after GI surgery

Obtain gastric specimens

Irrigation

Clean and Flush

Documentation

Blood in stomach
 Monitor bleed in stomach

Identify recurrence of bleeding in stomach

Types of Tubes

Short Term

NG tube

Single Lumen

Double Lumen

Risk of __________________

Nasoduodenal

Weighted tip

Provider insert

Long Term

Gastrostomy Tube

_________________ placement

PEG

Placed at bedside

PEJ

Placed at bedside

Assessment of Tube Placement
 Performed q shift, before placing anything into tube

Auscultation

Check _____________

Gold Standard- CRX for placement

Complications

GI complications

Nausea, vomiting, abdominal distention, cramps, diarrhea, malabsorption/maldigestion

Mechanical complications

Aspiration, tube malposition, tube ___________________
 Metabolic complications
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
Hyponatremia, hypernatremia, dehydration, hyperglycemia, hypokalemia, hyperkalemia

For all NG procedures:
 Equipment

Check orders

Check policy/procedures

Verify ______________ water

Wash hands

Introduce self

Provide privacy

Explain procedure to client

Irrigation
 Procedure

_____________________ position
 clean gloves
 protect bedding

Check placement (15 to 30 ml of air)

Gently flush 30 mls water (type of water depends on facility)

Document (I/O)
 Feedings

A variety of formulas are available; they differ in osmolarity, calories per milliliter, and amount of carbohydrate, protein, fat, and fiber

Products are tailored to meet the needs of patients in certain situations

Infusions

______________________ feedings

Ambulatory patients and caregiver convenience
 The patient's head should be elevated 30° to 45° during feeding and for a half hour to an hour after
 Check residuals 1 hour after feeding has ended

Continuous feeding

Started at low rate (20 mL/hr) and increased by 20 to 40 mL/hr over 8 to 24 hours to meet nutritional needs

Residual checks are recommended every few hours and before
__________________________________________________________

Bolus Feeding

Wash hands wear gloves
 High fowler’s position
 Confirm placement

Check residual

If > ______________may hold according to policy

Feed

Flush

Provide oral hygiene

Continuous Feeding

Wash hands wear gloves
2


Semi- High fowler’s position (> 30 o )

Confirm placement

Check residual every 6-8 hours
 If > 500ml, hold feeding (check policy)

Feed- check rate, use pump

Flush every four hours with _______________ ml water (type depends on facility)

Turn every two hours, I&O, Oral Hygiene

Administering NG meds

Liquid preferred

Caution with crushed

5+2x3

Verify free water
 Confirm placement and residual

Flush

Administer med (one at a time, flush between)

Flush

Clamp for _____________________ post med admin

Document

Free Water

200cc per shift

1 med pass (5 meds)
 30cc beginning and end = 60cc

15cc between each med = 60 cc

Dilution of each med = 80cc (16cc each)
 …if we use it all…but should we?

Reasons to Connect to Suction

Bowel obstruction
 Ileus

Stomach or intestinal surgery – minimize secretion of stomach acids

Removing a NG tube

Don clean gloves
 Place towel over client’s chest

Clamp or plug tube

Unpin tube from gown

Loosen tape securing tube

Inject tube with 30 ml air to clear fluid
 Pinch tube and remove with continuous steady pull

Provide nasal and oral hygiene

Elderly

Caution with fragile skin

Diarrhea and skin breakdown

Higher chance of aspiration

Decreased ____________________________

Diminished gag reflex
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
GI reflux

Supine position

Pediatrics

Size of NG may be as small as 8 french

Smaller body mass
 ↑ risk electrolyte imbalance

Educate _______________________________

Pain meds will not stop discomfort of NG insertion

Need to distract - May pull at tubing

Study showed that older children and teens (age 7 -16) with more detailed psychological preparation and support found having a NG less distressing.

Younger (2-6) preparation was not significant

Ethical issues

Key medical, legal and ethics organizations are in consensus:

Artificial nutrition and hydration is a medical procedure that may be withheld or withdrawn. . .

If this is a decision the patient would make, if able, or

If tube feeding does not serve the patient's best interests.
 ALL states recognize…
 the competent patient's right to forgo medical treatment of any kind (including artificial nutrition and hydration), at any time, regardless of the patient's condition or prognosis.
 the right of an incompetent patient to have his or her previously expressed wishes regarding medical treatment followed, regardless of the patient's condition or prognosis.
 Only difference among the states is the level of evidence that is required to establish what a patient's wishes would be for his or her present situation

Documentation

1200 - J.S. placed in semi-fowlers position for continuous feeding of Isosource. Pt stated he was
“comfortable”. Oral hygiene offered and pt refused. Placement of NG auscultated. 40cc of residual was aspirated and returned. Isosource started at 20ml/hr via pump. NG secured. Nasal and facial skin intact. Pt left with call light ----------------------------------------------------------------------------------------Jack Jones, RN

Remember to chart I & O!
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