Tubes Flashcards
Review the tubes, what they are for, and the nursing care.
What is a lumen in relationship to the different types of tubes?
A lumen is a tube:
- some lumens can have multiple tubes
- each tube has a separate function
What is the difference between a single, double, and triple lumen?
- a single lumen has 1 tube
- a double lumen has 2 tubes
- a triple lumen has 3 tubes
What is a (nasogastric) NG tube and what is its function?
Inserted in the nose and placed in the stomach to:
- remove fluids or gas (called decompression) / suction is turned ON
- give meds and nutrition (called tube feedings) / suction is turned OFF
What is the difference between NG tube feedings and total parenteral nutrition (TPN)?
Both give nutrients to the client but in completely different ways:
- NG tube feedings: liquid food in a tube goes directly into the stomach.
- TPN: nutrients go directly into an IV.
Is the insertion of an NG tube a sterile or non-sterile procedure?
A non-sterile procedure and clean gloves are used.
The nose, mouth, stomach, and colon are not sterile.
How is an NG tube measured before insertion?
NG tube measurement: NEX (Nose, Earlobe, Xiphoid process):
Measure the length of the tube from:
- the bridge of the nose
- to the earlobe
- to the xiphoid process
That is the length of tubing that will be inserted.
What are the steps of an NG tube insertion?
- place client in high-Fowler’s position
- measure tubing (NEX)
- lubricate tip
- insert tube and have client swallow water while head is bent forward
- secure tube to nose with tape
Click HERE to view an example of the NG tube insertion procedure.
What test is done to confirm placement of an NG tube before being used for the first time?
X-ray.
This is to make sure the tube didn’t accidentally go in the lungs, brain or get coiled in the back of the throat.
How is NG tube placement confirmed before meds or a feeding?
Check the pH of gastric secretions by aspirating a small amount: pH < 3.5 indicates the tube is in the stomach.
What is assessed before starting tube feedings?
- residual amount of fluid in the stomach by using a syringe to aspirate.
- bowel sounds to make sure they are not hyperactive.
When should a tube feeding be held?
- the residual is > 100 mL (depends on hospital policy)
- there are no bowel sounds
Healthcare providers have different preferences on when it is appropriate to hold an NG tube feeding.
Why should residual fluid from an NG tube always be replaced back into the stomach?
In order to prevent fluid and electrolyte imbalances.
What is the difference between a bolus feeding and continuous tube feeding?
- Bolus feeding: NG tube feedings are given quickly at once and several times throughout the day
- Continuous feeding: NG tube feedings are continuously given throughout the day
What position is a client placed in for bolus and continuous NG tube feedings?
- Bolus feedings: high-Fowlers for 30 minutes afterward.
- Continuous feedings: semi-Fowler’s at all times.
These positions are to prevent aspiration.
What is used to flush before and after NG tube med administration and NG tube feedings?
water or normal saline
Flushing is to assure that the client received all the meds or feeding and to prevent blockage in the tube.
How should meds be given through an NG tube?
Crush meds one at a time and give one med at a time.
This prevents interactions between crushed meds.
Which types of meds should NOT be crushed?
Extended-release or enteric-coated meds.
These meds are designed to be released over a longer time. Crushing the meds causes the client to receive too much of the med too quickly.
What are the steps to remove an NG tube?
- Tell the client to take a deep breath and hold it.
- Gently pull the NG tube out while coiling it around the hand.
What is a G-tube and J-tube?
They are both long term feeding tubes:
- G-tube: gastrostomy tube - placed in the stomach
- J-tube: jejunostomy tube - placed in the small intestine
Does placement need to be checked with a G-tube or J-tube?
No.
The tube is permanently placed and comes out through the abdominal wall.
How often is a bolus tube feeding and water bolus done?
Administered about every 4 hours during the day.
Why do water boluses also need to be given for tube feedings?
To prevent dehydration.
How often does the tubing that connects to the NG tube need replacement?
Every 24 hours.
This is to prevent bacterial growth.
What is a lavage tube?
It is used to pump out stomach contents very quickly.
It is usually used when a client has ingested poisons.
What is an esophageal Minnesota tube?
A tube used to place pressure against esophageal veins in order to control bleeding.
It is used for those with complications of cirrhosis.
What is a Foley urinary catheter for?
It is inserted through the urethra to continuously drain the bladder when the client is unable to urinate or when critically ill with strict intake and output measurements.
