Week 13 Part 2: Tube Feeds Flashcards Preview

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Flashcards in Week 13 Part 2: Tube Feeds Deck (55):
1

Candidates for tube feeding?

Those who have adequate digestion + absorption but cannot ingest, chew, or swallow food safely or in adequate amounts.

2

Most serious complication of tube feeding?

Aspiration

3

What kind of tubes are usually used in short term tube feeds?

nasogastric (NG) and orogastric (oR) and nasoenteric.

4

When is gastrostomy or jejunostomy tube indicated?

When feeding is going to be more than 4 weeks long
Or nose + mouth contraindicated

5

Who determines what kind of feeding a pt will get?

Dietician + nurse + physician collaborate to determine this

6

Most serious complication of NG tube insertion?

Inadvertent pulmonary intubation

7

Is small intestine feeding reliable preventative of pulm respiration?

Evidence is mixed...most recent doesn't seem to indicate this

8

What techniques can be used during insertion to inc chances of putting tube in right place?

Fluoroscopy
Capnogaphy (CO2 sensor on end of tube)

9

What height of bed should be maintained during feeding?

At least 30 degrees, preferably 45

10

Why is measurement of gastric residual volumes done?

To ID risk of regurgication + pulm aspiration of gastric contents
*Done at regular intervals during tube feeding

11

Can a decision to stop tube feeding be made solely based on GRV amounts?
What is the upper limit of GRV before indicates need to stop feeding?

No, this also has very mixed evidence...researchers agree must assess whole clinical condition in addition.

Is a range...some say 250-500mL.

12

If oral intake is not contraindicated for TF patient, what can be done around meal times to help psychological wellbeing?

Can still be encouraged to have oral intake
This can help to to sustain the social and psycological significance of meal time.

13

Factors that increase risk for complications r/t feeding tube insertion?

Altered LOC
Abnormal clotting
Impaired gag or cough reflex

14

Downside of wires put into NG tube during insertion?

Higher risk of pulm or esophageal injury

15

Nasal tube feeds contraindicated when?
Other things to look for in pt hx that may require alternate procedure?

basiliar skull # or facial trauma (may go through mouth in this case)
- hx of nasal problems, nosebleeds, facial trauma, nasal-facial sx, deviated septum, anticoagulant therapy, coagulopathy

16

Why is it important to look at a pt's coagulation status before tf insertion?

Because anticoag + bleeding disorders for epistaxis (nose bleed) during nasal tube placement

17

What should you get pt to do to indicate gagging or dicomofrt during tf insertion?

Can have raise index finger

18

If pt needs to be supine, what position for tf insertion?

Reverse trendelenberg

19

What might you want to attach to pt to monitor during insertion procedure?

Pulse oximeter

20

How do you prepare a NG or nasoenteric tube for intubation?

Inject 10mL H2) using 30-60mL luer-lok or catheter tip syringe (to ensure patency)

If using stylet, make certain that is it positioned securely within tube

21

How should patient be instructed to breath during insertion procedure?

Mouth breath

22

What to do when tip reaches level of carina (bifurcation of trachea into two bronchi)
Where is this?

10-12inches
Stop and listen for air exchange from distal portion of tube (if can head breath sounds, may indicate is in resp tract. Must remove)

23

What might indicate intubation into resp system? What to do?

Pt coughing, drop in O2 saturation, other signs of resp distress
WIthdraw tube into posterior nasopharynx until normal breathing resumes

24

What to do immediately after tube insertion to check placement?

Aspirate contents + check pH

25

What must be done prior to removing stylet from the ng tube after insertion?

Is it ok to reinsert style when tube is in place

xray ensures correct placement
- Never try to reinsert a partially or fully removed stylet while tube feed is in place (may perforate wall of tube + cause injury)

26

What to instruct pt to do while you remove tube feed?

What to do with tube prior to removal?

Take deep breath + hold it

Kink tube by folding it over on itself to prevent residual fluid in tube from flowing out.

27

What do if aspiration of stomach contents into resp tract, evidence by ausculatation of crkcles, wheezes, dysnea or fever?

- report changes to hc provider (suggest xray if not one recently done)
- Position pt on side
- Suction nasotracheally or orotracheally
- Prepare for possible initiation of abx

28

Displacement of ft to another side (eg: from duodenum to SI. Possibly occurs when pt coughs or vomits. What to do?

