#9 NGT TB - quizlet import

NGT: Enteral nutrition: feeding routes

Through the nose or mouth:

 Nasogastric (NG)/ Orogastric → into the stomach

Nasointestinal/ Orointestinal → into the intestines

Through the abdominal wall:

Gastrostomy (G-tube)/Jejunostomy (J-tube) – surgically placed

PEG/PEJ tubes – placed endoscopically

NGT: What is a large-bore sump tube used for?

Decompression or short-term feeding

NGT: What is a small-bore silastic tube used for?

Long-term feeding

What is the size range for NGT tubes?

6-12 Fr

What is the risk associated with smaller NGT tubes?

Higher blockage risk

What is a disadvantage of larger NGT tubes?

More discomfort

What NGT is used for Short term (less than 4 weeks)?

Nasoenteral tubes

What NGT is used for Long-term (more than 4 weeks)?

Surgical or endoscopic tubes

NGT: If feeding into the stomach isn't possible (e.g., delayed gastric emptying), feed into the...

jejunum

Postpyloric feeding (into the jejunum) lowers the risk of vomiting or aspiration

Types of Enteral Formulas: Polymeric

(1.0–2.0 kcal/mL):

Contain whole nutrients (protein, carbs, fats)

Require normal digestive and absorptive function

Can be milk-based, blenderized, or commercially prepared

Types of Enteral Formulas: Modular

(3.8–4.0 kcal/mL):

Contain a single macronutrient (e.g., protein, glucose, or lipid)

Not nutritionally complete – used to supplement other formulas

Indications for Enteral Nutrition

Cancer

Head and neck cancer

Upper GI tract cancer

Critical Illness or Trauma

Respiratory failure with prolonged intubation or poor oral intake

Critically ill patients with high catabolism

Trauma or burn patients in hypermetabolic states

Neurological & Muscular Disorders

Brain tumor

Stroke / Cerebrovascular accident (CVA)

Neuromuscular diseases (ALS, MS, Parkinson’s)

Myopathy (Muscle disease, weakens muscles used for swallowing)

Dementia

Gastrointestinal Disorders

Enterocutaneous fistula (opening between the intestine & skin)

Inflammatory bowel disease (IBD)

Mild pancreatitis

Inadequate oral intake

Prolonged intubation

Continuous feeding needs

Local trauma

Anorexia nervosa

Difficulty chewing or swallowing

Severe depression

Supine positioning (feedings can continue safely)

Elevate head of bed ≈45° to reduce aspiration risk and prevent ventilator-associated pneumonia

3 multiple choice options

What should be assessed to determine the need for enteral feeding?

Patient's NPO status, functioning GI tract, and ability to ingest nutrients.

Why is it important to identify the need for enteral feeding early?

To prevent malnutrition and related complications.

What must be reviewed before tube insertion and feeding?

The physician's order for tube insertion and feeding schedule.

What is the first step in preparing for enteral tube feeding?

Wear a mask and explain the procedure to the patient.

How do you assess the patency of nares?

Have the patient close one nostril and breathe through the other; inspect for irritation or obstruction.

What is the purpose of assessing the gag reflex?

To confirm the patient's ability to swallow and determine aspiration risk.

What should be done for patients who are intubated, sedated, or unconscious during tube insertion?

Tilt the head toward the chest to reduce aspiration risk.

What medical history factors should be reviewed before enteral feeding?

Conditions like nosebleeds, nasal/facial surgery, anticoagulant use, or aspiration history.

Why are certain conditions contraindications for nasoenteral tubes?

Conditions like nasal trauma, GI bleeding, and bowel obstruction can contraindicate the procedure.

What is the first step in enteral tube feeding?

Perform Hand Hygiene

What should you auscultate before enteral tube feeding?

Auscultate Abdomen for bowel sounds.

What does the absence of bowel sounds indicate? enteral feeding)

Decreased peristalsis, increasing aspiration and distention risk.

What should you tell the patient to do during tube insertion? enteral feeding)

Raise an index finger to signal gagging or discomfort.

How should the patient be positioned for enteral tube feeding?

In high Fowler's position with pillow support.

What is the rationale for positioning the patient in high Fowler's position? enteral feeding)

Eases tube passage, promotes swallowing, and reduces risk of aspiration.

What should be placed on the patient's chest before enteral tube feeding? enteral feeding)

An absorbent pad and facial tissues.

What is the purpose of placing an absorbent pad and tissues? enteral feeding)

Prevents soiling and provides comfort during insertion.

What method is used to measure and mark tube length? enteral feeding)

NEX method (Nose → Earlobe → Xiphoid) or NEMU method (Nose → Earlobe → Mid-Umbilicus).

How much should you add to the tube length for the oral route? enteral feeding)

Add 5 cm.

How much should you add to the tube length for the nasal route? enteral feeding)

Add 10 cm.

How much should you add to the tube length for duodenal/jejunal routes? (enteral feeding)

Add 20-30 cm.

What should you not do to plastic tubes before insertion? (enteral feeding)

Do not ice plastic tubes.

Why should you not ice plastic tubes? (enteral feeding)

Cold tubes become stiff and can damage nasal mucosa.

How much water should be injected into long-term tubes before insertion (enteral feeding)

Inject 10 mL water into the tube.

What is the purpose of injecting water into long-term tubes? (enteral feeding)

Activates tip mechanism to release guidewire after insertion.

What should be ensured about the guidewire before insertion? (enteral feeding)

Ensure guidewire is firmly positioned and connections tight.

Why is it important to ensure the guidewire is firmly positioned? (enteral feeding)

Prevents trauma and ensures smooth, controlled insertion.

What serious complications can arise from improper placement of the tube? (enteral feeding)

Pneumothorax and tracheal perforation.

