Transcript 120 mm Hg Intermittent * Must be used only with a Salem

Nasogastric Tubes
Lab I
Part II
NPO Oral Care q 2 to 4 hrs.
Examples -Brush, Rinse or mist with Water, or Suck
on moist cloth, Cautious use of ice chips…
Additional NPO Care Methods
• Oral care to prevent parotitis
– Brush teeth
– Normal Saline with Toothettes
– Lemon glycerin swabs
• acid damages enamel of teeth
• glycerin dries sub-mucosa
– Hydrogen peroxide & mouthwash with
alcohol dry and/or irritate mucosa
– Mouth & lip moisturizer
• Nasal care
– retape tube q 24 hr. & clean with N/S
Discontinuing a N/G Tube
• Check orders & Pt’s ID band
• Assess abdomen, bowel sounds,
swallowing
• Turn suction off
• Don gloves
• Flush with air&/fluid
• Flush with air leave syringe attached to
tube
• Untape tube
• Plug or clamp tube
• Hold breath or on exhalation D/C tube
• Nasal & oral care
Nasogastric Tubes
for
Decompression
Salem-Sump tubes
Two lumens
• Large - movement of liquids
in or out of the stomach
• Small Pig Tail - inflow of air
into stomach
Rationale for N/G Suction
Tube
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Nausea & Vomiting
Removal of Toxic substances
Upper gastrointestinal bleeding
Decompression for stomach or bowel surgery
Paralytic GI track or bowel obstruction
Salem-Sump Tubes
• Describe the purpose of the
Pig Tail.
• What is the only substance
that can be used to flush
the Pig Tail?
Salem-Sump Tube Uses
• Is it possible to use a Salem-sump for:
• feeding?
• medication administration?
• How is this tube different from those
normally used for feeding?
Flushing Tube after Aspiration
Usual volume:
30 to 60 ml.
Water or Normal Saline
* Modifications are
made if Fluids are
Restricted
Attaching a Salem-Sump to Suction
Suction Pump Settings
Connect tube to suction:
Strength
Frequency
Low - 80 to 120 mm Hg Intermittent
or
Constant
* High - > 120 mm Hg Intermittent
* Must be used only with a Salemsump tube
Tube Irrigation
• What’s the BEST solution for irrigating a
suction tube and why is it used?
• What’s the usual solution for irrigating a
feeding tube?
Saline for suctioning
When patient is NPO with suctioning:
Water or excessive consumption of ice chips
increases the production of gastric secretions
which contain electrolytes
Treat excessive thirst with:
Increased IV fluids
Frozen electrolyte solution chips
Remember the 4 S’s…
Salem-Sump, Suction, & Saline
Water normally goes with food and feedings!
Nursing Diagnosis
• Consider:
– Alteration of nutrition r/t vomiting
– Alteration in skin integrity r/t irritation to nasal
secretions
– Risk for fluid volume deficit r/t NPO status,
suctioning
Maintaining Salem-sump Tube
• Check function q 4 hr. & PRN for
– Pt.’s signs & symptoms
– Abdominal assessment - sounds &
distention
– Drainage – Mark suction container
– Suction status
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Check placement prior to irrigation
Irrigate 30 to 60 ml N/S as ordered PRN
Irrigate with 30 ml. air when clamping
Limit ice chips & sips of water
Flow Sheet Charting
• Usual Intake & Output q 8 hr.
– Subtract N/G irrigations from output
• > 100 ml. N/G output per hour should be reported
– Urinary output
• < 30 ml. per hour X 2 hrs. should be reported
• Report total output that exceeds intake
• Report B/P, pulse > 20 beats/min.above
normal for pt.at rest, seizures, confusion,
abnormal electrolyte values, etc.
Salem-Sump & Levine Tubes
Dobhoff tube a Flexible Tube
• Passed through stomach to duodenum for
continuous feeding
• Passing and checking for placement is
different
– Pass the tube with a stylet
– Inject air but do NOT aspirate
– Leave stylet in place
– Call for X-ray to validate placement
Common Feeding Tubes
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Compare Levine & Flexible Tubes:
Size
Flexibility & comfort
Cost
Danger of displacement once feeding is
in progress
You MUST Perform at least
2 Safety Checks:
Prior to each use of a N/G Tube:
Irrigation
Administering a Feeding
Administering Medications
Shift Assessment for Position
& Function
Q 4 hr. Assessment for Position &
Function
Check tube placement with
atleast 2 ways
• Inject 20-30 ml of air and listen with a
stethescope on the abdomen for the wosh
of air into the abdomen
• Aspirate gastric contents
• Check ph of gastric contents with ph strip
• X-Ray of tube positioning (ie:dobhoffs)
• Put end of tube in a glass of H2O if
bubbles in lung