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INSERTION & TUBE FEEDING

By: Rochelle Joy T. Ramos

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ENTERAL FEEDING

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Levin tube

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Salemsump

tube

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Gastrostomy tube

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PURPOSE/INDICATION

S

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CONTRAINDICATIONS

ENTERAL

GI obstructionProlonged ileusSevere diarrhea &vomiting

Intercutaneousfistula

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CONTRAINDICATIONS

NGTHead traumaAny presence of skullfractures

Severe facial trauma obstructed esophagusObstructed airwayEsophageal

strictures/varicesAlkali ingestion at riskfor esophagealpenetration

Patients withsuspectedCervicalspine

injury

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CONT AINDICATIONS

Gastrostomy tubeAspirationpneumoniaGros ascites

Blod coagulationdisordersEsophagealvaricesEnlargedliverorspleenHadpreviousgastricsurgery

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ASSESSMENTNGT

MedicalhistoryHistoryofnasalsurgeryordeviatedseptumNutritionalstatus

AnyexistingchronicillnessNares patency/discharge/irritationMentalstatus/abilitytocooperateFluidintakeandoutput

AllergiestoanyfoodPresenceofgagreflexDigestivetractfunctioningKidneyfunction/BUN/electrolytes

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ASSESSMENT

NGT

Hematocrit & urinespecificgravityMedsandtherapiesCorrectplacementoftubeBowelsoundsDiarrhea/constipation/flatulencePresenceofregurgitationandfeelingsoffullnessLackoftoleranceofpreviousfeedingsLactoseintolerant

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ASSESSMENTG-TUBEAbilitytoadjustchangeinbodyimage

Participationinself-carePsychologicalstatusofpt/ & familySkinconditionFluid & nutritionalneeds

SignsofmalnutritionWeight, FluidintakeandoutputUrinespecgravity,acetone & glucoseinurineLactoseintolerant

PropermaintenanceoftubePresenceofbowelsoundsProblemsthatsuggestlackoftoleranceofpreviousfeedings

Regurgitationandfeelingsoffullness

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Insertion ofNGT

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NGT Feeding

y Correct & typeofamountofsolution

y 60mL cathetertipsyringe

y Emesisbasin

y Cleangloves

y pHteststripmeter

y Wateratroomtemperature

y Largesyringe/calibratedplasticfeedingbag withlabel/prefilledbottle withadripchamber

y Measuringcontainer

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Feeding bag

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PROCEDURE &

NURSINGCARE

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NGT insertiony Gatherequipments

y Introduce self,verifyclientsidentity

y Explainpurposeandimportanceofprocedure

yEstablishamethodofcommunication

y Assessnares

y Positionclient,provideprivacy

y Placetowelonchest

y Observeinfectioncontrolmeasures

y Determinesizeoftubebymeasuringlength

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y Weargloves,lubricate 4 inchesofthetipofthetube

y Inserttube,tellpttohyperextendneck,swallow anddrink water

y Iftubemeetsresistance, withdraw andinsertitintoanothernostril. Donotforceagainstresistance. Stopif

ptexperiencerespiratorydistressy Passtubeuntillengthisinserted

y Determinecorrectplacementofthetube

y Foroptional-attachtosuctionasordered

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y Removegloves,disposecontaminatedmaterials

y Washhandsy Ensurecomfortandsafety.Placecalllight withinreach

y Document- typeoftubeinserted,dateandtimeinserted,colorandamountofgastriccontents,client

tolerance.

y Providedailynasogastric care

y Evaluateclientcomfortandtolerance

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Administering NGT Feedingy Checkexpirationdateoffeeding. Feedingformulain

roomtemperature.y Assess properplacementoftube

y Assessresidualfeedingsandreinstill gastriccontentsback

y Cleantopoffeedingy Connectsyringetoaclampedtube.

y Addfeedingtothesyringebarrel

y Allow feedingtoflow inslowly

y Ensureclientcomfortandsafety

y Askclienttoremainsittingforatleast 30min.

y Disposeequipmentor washreusable. Change

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Gastrostomy Tube Insertion & Feeding

y Gatherequipments

y Introduceself,verifyclient,explainprocedureanditsimportance

y Provideprivacy,observeinfectioncontrolmeasures

y

Insertion:y Weargloves,removedressing

y Discarddressing & gloves,applynew gloves

y Lubricateendoftube

y Insertitintotheostomy openingy Checklocationandpatencyofthetube

y Assessresidual

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y Holdbarrelofsyringe 3-6in.aboveostomy opening

y

Slowlypoursolutionintothesyringe,allow toflow bygravity

y Add 30mL ofwatertoflushtube

y Ensurecomfortandsafetyofclient

y Asktoremainsittingatleast 30min.y Assessstatusofperistomal skin

y Checkordersaboutcleaningtheperistomal skin

y Observeforcomplications

y Whenappropriate,teachclienthow toadministerfeedingsand whentonotifyhcp

y Evaluateeffectivenessoffeeding

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COMPLICATIONS

NosebleedSinusitissorethroat

EsophagealerosionPulmonaryaspirationCollapsedlung

Intracranialplacementthetube

DiarrheaConstipationNauseaandvomiting

Gas/bloating/cramping/Dumpingsyndrome

AspirationpneumoniaTubedisplacement

TubeobstructionNasopharyngealirritationHyperglycemiaDehydration,azotemia

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