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Nasogastric Tubes Lab I Part II

Nasogastric Tubes Lab I Part II. NPO Oral Care q 2 to 4 hrs. Examples -Brush, Rinse or mist with Water, or Suck on moist cloth, Cautious use of ice chips…. Additional NPO Care Methods. Oral care to prevent parotitis Brush teeth Normal Saline with Toothettes Lemon glycerin swabs

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Nasogastric Tubes Lab I Part II

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  1. Nasogastric TubesLab I Part II

  2. NPO Oral Care q 2 to 4 hrs. Examples -Brush, Rinse or mist with Water, or Suck on moist cloth, Cautious use of ice chips…

  3. Additional NPO Care Methods • Oral care to prevent parotitis • Brush teeth • Normal Saline with Toothettes • Lemon glycerin swabs • acid damages enamel of teeth • glycerin dries sub-mucosa • Hydrogen peroxide & mouthwash with alcohol dry and/or irritate mucosa • Mouth & lip moisturizer • Nasal care • retape tube q 24 hr. & clean with N/S

  4. Discontinuing a N/G Tube • Check orders & Pt’s ID band • Assess abdomen, bowel sounds, swallowing • Turn suction off • Don gloves • Flush with air&/fluid • Flush with air leave syringe attached to tube • Untape tube • Plug or clamp tube • Hold breath or on exhalation D/C tube • Nasal & oral care • Document

  5. Nasogastric TubesforDecompression Salem-Sump tubes Two lumens • Large - movement of liquids in or out of the stomach • Small Pig Tail - inflow of air into stomach

  6. Rationale for N/G Suction Tube • Nausea & Vomiting • Removal of Toxic substances • Upper gastrointestinal bleeding • Decompression for stomach or bowel surgery • Paralytic GI track or bowel obstruction

  7. Salem-Sump Tubes • Describe the purpose of the Pig Tail. • What is the only substance that can be used to flush the Pig Tail?

  8. Salem-Sump Tube Uses • Is it possible to use a Salem-sump for: • feeding? • medication administration? • How is this tube different from those normally used for feeding?

  9. Flushing Tube after Aspiration Usual volume: 30 to 60 ml. Water or Normal Saline * Modifications are made if Fluids are Restricted

  10. Attaching a Salem-Sump to Suction

  11. Suction Pump Settings Connect tube to suction: StrengthFrequency Low - 80 to 120 mm Hg Intermittent or Constant * High - > 120 mm Hg Intermittent * Must be used only with a Salem-sump tube

  12. Tube Irrigation • What’s the BEST solution for irrigating a suction tube and why is it used? • What’s the usual solution for irrigating a feeding tube?

  13. Saline for suctioning When patient is NPO with suctioning: Water or excessive consumption of ice chips increases the production of gastric secretions which contain electrolytes Treat excessive thirst with: Increased IV fluids Frozen electrolyte solution chips Remember the 4 S’s… Salem-Sump, Suction, & Saline Water normally goes with food and feedings!

  14. Nursing Diagnosis • Consider: • Alteration of nutrition r/t vomiting • Alteration in skin integrity r/t irritation to nasal secretions • Risk for fluid volume deficit r/t NPO status, suctioning

  15. Maintaining Salem-sump Tube • Check function q 4 hr. & PRN for • Pt.’s signs & symptoms • Abdominal assessment - sounds & distention • Drainage – Mark suction container • Suction status • Check placement prior to irrigation • Irrigate 30 to 60 ml N/S as ordered PRN • Irrigate with 30 ml. air when clamping • Limit ice chips & sips of water

  16. Flow Sheet Charting • Usual Intake & Output q 8 hr. • Subtract N/G irrigations from output • > 100 ml. N/G output per hour should be reported • Urinary output • < 30 ml. per hour X 2 hrs. should be reported • Report total output that exceeds intake • Report B/P, pulse > 20 beats/min.above normal for pt.at rest, seizures, confusion, abnormal electrolyte values, etc.

  17. Salem-Sump & Levine Tubes

  18. Dobhoff tube a Flexible Tube • Passed through stomach to duodenum for continuous feeding • Passing and checking for placement is different • Pass the tube with a stylet • Inject air but do NOT aspirate • Leave stylet in place • Call for X-ray to validate placement

  19. Common Feeding Tubes • Compare Levine & Flexible Tubes: • Size • Flexibility & comfort • Cost • Danger of displacement once feeding is in progress

  20. You MUST Perform at least 2 Safety Checks: Prior to each use of a N/G Tube: Irrigation Administering a Feeding Administering Medications Shift Assessment for Position & Function Q 4 hr. Assessment for Position & Function

  21. Check tube placement with atleast 2 ways • Inject 20-30 ml of air and listen with a stethescope on the abdomen for the wosh of air into the abdomen • Aspirate gastric contents • Check ph of gastric contents with ph strip • X-Ray of tube positioning (ie:dobhoffs) • Put end of tube in a glass of H2O if bubbles in lung

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