Week 5 Flashcards
What are the potential complications of enteral feeding and what can you do as a nurse to prevent them?
Insertion complications
Aspiration Trauma Vomiting Gagging/coughing/choking Laryngeal spasm Pain Epistaxis on insertion
HOB 30 degrees No more than 3 attempts X-ray after insertion Analgesia Withdraw tube
GI/Metabolic complications
Not meeting caloric requirements Hyper/hypoglycaemia Over dehydration Diarrhoea/constipation Altered electrolytes
Conduct regular blood and urinalysis tests
Mechanical complications
tube migration
Tube blockage/obstruction
Secure tube with tape and change daily
Measure external length of tube every shift
Flush 50mL water before and after meds and feeds
Avoid crushing tablets - alternate route or obtain elixirs
Infection complications
Aspiration pneumonia
Tube contamination
Contamination of feed
Clean NTT when handling feeds
Check batch expedite and use by date prior to administration
Hand hygiene before and after tube manipulation
Change feed set every 24 hours
Do not have feed hanging >8/24 hours
Keep patient >30 degrees when feeding or left lateral position with bed head tilted to reduce risk of aspiration
What types of patients would you expect to see having NGT intubation and why?
Long term care patients - nutritional support
Surgical - removal of gastric contents and gas
Pancreatitis - removal of gastric acid and stomach contents
Pre-term infants - nutritional support due to lack of suckling and swallow reflexes
What are the signs of intolerance to enteric feeding?
Respiratory distress
Nausea
Vomiting
Diarrhoea
Constipation
Cramps
Aspiration
GORD
blood sugar fluctuations
When administering medication via NGT, what 3 things should the nurse do?
Flush before, between and after giving meds
Use elixirs if possible
Check with pharmacy if OK to crush tablets
How does the nurse prevent NGT complications?
6 hourly flush with water
Check and document tube length every shift
Clear blockages with water, carbonated water or effervescent vitamin C
Regular oral hygiene
Replace tape when loose
Give oral meds by another route if on free drainage
Check nares each shift for evidence of pressure injury
When is NGT position verified?
After insertion
Every shift
Every 4 hours in critical care or when continuous feeding
Prior to administration of anything down the tube
If tube has not been used for some time
If patient had been sick or coughed violently
What type syringe is used for flushing the NGT?
Disposable 50mL catheter tip syringe
When passing the NGT, what does coughing and choking indicate?
Tube has entered the trachea
What 2 checks are done to check position of the NGT?
X-ray
Aspiration
How many attempts can be made to insert a NGT?
No more than 3 attempts!
How is a NGT measured and what is the average length for an adult?
From tip of nose to ear
From ear to xiphoid process
Note mark on tube
54cm
What are the contraindications for NGT insertion?
Max-fax disorders, surgery, trauma
Pts post larygngectomy
Oesophageal tumours or related surgery
Confirmed or suspected skull fracture
Unstable cervical spinal injuries (vertebra 4>)
Clotting issues/disorders
Ingestion of corrosive material
What are the 3 types of NGTs?
Ryles (drainage) tube
Salem sump
Core-flow fine-bore nasogastric feeding tube
What is a Tiger Tube?
Fine bore specialty device used for longer term use in patients unable to tolerate nasogastric feeds.
The tube is inserted into the stomach then advances into the small intestine.
Has small protrusions on outside of catheter.
What is a Hiatus Hernia and what are the symptoms and treatment?
Hiatus hernia is a hernias ion of a portion of the stomach through the oesophageal hiatus in the diaphragm.
Asymptomatic or GORD symptoms Gastric reflux Heartburn Pain Bleeding Anaemia Retching/vomiting when bending over or laying down.
Lifestyle changes
Meds as per GORD
Surgery
