EQUIPMENT
Warmed saline or water for irrigation Catheter
tip syringe
Chux pad and/or towel Gloves
nonsterile Stethoscope
PROCEDURE
1. Gather equipment. Promotes organization and efficiency.
2. Wash hands. Reduces transmission of microorganisms.
3. Prepare child and family. Enhances cooperation and participation and reduces anxiety and fear.
4. Put on nonsterile gloves. Prevents nurse from contact with gastrointestinal fluids.
5. Turn off suction or feeding as appropriate. Disconnect nasogastric tube from suction or feeding source or unclamp as appropriate.
6. Re verify placement of nasogastric tube by injecting 5 cc of air while ascultating the abdomen.
7. Fill the syringe with the prescribed amount of solution or 5-10 cc and inject it slowly into the tubing. Do not force. Forcing may injure tissue and increase child's discomfort. a. If solution does not flow easily try 1. Rotating the tubing or moving it slightly. 2. Alternately push and pull the plunger of the syringe. Alternating pressure helps work out the obstruction. b. Notify physician if solution cannot be injected without considerable force.
8. Aspirate the amount used in the irrigation from the tubing. Prevents adding extra fluid volume to the stomach.
9. Remove syringe and reconnect the nasogastric tube to the appropriate suction or type of feeding.
10. Remove gloves. Wash hands. Reduces transmission of microorganisms.
DOCUMENTATION
1. Verification of tube placement.
2. Time of procedure.
3. Type and amount of solution irrigated and amount of return.
4. Child's response to procedure and how tolerated.
NG tube; a tube of soft rubber or plastic that is inserted through a nostril and into the stomach for instilling liquid foods or other substances or for gastric decompression. Both medications and nutritive feedings can be given through the tube; see also tube feeding. Prior to insertion of the tube a measurement is made to assure that the distal end of the tube will be positioned in the stomach. This is done by placing the tip of the tube on the bridge of the patient's nose and then marking on the tube the point at which it touches the tip of the xiphoid process. Once the tube is inserted its position should be checked to be sure it is in the stomach and not the trachea or bronchi. This is done by aspirating for stomach contents, using a bulb syringe or 50-ml aspirating syringe. Alternatively, the syringe can be used to inject air into the tube while at the same time listening through a stethoscope for a “whooshing” sound made by the air being injected. The tube should be anchored so that it points downward away from the nares. It is not brought up over the nose and anchored by tape over the bridge of the nose. This increases irritation of the nasal mucosa, impedes circulation, and causes unnecessary discomfort. To avoid tension and drag on the tube a pin and rubber band can be used to secure the tube to the shoulder of the patient's gown or pajama top. mouth care is of particular importance while a nasogastric tube is in place.
Nasogastric tube. From Lammon et al., 1996.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition। © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.
Feeding tube one for introducing high-caloric fluids into the stomach; see also tube feeding.
tube feeding a means of providing nutrition via a feeding tube inserted into the gastrointestinal tract; it may be done to maintain nutritional status over a period of time or as a treatment for malnutrition. It can be used as the only source of nutrition or as a supplement to oral feeding or parenteral nutrition.
Patients who may require tube feeding include those unable to take in an adequate supply of nutrients by mouth because of the side effects of chemotherapy or radiation therapy, those with depression or some other psychiatric disorder, and those suffering from severe hypermetabolic states such as burns or sepsis, or malabsorption syndromes. Other conditions that may require tube feeding include surgery or trauma to the oropharynx, esophageal fistula, and impaired swallowing such as that which occurs following stroke or that related to neuromuscular paralysis.
There are commercially prepared formulas for tube feeding. Some contain all six necessary nutrients (carbohydrates, fats, proteins, vitamins, minerals, and trace elements) and need no supplement as long as they are given in sufficient volume to meet nutritional and caloric needs. Other types of tube feeding formulas are incomplete and therefore will require some supplementation. Choice of formula is based on the patient's particular needs, presence of organ failure or metabolic aberration, lactose tolerance, gastrointestinal function, and how and where the feeding is to be given, that is, via nasogastric, gastrostomy, or enterostomy tube.
