Gastrointestinal Intubation Chapter 29: Gastrointestinal Intubation

Intubation Intubation: placement of a tube into a body structure Types of intubation Orogastric: mouth to stomach Nasogastric: nose to stomach Nasointestinal: nose to intestine Ostomy: surgically created opening

Intubation (cont’d) Gastric or intestinal tube uses include: Performing gavage- nourishment Administering oral medications Sampling sections for diagnostics Performing a lavage- removing substances from stomach- ex. Poisons Compression-Pressure gastric bleeding Decompression-removing gas and liquid contents from stomach or bowel

Types of Tubes Gastrointestinal tubes Orogastric tubes Nasogastric tubes Some have more than one lumen Gastric sump tubes (double- lumens)

Types of Tubes (cont’d) Nasointestinal tubes Longer than nasogastric tubes Feeding, decompression Transabdominal tubes Gastrostomy tube Jejunostomy tube

Question Is the following statement true or false? A nasointestinal tube is a tube placed through the nose and advanced to the stomach.

Answer False. A nasointestinal tube is inserted through the nose for distal placement below the stomach.

Nasogastric Tube Management Insertion assessments: Level of consciousness; weight Bowel sounds; abdominal distention Nasal/oral mucosa integrity Swallow, cough, gag ability Nausea or vomiting present?

Question Is the following statement true or false? Assessing abdominal distention is part of preintubation assessment conducted by the nurse.

Answer True. Assessing abdominal distention is part of preintubation assessment conducted by the nurse.

Tube Measurement and Placement NEX measurement Length from nose to earlobe to xiphoid process, marking tubing for reference Insertion should cause as little discomfort as possible Determine proper placement using: Abdominal xray and monitoring external tube length

Nasointestinal Tube Management Insertion of nasointestinal tubes NEX measurement + 9 inches Checking tube placement Initially via x-ray Test pH of aspirated fluid-Gastric <5 Small intestines >6

Tube Feedings Enteral nutrition is provided via stomach or small intestine rather than oral route Benefits and risks Uses body natural reservoir for food Dumping syndrome-weakness, dizziness, sweating, nausea, low blood sugar, diarrhea Formula type based on client’s nutritional needs (table 29-4)

Tube Feedings (cont’d) Tube-feeding schedules Bolus feedings-250cc-400cc given in 30 min 6 times a day- least desirable-distends stomach rapidly Intermittent feedings-gradual instillation of liquid 4 to 6 times a day, over 30-60 min 250-400 cc per administration

Tube Feedings (cont’d) Cyclic feedings –continuous instillation of liquid for 8-12 hours followed by a 16-12 hour pause. Use to help wean people from tube feedings Continuous feedings-instillation of liquid nutrition without interruption- usually 1.5 ml/min given beyond the stomach reduces the risk of vomiting.

Question Which is a symptom of the dumping syndrome? Select all that apply. a. Sweating b. Appetite loss c. Weakness d. Nausea

Answer a. Sweating, c. Weakness, d. Nausea The symptoms of dumping syndrome are weakness, dizziness, sweating, and nausea, due to fluid shifts from the circulating blood to the intestine, and low blood glucose level related to a surge of insulin. Appetite loss is not a symptom of the dumping syndrome.

Tube Feedings (cont’d) Daily client assessment: weight, vital signs, intake/output, bowel sounds, lung sounds, breathing, mucosal condition, etc. Regular gastric residual assessment No more than 100cc or 20% of the last hours TF volume. If residual is high the stop feeding and recheck every 30 min until it is within a safe volume to resume feeding

Tube Feedings (cont’d) Nursing management Maintain tube patency- flush tube with 30-60 ml of water after feeding or medication; Clear obstructions-flush with 30-60 cc of warm water and a back and forth motion. If it cannot be cleared, tube is removed and another is reinserted Provide adequate hydration-Adults require 30 ml of water/kg of body weight; Ready client for home care See table 29-5 page 675