Gastro-Intestinal Tubes

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Gastro-Intestinal Tubes Enteral Nutrition

• NURS 108
• Majuvy L.Sulse MSN, CCRN

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Enteral Feeding

• Nutrients given via the GI tract
• Easier to give especially for home care
• Types
• Polymeric-1 to 2kcal/ml-milk based blenderized
  foods prepared by the dietary or at home
• Modular-3.8 to 4kcal/ml-single and incomplete
  formulas
• Elemental-1 to 3kcla/ml predigested nutrient
  formulas for a partially functional GI to absorb
• Specialty formulas-1 to 2 kcal/ml-formulas
  designed to meet specific needs in certain
  illness.

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Feeding Tubes

• Nasoenteric tubes (NET)- usually for short term
  lt4 weeks
• Nasogastric (NGT)-
• Nasointestinal-doudenal or jejunal (NDT/NJT)
• Surgically placed (enterostomal) gastrostomy
  Jejunostomy tubes-long term use
• Endoscopic
• gastrostomy (PEG)
• Jejunostomy (PEJ)-bypass stomach in presence of
  gastric disease, UGI obstruction, abnormal
  gastric or doudenal emptying

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Feeding Tubes

• Nasointestinal tubes are longer than NG tubes and
  are indicated to medically treat an obstruction
  of the small intestine in someone who's a very
  poor surgical risk. They rely on a weighted
  distal end and peristalsis to advance the tube
  along the intestinal tract in an attempt to
  relieve the obstruction

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Feeding tubes
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Indications for Enteral feedings

• Inadequate oral intake
• Continuous feedings
• CVA
• Difficulty swallowing-absence of gag reflex
• Anorexia Nervosa
• Severe depression
• Local trauma or critical illness
• Prolonged intubation
• Gastrointestinal disorders
• Fistulas, IBD, mild pancreatitis

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Indications for Enteral feedings

• Neurological and mascular disorders
• Brain neoplasm
• CVA
• Dementia
• Myopathy
• Parkinsons disease
• Cancer
• Upper GI
• Head Neck

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Nursing Management

• Patient position
• HOB 30-45 degrees
• Patency of tube
• Irrigate with water before and after each feeding
  (if intermittent) or medication administration
• Tube position
• Check tube placement before each feeding and drug
  administration
• Xray most accurate assessment of placement
• Aspirate gastric contents
• Check pH contents-less than 5 indicative of
  stomach contents
• Check every 4-8 hours with continuous feedings
• Check for bowel sounds

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Nursing Management

• Formula
• Given at room temperature
• Amount in bag should not exceed 4 hours or per
  policy
• Labeled with date and time initially used
• Aspirate contents measure amount-if volume is
  gt200 ml with signs of intolerance, hold feeding
  for an hour and recheck residual volume. Aspirate
  should be re-instilled.

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Nursing Management

• Feeding administration-rate volume increased
  gradually to minimize side effect as nausea
  diarrhea. Water flushes or boluses given
• Feeding pump-continuous
• Gravity method-intermittent-volume is usually
  200-500/feeding
• Nursing care
• Daily weights or as per policy
• I/O
• Blood glucose
• Oral care

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Complications related to Tube Feedings

• Vomiting or aspiration
• Improper tube placement
• Delayed gastric emptying
• Contamination of formula
• Diarrhea
• Feeding too fast, hypertonic formula, medications
• Lactose intolerance
• Contamination of formula
• Low fiber formula

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Complications related to Tube Feedings

• Constipation
• Formula components
• Poor fluid intake
• Drugs
• Impaction
• Dehydration
• Excessive diarrhea
• Poor fluid intake
• Hyperosmotic diuresis
• High protein formula

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Nursing diagnosis

• Imbalance nutrition less than body requirements
• Weight monitoring to make caloric adjustment
• Progress slowly to avoid gastric distention
• Gradually add high calorie foods to maintain
  weight
• Impaired skin integrity related to enzymatic
  action of gastric juices
• Assess skin daily for signs symptoms of
  irritation
• Apply protective skin barrier
• Strict handwashing
• Patient family teaching

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Nursing diagnosis

• Risk for aspiration
• Positioning
• Aspirate gastric contents before feeding
• Disturbed body image related to presence of
  feeding tube
• Encourage expression of feelings
• Acknowledge patient fears
• Provide correct information

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Nursing diagnosis

• Risk for deficient fluid volume/volume overload
• Monitor mucous membranes skin turgor, VS, I/O
• Provide adequate fluid intake
• Reinstill gastric contents to prevent electrolyte
  losses
• Ineffective therapeutic regimen management
• Give detailed information and return
  demonstration techniques to validate learning

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Legal Ethical Issues

• Withholding food fluids-what happens if clients
  are not able to make decisions or make their
  wishes known????
• Review what is known about tube feedings
  especially risks benefits
• Review medical facts about the client
• Obtain the opinion of all stakeholders in this
  situation
• Delay any action until consensus is achieved

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Decompression Tubes

• Occasionally, a tube can be used for acute
  treatment of active bleeding from esophageal or
  gastric varices. Two types are most common
• The Sengstaken-Blakemore tube has a large
  balloon to compress the esophagus and a smaller
  one to anchor the tube and exert pressure against
  varices in the distal esophagus and the cardia of
  the stomach. It has three lumens-one each to
  inflate the balloons and one attached to suction
  to aspirate gastric contents. To suction
  secretions above the esophageal balloon, an
  additional tube, such as a Salem sump tube, is
  placed in the proximal esophagus.
• The Minnesota tube is similar to the
  Sengstaken-- Blakemore tube, but it also has an
  esophageal aspiration lumen that eliminates the
  need for an additional drainage tube.

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Decompression Tubes

• Gastric tubes-commonly used NG tubes that are
  placed for GI decompression or drainage..
• Salem sump- The Salem sump has two lumens, one
  for drainage and one for air. The drainage lumen
  is usually connected to low continuous suction.
  At times, however, higher levels may be needed.
  The air vent keeps the tube away from the stomach
  wall to prevent damage to the mucosa
• The single-lumen Levin tube is typically
  connected to intermittent low suction for the
  same purpose.

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Decompression Tubes

• Intestinal Tubes mercury-filled balloon at the
  distal end. These tubes are rarely used today
  because the balloon could rupture and leak
  mercury. The newer Andersen tube, with a
  pre-weighted tungsten tip, is a safer option
• Miller Abbot tube-A long 10 (3 m) double-channel
  intestinal tube. Inserted through a nostril, the
  tube is passed through the stomach into the small
  intestine. Used for sampling gastrointestinal
  fluid or for therapeutic aspiration to relieve
  intestinal distension.
• Cantor tube- 10 single-lumen tube with a suction
  port in the lumen to aspirate contents
• Harris Tube- short around 6single lumen also to
  relieve distention, Y end allows lavage of
  intestinal tract
• Dennis tube-10 3 lumen irrigation, drainage
  balloon inflation

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Andersen tubes