Alternative Feeding Methods
Salem Sump
Has pig-tail vent
Return all aspirated contents - why??
Nutrients & electrolytes
Formula considerations
Nutritional status, caloric needs, medical condition, Length of therapy, Feeding schedule
Not a preferred nutritional supplement for a long time
PPN
PPN (Peripheral Parenteral Nutrition)
Partial nutrition, the patient may be getting nutrition from other sources along with the PPN; lesser concentration, and can be delivered through a peripheral vein
What tubes are prone to blockage?
Pedi
Short term Nourishment
Pedi of feeding tube
Nasoentric Tubes
Pedi tube or Keofeed tube
Has wire to guide tube down
Pedi tubes
Nose to Earlobe --> place a mark
Places the tube at the Nasal Pharynx (Back of throat above the gag reflex)
Bolus schedule
Pour formula in
Gavage (NG tube)
Provide Nourishment; administration of oral meds; obtain samples for diagnostic testing
Transabdominal Tube locations
Provides access to various areas of the GI tract
Observe skin with tubes...
Redness, swelling, drainage or tissue maceration
**Decompression** (NG tube--MAIN REASON)
Remove gas and secretions from the stomach or bowel
Lavage (NG tube)
Remove poisonous substances
Dumping Syndrome (Intestinal Tubes)
Result from the rapid infusion of calorie dense nourishment in the small intestine
Duration of use
Short term; <6 wks - Too uncomfortable, Higher Aspiration rate
Gastrostomy Tube (G Tube) location
Stomach
Enteral Feedings Purpose
Supplement oral nutrition, Neurological disorders, Premature infants, Failure to thrive, Specific bowel diseases
"Salem Sump"
NG Tube
Calories per unit
0.5 to 2.0 kcal/mL
Cyclic schedule
Block of time on/off
Excess Residual
Can pull back with syringe
Continuous Feedings
1.5mL/min; *Reduces the danger for vomiting and aspiration*
When should tube placement be checked?
Continually
Most accurate way to check placement?
X-RAY
Only way to confirm position of feeding tube
X-RAY
Hold feeding if aspirated contents more than ___
100 mL
Transabdominal Tube Sizes
12-14 F or 5-14 F
NG Tube Sizes
14-18 F, 20 F,
HOB should be...
30 DEGREES OR MORE!!!
If pt has to be flat, when should machine be turned off?
30 min BEFORE LYING THEM DOWN
Levin tube Length
42" to 50" long; multiple openings
Syringe used to check gastric residual
60 mL
Diameter of Keofeed or Pedi tubes
8F
Cyclic Feedings
<24 hrs (8-12 hrs or 16-12 hrs then a rest); *Wean a pt off tube feedings*
Formula Types...
Basic; High protein; Elemental amino acids or pepties; Diabetic; Renal; Pulmonary; Fiber
Nasal Inspection
Blow nose; Inspect nasal passage & determine patency of each nostrol
DYSPHAGIA
Cannot swallow; Tube feeding for months or permenant
Aspirating the tube (Checking placement) * ALWAYS RETURN*
Clear, brownish-yellow or green presume -> It is in the stomach
Compression or Tamponade
Control gastric bleeding
How often should skin be inspected?
DAILY
Levin (NG Tube)
Decompression; Single lumen-No pigtail vent
Hypertonic Solutions maycause
Diarrhea
Intermittent schedule
Different times
Management of Tube
Dressing change; Skin barrier if ordered
Comatose, Stroke Pts
Enteral Feedings
How often do you flush tube if on continuous feedings?
Every 4 hours
Keofeed or Pedi tubes Purpose...
FEEDING
NE Tube: 8F used for...
Feeding
Parenteral
Feeding administered intravenously
Feeding Tubes - Less risk of Gastric Reflux..
Feeding is delivered BEYOND the stomach
Enteral Feeding
Feeding through the intestinal tract
Keofeed/Pedi Characteristics
Flexible; May curl; May become obstructed
When administering a medication or feeding, what do you do?
Flush tube
Long term Nourishment
G tube, J tube
Long Term feedings (3)
G tube, J tube, PEG tube
Gastric Feedings risk??
Gastric Reflux
Gastic Reflex Precaution
Gastric contents can potentially enter the trachea and lead to ASPIRATION PNEUMONIA
Transabdominal tube Purpose
Gavage, Long term
Doctor's order needed for...
INSERTION
Nasoentric Tube (NE Tube) location
In nose to outside/beyond stomach
Nasogastric Tube (NG Tube) location
In nose to stomach
Residual in Stomach =...
Increased risk for aspiration
Earlobe to the tip of Xiphoid Process --> place a mark
Indicates the depth required to reach the stomach
Auscultating the stomach (Checking placement)
Insert 10-30 mL of air down tube while listening over the stomach for a swishing sound
PEG Tube contains..
Internal & external crossbars (BUMPERS) that anchor the tube in place
Jejunostomy Tube (J Tube)
Jejunum of the small intestine
Assessment before insertion
LOC; Weight; Bowel sounds?; Gag reflex/Aspiration; Check LS~No adventitious ounds, GI-Auscultate/Palpate; Integrity of nasal & oral mucosa; Presence of N/V
Bolus Feedings
Large vol in short time; *Rapid infusion may cause gastric distention and discomfort*; Increase risk for *gastric reflux*; Risk for *regurgitation, vomiting and aspiration*
Larger the #....
Larger the tube (5F to 40F)
Sizing of tubes
Measured using French scale - Diameter
Gavage, Intestinal Decompression
NE Tube
Insertion: Nose to the small bowel
NE Tube
Tube Measurement
NEX Measurement
Nasal Contraindications
Nasal polyps; Deviated septum; Narrow nasal passageway
Jejunostomy Tube (J Tube) location
Through abdominal wall
Percutaneous Gastrostomy Tube (PEG Tube) location
Through abdominal wall through skin
How are Transabdominal tubes inserted?
Through the abdominal wall
Intermittent Feedings
Throughout the day and evening; 250-400mL; Instilled by *gravity*; Container set-up changed every 24 hrs
TPN (Total Parenteral Nutrition)
Total nutrition, which is provided when a patient does not receive any other form of nutrition; a higher concentration and can only be administered through a larger vein.
Transabdominal Tubes
Tubes placed through the abdominal wall
Weighted tip stylet purpose?
Used to insert
Dumping Syndrome signs
Weakness, dizziness, sweating and nausea; result of fluid shifts and insulin demand
NE Tube 16F Distal tip...
Weighted with tungsten, Length 6-10 feet
Gastric Residual
What is left in the stomach after allowing time for the stomach to empty