Patients who may require tube feeding include those unable to take in an adequate supply of nutrients by mouth because of the side effects of chemotherapy or radiation therapy, those with depression or some other psychiatric disorder, and those suffering from severe hypermetabolic states such as burns or sepsis, or malabsorption syndromes. Other conditions that may require tube feeding include surgery or trauma to the oropharynx, esophageal fistula, and impaired swallowing such as that which occurs following stroke or that related to neuromuscular paralysis.
There are commercially prepared formulas for tube feeding. Some contain all six necessary nutrients (carbohydrates, fats, proteins, vitamins, minerals, and trace elements) and need no supplement as long as they are given in sufficient volume to meet nutritional and caloric needs. Other types of tube feeding formulas are incomplete and therefore will require some supplementation. Choice of formula is based on the patient's particular needs, presence of organ failure or metabolic aberration, lactose tolerance, gastrointestinal function, and how and where the feeding is to be given, that is, via nasogastric, gastrostomy, or enterostomy tube.
Patient Care. In addition to frequent and periodic checking for tube placement and monitoring of gastric residuals to prevent aspiration, other maintenance activities include monitoring effectiveness of the feeding and assessing the patient's tolerance to the tube and the feeding. Special mouth care is essential to maintain a healthy oral mucosa. A summary of the complications related to tube feeding, their causes and contributing factors, and interventions to treat or prevent each complication is presented in the accompanying table.
fermentation tube a U-shaped tube with one end closed, for determining gas production by bacteria.
Levin tube a gastroduodenal catheter of sufficiently small caliber to permit transnasal passage; see illustration.
Two types of nasogastric tubes। From Ignatavicius et al., 1995.
Linton tube a triple-lumen tube with a single balloon used to control hemorrhage from esophageal varices. Once it is positioned under fluoroscopic control and inflated, the balloon exerts pressure against the submucosal venous network at the cardioesophageal junction, thus restricting the flow of blood to the esophageal varices.
Miller-Abbott tube see miller-abbott tube.
Minnesota tube a tube with four lumens, used in treatment of esophageal varices; having a lumen for aspiration of esophageal secretions is its major difference from the sengstaken-blakemore tube.
nasogastric tube see nasogastric tube.
nasotracheal tube an endotracheal tube that passes through the nose.
neural tube the epithelial tube produced by folding of the neural plate in the early embryo.
orotracheal tube an endotracheal tube that passes through the mouth.
otopharyngeal tube eustachian tube.
Rehfuss tube a single-lumen oral tube used to obtain specimens of biliary secretions for diagnostic study; it is weighted on one end so that it can be passed through the mouth and positioned at the point where the bile duct empties into the duodenum. See also biliary drainage test.
Salem sump tube a double-lumen nasogastric tube used for suction and irrigation of the stomach. One lumen is attached to suction for the drainage of gastric contents and the second lumen is an air vent. See illustration.
Sengstaken-Blakemore tube see sengstaken-blakemore tube.
stomach tube see stomach tube.
T-tube one shaped like the letter T and inserted into the biliary tract to allow for drainage of bile; it is generally left in place for 10 days or more in order to develop a tract through which bile can drain after the tube is removed. A T-tube cholangiogram is usually performed prior to removal of the tube in order to determine that the common duct is patent and free of stones. If stones are found they can be removed through the tube tract by instruments inserted under x-ray guidance.
test tube a tube of thin glass, closed at one end; used in chemical tests and other laboratory procedures.
thoracostomy tube a tube inserted through an opening in the chest wall, for application of suction to the pleural cavity; used to drain fluid or blood or to reexpand the lung in pneumothorax. See also chest tube.
tracheal tube endotracheal tube.
tracheostomy tube a curved endotracheal tube that is inserted into the trachea through a tracheostomy; see discussion under tracheostomy.
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