= Aspirate GI contents + measure pH
- Remove displaced tube + insert and verify placement of new tube
- If there is question of aspiration, get chest xray

29

How to measure length of tube to be inserted in pediatrics?

Nose-ear-mid umbilicus better for neonates + children then nose-ear-xyphoid

30

Is child typically sent to xray to verify tube placement?

What other routine procedure is not recommended in peds?

Special consideration regarding insertion in pediatrics (has to do with heart rate)

No, not routine because of radiation risk

Routine flushes not recommended

Look for vagal stimulation (evidenced by decreased HR)

31

Special geri consideration for tube insertion?

Ensure adequate lubrication of tube d/t decreased secretions

32

How frequently is verification of tf placement usually done (asirating for pH)

Q4-6 hours
+ before administering meds + feed
(or depending on patient condition)

33

Dislocation of the tube upwards can increase risk of?

Aspiration

34

What different ways are used to determine tip location of feeding tubes?

Are results of pH reliable?

1) Monitor external length of tube + observe the appearance, volume, and pH of fluid aspirated though it
2) Testing pH of aspirate at the bedside
3) repeat xray if any doubt about movement of tf
* Results of pH offers some info but not reliable during continuous feeds + should be used in combo with other methods and careful assessment of pt in the clinical setting.

35

How does colour help to indicate tip position?

Most intestinal aspirates stained by bile to distinct yellow colour, gastric are not
(However if you look at the pictures in p+p p. 783 it seems to indicate otherwise...)

36

Do you inject air into the ttube feed prior to aspirating to listen for tip position?

No - listening to air instilled through the tube in unreliable
(Stephen said he still does this sometimes but you neeed a well trained ear and not typically used now)

37

What conditions increase risk for spontaneous tube migration or dislocation?

- altered LOC/agitation
- Vomiting, coughing
- Nasotracheal suction

38

What to check on patient prior to aspirating (as another way of checking placement)?

Observe external portion of tube to see if ink mark still at mouth or naris

39

For intermittently tube fed patients, when should checking tube site through aspiration be done?

Immediately before each feeding or med (as this will lead to aspiration if tube is displaced!)

40

Do you aspirate for pH checks while a tube feed is infusing?

Perry + Potter says that according to some protocol you'll need to stop the infusion a few hours prior for an accurate reading.
It also says you don't usually interrupt a continuous feed to do this pH checking...only be doing so if is being stopped for some other procedure.

41

Wait to verify placement at least ____hrs after mediacation admin by tube or mouth.

1 hour

42

Procedure for aspirating for pH to check placement of tf

- inject 30mL air in 60mL syringe
- Draw back 5-10mL gastric contents SLOWLY
- Gently mix aspirate in syringe
- Expel few drops into clean medicine cup
- dip pH strip by dipping or applying a few drops
- Compare colour to chart
- IRRIGATE tube

43

Why inject air prior to aspirating?
Why 60mL syringe?

- Burst of air aids in aspirating fluid more easily
- Small syringe generates unnecssary pressure in tube

44

What can be helpful to do if aspirating fluid is difficult?

Get patient to reposition side to side
In some cases more than one bolus of air may be necessary

45

Why aspirate slowly?

Using too small of a syringe or drawing back too quickly may cause tube to collapse

46

Is it typically harder to aspirate from a small intestine or stomach placement tf?

Intestine

47

When might gastric contents be bile stained?

If intestinal contents refluxed into stomach

48

What is the normal pH of a patient that has fasted for at least 4 horus
Pt with continuous tube feed?

What about from the small intestine?

Usually 5.0 or less
Continuous tf may have ph of 5.0 or higher

SI: pH >6.0

49

gastric pH paper should have a range of what?

0 to 11.0

50

pH reading of ___ of less is reliable indicator of stomach placement

5.0 or less

51

pH of pleural fluid from tracheobronchial tree generally?

>6.0

52

WHat to do if you can't aspirate after several attempts?

If has been confirmed by xray to be indesired position and there are no risk factors for tube dislocation, monitor external lengtth + watch pt for evidence of resp distress

53

What to do if: red or brown colouring (coffee grounds) of fluid aspirated from ft indicates new or old blood in GI tract

If colour not r/t mediactions recently administered, notify hc provider

54

What to do if pt develops severe resp distress (dyspnea, decreased sats) as results of aspiration?

STop any enteral feedings
Notify hc provider
Obtain CXR as ordered

55

What to do if abdomen becomes distended with tf?

Stop feed + notify dr