GASTRIC TUBES

1. GASTRIC TUBES TYPES: SALEM (DOUBLE LUMEN GASTRIC) SUMP TUBE ENTEROFLEX G-TUBE/PEG TUBE J TUBE LEVIN (SINGLE LUMEN TUBE)

2. Salem (Double Lumen) pump Most common nasogastric tube Used for irrigation of stomach and tube feedings Sizes 14-18 French 120 cm long If suction is needed, connect the larger bore to suction Blue vent is always open to air for continuous atmospheric irrigation Prevent reflux by having the blue vent port above patient’s waist

3. Single Lumen Tubes Levin Sizes 14-18 French and 125 cm long Used for stomach decompressing, withdrawing specimens, washing the stomach free of toxic substances, and irrigating the stomach and treat upper GI bleeds Can be used to administer meds and/or feedings

4. Dual-Purpose Tubes Moss Mark IV, Dobbhoff Nasojejunal Inserted nasally and ends in the duodenum or jejunum Gastric decompression port connects to suction Use the smaller, more distal port, for feedings Reduces reflux through removing excess feedings 3 rd port is a retention balloon

5. Double-Lumen Nasointestinal Tube Miller- Abott Tube Rubber balloon tip that should not be inflated until passed through the pylorus Peristalsis moves balloon along Second port is for suction for sampling Label the ports to alleviate confusion

6. Tubes for Upper GI Bleeding for Varices Sengstaken -Blakemore Two lumens inflate the gastric and esophageal balloons 3 rd lumen reserved for gastric suction or drainage Can be inserted orally or nasally Compresses esophageal varices or reduce gastrointestinal hemorrhage

7. Percutaneous Endoscopic Gastrostomy (PEG) Tube Procedure for placing a feeding tube directly into the stomach through a small incision in the abdominal wall Peg tubes can be temporary or permanent Peg tube care should be completed every 8 hours with part hydrogen peroxide part sterile water, then place a drainage sponge around port

8. J-tube Placed in the jejunum Lasts >= 30 days Decreases risk for reflux Decreases risk for complication in comparison to Peg tube Can be a combo of J/G tube

9. Contraindications for ng tube placement Mid-face trauma Recent nasal surgery Esophageal perforation High Risk head/brain trauma Deviated septum Esophageal varices /strictures Recent banding/ cautery of varices Coagulation abnormalities Alkaline ingestion Nasal polyps

10. Questions You have a patient that needs gastric suctioning and may need feedings after a few days post-op. Which tube would you most likely use? Salem sump gastric tube

11. Can you close the vent, blue, port on a salem sump tube? No, the ventilation port should not be closed off. To ensure this, you can use an anti reflux valve (seen above) as long as it is positioned correctly to allow air to circulate or a syringe without a plunger to guarantee the ventilation port remains higher than the patients abdomen.

12. Enteral Nutrition Indications Patients unable to eat due to surgery, injury, or disease like mechanical ventilation, comatose, and head and neck surgeries Post-CABG, MVA head traumas Nutritional deficits from reduced food ingestion or malabsorption Low albumin, decrease appetite Impaired gag or swallow reflexes Stroke, tracheostomy patients

13. Enteral Feeding Administration and Maintaining Tube Patency Initiation after tube feed placement checked Start at 10-40mLs/hr Progression to goal Increase by 10-20 mLs every 8-12 hrs Critical care/greatly malnourished Increase by 10 mLs every 12-24 hrs Flush tube with 20-30mLs every 4 hrs Before and after intermittent feedings 10 mLs before and after each medication administration 30 mLs before and after each residual check

14. Patient/Family Education for Feedings Stay upright if tolerate during and after feedings Pause if Head of bed is less than 30 degrees Fullness, increased gas, belching, or diarrhea is common X-rays will be completed to ensure placement after placement Use of a lopez valve or leur-lok system during feedings is preferred Absent bowel sounds are not a contraindication to feedings Residuals cannot be checked if jejunum or duodenum is accessed by tube Immunocompromised or critically ill patients should have sterile water flushes.

15. Nursing considerations for feeding Tube feeds should be at room temperature Liquids not room temperature can cause gastric cramping and discomfort Shake tube feed well Gastric residuals greater than 500mls can cause aspiration Change tubing and tube feed bags a minimum of every 24hrs Blood sugar checks should be a minimum of every 6 hours Check gastric residual before each feeding and every 4-6 hours initially for continuous feedings for 24 hours, then every 6-8 hours Once small bowel feedings tolerance, there is no benefit to performing residual checks and will clog the tube If residual is high, then intestinal tubes may be dislodged Enteroflexes are unable to check residuals due to the density of the tube

16. Parentral Nutrition (TPN) Indications Bowel rest Nonfunctioning GI tract Severe malnutrition in which the patient does not eat for 5 days or more Contraindications Treatment of < 5 days without malnutrition No IV access Functioning GI tract

17. Parentral Nutrition (TPN) Peripheral Nutrition 10-14 days without fluid restriction Central Nutrition Long-term, fluid restriction, poor peripheral access Bags last for 24 hours and a new order must be placed by 1800 for pharmacy to have for patient Complications Abnormal labs, fatty liver, GI atrophy, catheter complications Transition slowly to po diets Decrease TPN volume by half every 1-2 hours Maintain TPN If TPN continuing without next bag present, start D10 to maintain blood sugar.