Gastric Tubes

Question 1

What are the six purposes of gastric intubation?

Answer 1

1. decompress the stomach
2. meet nutritional requirements when oral intake is not possible
3. administer medications
4. diagnose GI disorders
5. compress bleeding site (ER only)
6. lavage stomach (ER only)

Question 2

What are the different types of gastric tubes?

Answer 2

nasogastric, nasoenteric, gastrostomy/jejunostomy

Question 3

What is the purpose of a nasogastric tube?

Answer 3

decompression of stomach until normal peristalsis returns.
feeding
short-term

Question 4

What is the purpose of nasoenteric tubes?

Answer 4

feeding only.
lasts several weeks

Question 5

What is the purpose of a gastostomy/jejunostomy

Answer 5

feeding only.
long-term.

Question 6

What are the types of gastrostomy tubes?

Answer 6

G-tube
PEG (percutaneous endoscopic gastrostomy) tube

Question 7

What are the types of jejunostomy tubes?

Answer 7

PEJ (percutaneous endoscopoic jejunostomy) tube

Question 8

What is the point of a nasogastric pigtail?

Answer 8

The pigtail is an air vent that prevents suctioning of the gastric mucosa. Gastric fluid should not be present in the pigtail.

Question 9

What interventions should you take if the pigtail clogs?

Answer 9

push air (10-20mL) or fluid (20mL) through the tube. The anti-reflux valve should prevent clogging. Always place the pigtail above the stomach.

Question 10

What is the common suction pressure for a Salem Sump?

Answer 10

80mmHg

Question 11

How do you check the placement of a salem sump?

Answer 11

X-ray or pH

Question 12

How do you use a salem sump for stomach decompression?

Answer 12

Intermittent suction at 80mmHg

Question 13

What should you never do with the pigtail of a salem sump?

Answer 13

Never clamp it, connect it to suction, or use for irrigation

Question 14

What are some reasons for decreases in suction output? What interventions do you take?

Answer 14

Displaced tube - check placement
tube obstruction - flush or irrigate
other etiology - assess patient for N/V, abd distention

Question 15

What is an Enfit connector and what is it for?

Answer 15

Enfit connectors promote patient safety by reducing medication administration errors.

Question 16

What does a nurse need to consider prior to insertion of a gastric tube?

Answer 16

1. it needs a provider’s order
2. reason for insertion
3. patient related factors: feeding duration
4. risk factors of complications

Question 17

What are some risk factors of complications prior to gastric tube insertion?

Answer 17

1. level of consciousness
2. coagulation status
3. nasal polyps/surgery
4. gagging
5. esophageal disorders

Question 18

What are common regular interventions for gastric tube maintenence?

Answer 18

maintain patency by flushing regularly

Question 19

How do you insert a nasogastric tube?

Answer 19

1. place patient in high fowler’s position.
2. measure from nose to ear lobe to xiphoid process, then add up to 15cm
3. lubricate tube
4. extend head back and insert the tube downward
5. apply gentle pressure to advance until the nasopharynx
6. tilt head forward and advance as patient swallows
7. if continued gagging, check if tube has coiled in the throat
8. mark length at nose
9. check placement with aspiration & pH, then CXR
10. secure tube with tape, and to the gown with a safety pin.

Question 20

What are the ways to verify NG tube placement?

Answer 20

1. CXR
2. pH
3. auscultatory air bolus, water bubbling
4. tube length
5. placement in pulmonary system = observe for S/Sx respiratory distress, keep HOB 30 degrees, capnography monitoring

Question 21

If the aspirated contents are green, yellow, or red, and the pH is less than 5, where is the most likely source?

Answer 21

gastric fluid

Question 22

If the aspirated contents are yellow, and the pH is greater than 6, where is the most likely source?

Answer 22

pulmonary lung fluid

Question 23

If the aspirated contents are yellow, orange, or red, and the pH is greater than 7, where is the most likely source?

Answer 23

intestinal fluids

Question 24

What type of tubes can be used to administer enteral nutrition?

Answer 24

NG tube, G-tube, NJ tube, PEG tube, OG tube
via intermittent/bolus feedings or continuous feeding

Question 25

What are some indications for enteral nutrition?

Answer 25

1. patients at high risk for aspiration: altered LOC, dysphagia, impaired gag reflex, ventilation, esophageal disorders, delayed gastric emptying 2. abnormal or obstructed ingestion and absorption of nutrients: surgical resection, obstruction, pancreatitis, liver failure, fistula 3. decreased oral intake: anorexia, nausea, depression

Question 26

How do you prevent aspiration risks in tube feedings?

Answer 26

1. Administer at prescribed rate and method 2. observe patient tolerance 3. measure GRVs prior to feeding or every 4-6 hrs 4. hold feeding if GRV >200mL two times in a row 5. keep patient upright during and for an hour after feeding

Question 27

How is tube patency maintained?

Answer 27

routine irrigation - continuous: flush every 4 hrs - intermittent: flush before and after each feed - flush before and after each med, feeding, checking of GRV, disconnecting or clamping tube - pediatrics: 1-3mL for neonates, 3-5mL for pediatrics.

Question 28

How long can a feeding hang for and how often do the bags need to be changed?

Answer 28

feedings should not hang for more than 4-8 hours, and bags need to be changed every 24 hours.

Question 29

What considerations need to be taken when administering medications?

Answer 29

1. do not mix with feedings 2. use liquid medications 3. do not crush SL, ER/DR, or enteric coated pills 4. crush pills and mix with water 5. poke a hole in the capsule and squeeze it out

Question 30

What are common problems and potential complications of NG tubes and feedings?

Answer 30

tube displacement, tube obstruction, irritation and ulcers or mucosa aspiration and pneumonia N/V, diarrhea, gas, bloating cramping

Question 31

How can feeding cause diarrhea? N/V? Gas, bloating, cramping?

Answer 31

diarrhea: too fast, too rich, too much fiber N/V: too much or delayed gastric emptying Gas: too fast, too rich, too cold, too much fiber

Question 32

If flushing with water does not declog a tube, what other solutions can be used?

Answer 32

cranberry juice soda meat tenderizers (papain) pancreatic enzymes

Question 33

What are common problems associated with gastrostomies or jejunostomies?

Answer 33

1. wound infection 2. GI bleeding 3. premature removal of tube 4. constipation 5. diarrhea

Question 34

Determine which procedures can NAP assist with in relation to gastric tubes.

Answer 34

1. Insert a feeding tube 2. patient positioning and comfort 3. Verify placement of a tube 4. reporting changes in patient condition 5. nasal and oral hygiene 6. measurement of drainage 7. anchoring tube to patient gown

Question 35

What differences do nurses need to consider when inserting a NG tube in a pediatric patient?

Answer 35

1. measurement of the tube ends between the xiphoid process and belly button. 2. gastric tube sizings are smaller 3. confirm placement with x-ray 4. vagal stimulation may occur with tube placement.

Question 36

What differences do nurses need to consider when inserting a NG tube in a geriatric patient?

Answer 36

1. GRV checks are needed 2. remove ill-fitting dentures for comfort and safety 3. lubricate tube for insertion d/t dry mucosa.