1. Gastrointestinal Intubation
Chapter 29:
Gastrointestinal Intubation

2. 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

4. 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

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

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

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

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

9. 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?

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

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

12. 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

13. 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

14. 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)

15. 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 min cc per administration

16. Tube Feedings (cont’d)
Cyclic feedings –continuous instillation of liquid for 8-12 hours followed by a 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.

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

18. 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.

19. 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

20. Tube Feedings (cont’d)
Nursing management
Maintain tube patency- flush tube with ml of water after feeding or medication;
Clear obstructions-flush with 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