INTESTINAL TUBESTube inserted into the intestine for

decompression proximal to an obstruction, relief of obstruction, decompression of post op edema at the surgical site

INSERTION:Same with NGT but add 3-4 inches to the

measurement for correct tube placementAfter inserting NGT into stomach with client in

high fowlers, turn client on right side to allow for advancement of the tube through the pylorus of the stomach and into the small intestine (may take up to 24 hours)

Confirm placement by testing the pH of aspirate ff by X-ray before taping in place

Purpose Example of Use

Key Points

CANTOR AND HARRIS

- Single Lumen tubes with mercury at the tip of the tube

To decompress the lower intestinal tract

•Small bowel obstruction•Intussusception•Volvulus

• Passed nasally into small intestine• Tube enters small intestine through the pyloric sphincter• Orders will be written on how to advance the tube a few inches each hour, patient position may affect advancement of tube

Purpose Example of Use

Key Points

MILLER-ABBOTT

- Long double lumen.- 1st lumen leads to mercury once in the stomach-2nd lumen is for drainage

To decompress the lower intestinal tract

•Small bowel obstruction•Intussusception•Volvulus

• Passed nasally into small intestine• Tube enters small intestine through the pyloric sphincter• Orders will be written on how to advance the tube a few inches each hour, patient position may affect advancement of tube

The physician orders an intestinal decompression using a Harris tube for a client after gastric surgery. The primary purpose of this tube is to

A. Provide an alternative route for drug administration

B. Break up the obstructionC. Preventing the fluids to accumulate in the

stomachD. Relieve fluid and gas in the intestine

The physician orders an intestinal decompression using a Harris tube for a client after gastric surgery. The primary purpose of this tube is to

A. Provide an alternative route for drug administration

B. Break up the obstructionC. Preventing the fluids to accumulate in the stomachD. Relieve fluid and gas in the intestineRationale: D. Harris tube is used to decompress the

intestine after surgery by removing the fluid and gases that causes build up of pressure.

During insertion of a Miller-Abott tube, the nurse should position the patient in

A. Upright in bedB. Semi-fowlersC. Right side lyingD. Left side lying

During insertion of a Miller-Abott tube, the nurse should position the patient in

A. Upright in bedB. Semi-fowlersC. Right side lyingD. Left side lying

Rationale: C. the client is placed in a right side lying position to facilitate movement of mercury-weighted tube through the pyloric sphincter.

To decrease the risk of aspiration during insertion of Miller-Abbot tube, the nurse plans to incorporate the following to her care planA. Inflating the balloon during insertionB. Instructing the client to cough when the tube passes in the pharynxC. Instructing the client to perform Valsalva maneuverD. Placing the client in a high-Fowler’s position

To decrease the risk of aspiration during insertion of Miller-Abbot tube, the nurse plans to incorporate the following to her care planA. Inflating the balloon during insertionB. Instructing the client to cough when the tube passes in the pharynxC. Instructing the client to perform Valsalva maneuverD. Placing the client in a high-Fowler’s positionRationale: D. Placing the client in high- Fowler’s position decreases the risk of aspiration if vomiting occurs.

Finding for correct placement of Cantor tube includesA. pH of 7 or greater of the aspirate

B. pH of 4.5 or less of the aspirateC. Presence of gastric contents when

checking residualsD. Auscultation of air when tube is inserted in

the abdomen

Finding for correct placement of Cantor tube includesA. pH of 7 or greater of the aspirate

B. pH of 4.5 or less of the aspirateC. Presence of gastric contents when

checking residualsD. Auscultation of air when tube is inserted in

the abdomenRationale: A. Cantor tube is an intestinal

tube. The nurse can ensure proper placement by checking the pH of aspirate. pH of 7 or greater indicates intestinal contents not gastric contents.

