Gastrointestinal-Intubation-1.pptx

Folleys catheter

1. Gastrointestinal Intubation Lokesh Silvester. J House surgeon S1

2. INTRODUCTION Intubation : Placement of tube into body structure Types of intubation Orogastric: Mouth to stomach Nasogastric: Nose to stomach Nasointestinal : Nose to intestine Ostomy: Surgically created opening

3. GIT INTUBATION USES Performing a gavage Administering oral medications Sampling sections for diagnostics Performing a lavage Compression/decompression

4. TYPES OF TUBES Orogastric tubes Nasogastric tubes Some have more than one lumen Gastric sump tubes (double-lumens) Nasointestinal tubes Longer than nasogastric tubes Transabdominal tubes Gastrostomy tube Jeunostomy tube

5. Types of NasogastricTube Levin catheter , which is a single lumen,small bore NG tube. f or administration of medication or nutrition. Salem Sump catheter : large bore tube with double lumen. For aspiration in one lumen, and venting in the other to reduce negative pressure and prevent mucosal adhesion. Dobhoff tube , which is a small bore NG tube with a weight at the end intended to pull it by gravity during insertion

6. TYPES OF TUBES Nasogastric Tube

7. Technique Explain procedure to client Position the client in Fowlers position Examine feeding tube Determine length of tube to be inserted Measure distance from tip of nose to earlobe and to xyphoid process of sternum Prepare tube for insertion

8. Implementation Wash Hands Put on clean gloves Lubricate the tube Hand the client a glass of water Gently insert tube through nostril to back of throat. Aim back and down toward the ear. Have client flex head toward chest after tube has passed through nasopharynx

9. Emphasize the need to mouth breathe and swallow during the procedure Swallowing facilitates the passage of the tube through the oropharynx. When the tip of the tube reaches the carnia stop and listen for air exchange from the distal end of the tube. If air is heard remove the tube. Advance tube each time client swallows until desired length has been reached Do not force tube. If resistance is met (cough, choke or become cyanotic) stop advancing the tube and pull back Check placement of the tube. X-ray confirmation Testing pH of aspirate 13. Secure the tube with tape or commercial device

10. Evaluation Observe client to determine response to procedure Persistent gagging can result in vomiting and aspiration Coughing may indicate presence of tube in airway Note location of external site marking on the tube Documentation size of tube , which nostril and client’s response Record length of tube from the nostril to end of tube Record aspirate pH and characteristics

11. Testing placement Wash hands and put on clean gloves Draw up 30cc of air into syringe and attach to end of NG tube. Flush tube with 30cc of air proper to attempting to aspirate fluid. Draw back on syringe to obtain 5-10cc of gastric aspirate. Observe appearance of aspirate; From enteral feeding: Appearance of enteral feed From nasointestinal : Bile stained From stomach (non feed): Green, tan, bloody, brown Pleural fluid: Pale yellow and serous

12. Complications Clogged tube : Most common Dumping Syndrome : solution with high osmolality- water moves into stomach and intestines from fluid surrounding the organs and vascular system causing dehydration, hypotension and tachycardia Aspiration : ensure head of bed is elevated at least 30 degrees while feeds are being administered Dehydration : diarrhea is common problem Electrolyte imbalance : Hyperkalemia and hypernatremia Oral mucosa breakdown Nasal irritation

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