Unit 6: Management of nasogastric, enteral and rectal tubes

Enteral Nutrition

refers to nutrients given via the gastrointestinal tract. This is indicated when the patient cannot ingest food but is still able to digest and absorb nutrients.

Large-bore sump tubes

are most often used for both decompression and short-term feeding

Small-bore silastic tubes

is used for longer-term feeding needs

Radiography

the best confirmation of proper tube placement

Gastric ileus

may prevent nasogastric feedings

Nasointestinal/Jejunostomy tubes

allow successful postpyloric feeding of formula directly into the small intestine or the jejunum.

Polymeric formulas

(1.0 to 2.0 kcal/mL) include milk-based blenderized foods prepared by hospital dietary staff. This classification includes commercially prepared whole nutrient formulas. For this type of formula to be effective, the patient’s gastrointestinal tract must be able to absorb whole nutrients.

Modular formulas

(3.8 to 4.0 kcal/mL) are singe-macronutrient (e.g., protein, glucose, lipids) preparations and are not nutritionally complete. This type of formula is added to other foods for meeting the patient’s individual nutritional needs.

Elemental formulas

(1.0 to 3.0 kcal/mL) contain predigested nutrients that are easier for a partially dysfunctional gastrointestinal tract to absorb.

Specialty formulas

(1.0 to 2.0 kcal/mL) are designed to meet specific nutritional needs in certain illnesses (e.g., liver failure, pulmonary disease, or human immunodeficiency virus [HIV] infection)

Refeeding syndrome

metabolic disturbances that occur as a result of reinstitution nutrition. Because cations such as potassium, magnesium, and phosphate move intracellularly during enteral nutrition of parenteral nutrition therapy.

Gastric decompression

is the use of suction to drain the stomach to relieve blockage of the intestinal tract, to wash out stomach contents when a person has taken poisonous material, or after surgery.

Parenteral Nutrition

is a form of specialized nutrition support in which nutrients are provided intravenously. Safe administration of this form of nutrition depends on appropriate assessment of nutrition needs, meticulous management of the central venous catheter or central venous access device, and careful monitoring to prevent to treat metabolic complications

Lipid emulsions

provide supplemental kilocalories and prevent deficiencies of essential fatty acids. These emulsions can be administered through a separate peripheral catheter, through the CVC by enteral nutrition solution.

Nasogastric Tube

• A tube that goes through the nose into the stomach

• Feedings can be administered as continuous, intermittent, or bolus and delivered via gravity, syringe, or pump method, depending on the patient’s needs & tolerance.

Nasointestinal Tube

• A tube that enters the nose and goes into the small intestine.

• Intestinal (or smallbowel) feedings are continuous in nature and are therefore delivered via a pump

Orogastric

• A tube placed into the mouth that goes into the stomach.

• Used if the patient has trauma to the nose, cranial injury or surgery, facial surgery, or esophageal varices.

• More common in intubated patients

6-12 Fr

Recommended tube size for enteral feeding

Gastric Residual Volume

● Assessing ] involves withdrawing and measuring stomach contents at regular intervals during tube feeding.

● Feeding is stopped when it exceed a specified level

● Recommendations for stopping tube feeding for elevated range from 250 to 500 mL, but automatic cessation of feeding should not occur for less than 500 mL in the absence of other signs of intolerance

PEG tube

is a feeding tube inserted directly into the stomach through the abdominal wall, used for longterm enteral nutrition when oral intake is insufficient or unsafe.

G-tube

● Tubes range in size from 12 to 30 Fr

● Exit through an incision/stoma in the upper left quadrant of the abdomen, where an internal bumper or balloon and an external bumper or disc hold the tube in place

● Once the stoma tract is well formed, balloon gastrostomy tubes are replaced every 6 months by specially trained nurses on the unit

J-tube

are used when there's a high risk for aspiration, such as with severely delayed gastric emptying or conditions like pancreatitis.

They are typically smaller (5-16 Fr) and can be placed either surgically or threaded through the stomach into the jejunum under fluoroscopy.

Some tubes are dual-channel devices, allowing both gastric decompression and jejunal feeding

G-J tube

When a J-tube is places through an existing PEG tube

Rectal Tubes

These tubes relieve pressure, gas or liquid poop, especially after surgery or during severe bowel problems. They also protect surgical sites while keeping you clean and comfortable.

Indications:

• Release trapped gas

• Relieve severe bloating

• Drain liquid poop (diarrhea)

• Treat severe diarrhea and constipation

• Manage fecal incontinence (when you can’t control your bowel movements)

• Reduce pressure in your bowels after surgery (decompression)

• Help protect your skin and keep you clean and comfortable

• Help prevent leaks at surgical connection sites in your bowels

• Deliver medications and fluids