Is the insertion of a urinary catheter a sterile or non-sterile procedure?
Sterile.
The tube is entering the sterile cavity of the bladder.
What are the steps to insert a Foley urinary catheter?
- wash hands and apply nonsterile gloves
- clean perineal area with soap and water
- open catheter kit (it’s sterile inside)
- apply sterile gloves
- lubricate catheter
- attach syringe to ballon port
- spread labia or pull back foreskin
- clean perineal area with antiseptic cotton balls or swab sticks
- insert catheter into urethral meatus until urine drains into bag
- inflate ballon with 10 mL of fluid and secure tubing
Click HERE to view the Foley urinary catheter insertion procedure.
What is a straight cath?
A urinary catheter that has one lumen. It is only used once to either:
- empty the bladder
- obtain a sterile urine specimen
- drain residual urine after a client voids
Sterile technique is used in the hospital and clean technique in a home setting.
What are the steps to remove a Foley urinary catheter?
- insert 10mL syringe onto ballon injection port and remove all the fluid (about 10 mL)
- pull catheter out slowly and smoothly
What is a nephrostomy tube or ileal conduit tube?
A stoma that is made to go through the skin to drain urine from the ureters or urethra.
A small amount of mucus is expected in the bag. Mucus comes from the shedding of the stoma lining.
What is an endotracheal tube (ET) tube for?
To maintain a patent airway.
It is used with a ventilator or Ambu bag when the patient is unable to breathe on their own.
How is an ET tube placement confirmed?
X-ray: the tube should be 1 to 2 cm above the carina
Assess respiratory chest wall movement with the use of Ambu bag. Both sides of the chest should inflate. If only one side inflates the tube is too deep and needs to be pulled back.
What is a tracheostomy (trach)?
An opening on the front of the throat directly into the trachea to establish an airway - a tube is inserted.
The client may or may not be mechanically ventilated.
What are the steps to suction a tracheostomy?
- Prepare suction equipment and turn on suction
- Give humidified oxygen and hyperoxygenate client
- Monitor respirations and O2 saturation
- Apply sterile gloves
- Insert catheter without suction applied
- Apply suction intermittently while rotating the tube and withdrawing the catheter
- Limit suction to 10 seconds
Click HERE to view the tracheostomy procedure.
What is the immediate action if the tracheostomy tube dislodges?
(Immediate Complication)
- Extend neck and open the tissues of the stoma
- Pull the retention sutures to spread the opening
- Use a tracheal dilator to hold the stoma open
- Resuscitate with an ambu bag
What is the immediate action if the tracheostomy tube falls out within the first 72 hours?
(Immediate Complication)
Manually resuscitate using an Ambu bag and call the HCP.
What are the steps to clean around a tracheostomy?
- Use half strength hydrogen peroxide or normal saline to clean
- Wash hands and apply clean gloves
- Clean around site and apply new dressing
- Put new ties on first, then cut off old ties (ties may be made of velcro instead)
What are chest tubes for?
Drain fluid or air out of a client with a collapsed lung.
What are the 3 chambers in a chest drainage unit (CDU)?
- suction control chamber
- water seal chamber
- drainage collection chamber
What is the purpose of the suction control chamber in a CDU?
It controls the suction on how quickly or slowly fluid or air is removed.
What type of bubbling is expected in the suction control chamber?
Expect gentle, continuous bubbling.
What is the purpose of the water seal chamber in a CDU?
The water seal chamber is a tube that is placed in water that allows fluid and air to drain from the pleural space but prevents air from getting back into the pleural space.
How should the water move in the water seal chamber?
- up with inhalation
- down with exhalation
What does excessive or continuous bubbling in the water seal chamber indicate?
A leak.
The tube may need to be clamped to figure out where the leak is.
What has happened if the fluctuation of water stops in the water seal chamber?
It means:
- the tube is obstructed
- there is a dependent loop
- the lung has re-expanded
What is the purpose of the drainage collection chamber in a CDU?
It collects drainage from the collapsed lung.
What is the immediate intervention if the chest tube drainage system breaks or cracks?
(Immediate Complication)
Sometimes the CDU falls over and breaks.
Put the chest tube in a bottle of sterile water to act as a water seal so air doesn’t go into the client.
What is a Jackson-Pratt drain (JP drain) for?
Used to drain fluid or blood from a surgical incision into a bulb-shaped container.