What should be applied to the tube to ease its passage into the naris? (enteral feeding)

Dip in water or apply water-soluble lubricant.

What is the rationale for applying lubricant to the tube? (enteral feeding)

Eases passage into naris and minimizes mucosal trauma.

For long-term tube: inject ...

10 mL of water and insert stylet/guidewire.

Rationale: Activates mechanism allowing guidewire removal later.

Ensure guidewire is securely positioned and connections are snug.

After injeccting 10ml of water and securing guidewire, the next steps for enteral feeding are...

Cut 10 cm tape, split one end 5 cm.

Dip tube in water& lubricate or apply water-soluble lubricant.

Insert tube through nostril toward ear

Have patient tilt head forward after tube passes nasopharynx

Encourage swallowing with water or ice chips if alert.

If sedated or intubated → tilt head forward and advance tube slowly.

Rotate tube 180° if resistance occurs.

Instruct patient to mouth-breathe and swallow

Advance tube as patient swallows

Rationale: Swallowing opens the esophagus and minimizes trauma.

Stop immediately if coughing, choking, cyanosis, or resistance occurs.

X-ray confirmation is essential; coughing alone is not reliable in sedated patients.

while inserting enteral feeding tube you must..

Advance tube as patient swallows

Swallowing opens the esophagus and minimizes trauma.

How do you check tube placement after inserting enteral tube

using a penlight + tongue blade

also verifying with X ray to Prevent aspiration and ensures gastric placement.

If coiled or patient in distress → withdraw and retry.

Withdraw tube immediately if tube is coiled, respiratory status of patient changes, or patient begins to cough and skin colour changes.

You must verify tube placement prior to feeding using the following methods

X-ray (most accurate).

Check tube marking length.

Review chest/abdominal X-rays.

Assess aspirate volume & pH.

If uncertain, recheck with radiograph

How do you anchor tape to the patients nose after inserting a enteral NGT?

Option A – Tape:

Apply tincture of benzoin (adhesive) to nose and tube.

Secure tape across bridge and wrap ends around tube.

Reposition every 8 hours to prevent skin breakdown.

Option B – Fixation device:

Apply adhesive patch and secure connector around tube.

What position does your patient need to be in after inserting an enteral NGT?

Right side (for intestinal placement)

- Promotes tube passage into duodenum or jejunum.

After x ray confirms placement, continue the following steps

26. Perform oral hygiene and clean tubing

27. Remove gloves, dispose of equipment, and perform hand hygiene

28. Inspect naris and oropharynx

29. Assess patient comfort

30. Observe for respiratory distress

31. Auscultate lung sounds

Abnormal lung sounds can be an early sign of aspiration.

What symptoms may indicate tube misplacement?

Coughing, gagging, or dyspnea

What existing conditions can be aggravated by tube misplacement?

Heart failure, pneumonia, asthma, and other cardiac or respiratory conditions

Reassess enteral feeding NGT placement every how many hours?

4 hours

Reassess enteral feeding NGT placement every 4hrs, you need to check for what?

External tube length

Aspirate volume changes

pH of aspirate

Obtain X-ray if in doubt

you need to assess feeding tolerance for NGT how often?

every 4 hours

* Signs & interventions: Aspiration of stomach contents into respiratory tract (immediate response)

coughing

dyspnea

cyanosis

crackles

wheezes

Interventions:

Position patient on side

Suction nasotracheally and orotracheally

Consult physician immediately for chest X-ray

* Signs & interventions: Aspiration of stomach contents into respiratory tract (delayed response)

dyspnea

fever

crackles or wheezes

Interventions:

Consult physician for chest X-ray order

Prepare for possible antibiotics

* interventions for: Development of bacterial aspiration pneumonia from contaminated saliva (for NPO or enteral feeding patients)

Maintain oral hygiene with soft toothbrush (teeth, gums, roof of mouth, cheeks)

Educate patient and family on oral hygiene

Provide oral cleansing with chlorhexidine oral swabs

twice daily for patients unable to perform self-care

Keep patient in a semi-recumbent position (head up 45°) if not contraindicated

Patients who are unable to contribute to their oral hygiene should have anoral cleansing program provided by using chlorhexidine oral swabs twice daily, especially for chronically intubated patients

* interventions: Displacement of feeding tube (e.g., duodenum → stomach from coughing or vomiting)

Confirm tube mark at exit site

Remeasure from naris to mid-umbilicus and compare to baseline

Aspirate gastrointestinal contents and measure pH

Discuss findings with physician

Reconfirm placement by X-ray if needed

Remove displaced tube and insert a new tube, verify placement

Obtain chest X-ray if aspiration suspected

* interventions: Clogging of feeding tube

Use liquid medications whenever possible

Crush tablets or open capsules only if not contraindicated

Dissolve and administer medications separately

Flush tube after each medication and after all medications

Aspirate gastric contents with 60-mL syringe to assess patency

Irrigate tube with sterile water

Do not use carbonated drinks or cranberry juice

Use pancreatic enzyme/sodium bicarbonate solution only with prescriber's order

Do not use small-barrel syringes (≤ 20 mL) due to risk of tube rupture

* interventions: Irritation of naris and nasal mucosa

Provide hygiene

Remove and replace tube (physician order required)

Consider using opposite naris for insertion (physician order required)

How can you prevent clogging of feeding tube?

Flush tube before/after medications and q6h with 30 mL sterile water

Use sterile water for oral meds and free water administration

Consider alternative routes for medications with small-bore tubes to prevent clogging

what should you Document After enternal tube procedure

Type and size of tube placed

location of distal tip of tube (mark and measure)

patient's tolerance of procedure

pH value

confirmation of tube position by X-ray examination.