E. ESOPHAGEAL AND GASTRIC TUBES

Purpose Example of use

Key points

SENGSTAKEN BLAKEMORE TUBE – triple lumen with inflatable esophageal and gastric balloon, gastric aspiration lumen

Apply pressure against

esophageal veins to control bleeding

Bleeding esophageal varices

1. Gastric balloon- pressure at gastroesophageal junction to compress gastric varices and decrease blood flow

Continuation of Key points2. Esophageal balloon compress esophageal

varices3. If bleeding does not stop w/ gastric

balloon, inflate esophageal ballon to 25 to 45 mmHg

4. X-ray of chest and upper abdomen confirms placement

5. Gastric contents aspirated thru gastric lavage or intermittent suction via the gastric aspiration port

6. Insert NGT in opposite nares to collect secretion that accumulate above the esophageal balloon

SENGSTAKEN BLAKEMORE TUBE

MINNESOTA TUBE – four lumen gastric tube (additional lumen for aspirating esophagopharyngeal secretions )

Nursing Considerations for Sengstaken Blakemore

Provide oral care q2 hours and inspect the oral cavity for continued bleeding.

Label each lumenPlace client in upright or fowler’s positionDouble clamp the balloon parts to

prevent air leaksKeep scissors at bedside; monitor for

respiratory distress

Nursing Considerations

To prevent ulceration or necrosis of the esophagus, release esophageal pressure as prescribed by agency

Monitor for increased bloody drainage, which may indicate persistent bleeding

Monitor for signs of esophageal rupture – drop in BP, increased HR and back and upper abdominal pain

Balloons are generally deflated after 24 to 48 hours to assess for continued bleeding. The esophageal balloon is deflated first (if previously inflated), followed by the gastric balloon 12 to 24 hours later.

The tube is generally left in place for another 12-24 hours before removal.

The esophageal balloon must be deflated before the gastric balloon is deflated. The balloons may only be re-inflated by a physician.

A patient has a bleeding esophageal varices and is inserted with a Sengstaken-Blakemore tube. After the tube is inserted, the client shows difficulty of breathing. The nurse’s initial action would be to

A. Encourage him to take a deep breathB. Placing him in a Fowler’s positionC. Notifying the physician immediatelyD. Deflating the esophageal balloon

A patient has a bleeding esophageal varices and is inserted with a Sengstaken-Blakemore tube. After the tube is inserted, the client shows difficulty of breathing. The nurse’s initial action would be to

A. Encourage him to take a deep breathB. Placing him in a Fowler’s positionC. Notifying the physician immediatelyD. Deflating the esophageal balloonRationale: D. If the client’s airway is obstructed,

esophageal balloon should be immediately deflated using a scissor to allow the patient to breath.

The nurse understands the correct intervention for a patient prescribed with a Minnesota tube when she performs the following, exceptA. Placing the client in Sim’s right lateral position for insertionB. Preparing patient for radiography to verify placementC. Double clamps the balloon ports to prevent air leaksD. Maintaining the head of patient elevated after insertion 

The nurse understands the correct intervention for a patient prescribed with a Minnesota tube when she performs the following, exceptA. Placing the client in Sim’s right lateral position for insertionB. Preparing patient for radiography to verify placementC. Double clamps the balloon ports to prevent air leaksD. Maintaining the head of patient elevated after insertionRationale: A. Minnesota tube is a form of a modified Sengstaken-Blakemore tube with additional lumen for aspirating esophageal secretions. Patient should be placed in an upright or Fowler’s position during insertion. 

A nurse who deflates the esophageal balloon (Sengstaken-Blakemore tube) of a client anticipates the risk forA. Tracheal deviationB. Recurrent hemorrhageC. Esophageal necrosisD. Aspiration due to gag reflex stimulation

A nurse who deflates the esophageal balloon (Sengstaken-Blakemore tube) of a client anticipates the risk forA. Tracheal deviationB. Recurrent hemorrhageC. Esophageal necrosisD. Aspiration due to gag reflex stimulationRationale: B. Sengstaken-Blakemore tube is used to decompress esophageal varices to prevent bleeding.