Clinical Skills and Care for Enteral Tubes

Clinical Skills and Care for Enteral Tubes

Introduction to Enteral Tubes

  • Purpose of Enteral Tubes:
    • Decompress the stomach postoperatively, after abdominal injury, or to treat intestinal obstruction.
    • Provide nutritional support or medication administration.
    • Collect gastric contents for diagnosis, such as pH analysis or blood testing.

Preparing for NG Tube Insertion

  • Patient Preparation and Environment:

    • Communicate with the patient to alleviate anxiety. This engagement helps reduce fear and improves cooperation during the procedure.
    • Gather necessary supplies, wash hands, verify the patient's identity, and ensure privacy.
    • Raise the bed to a working height and lower the bed rails to facilitate easy access to the patient.

  • Supplies Preparation:

    • Prepare silk tape: two pieces - one 1 inch and another 3 inches.
    • Lubricate the NG tube's tip with water-soluble lubricant.
    • Prepare a stethoscope for assessing placement.
    • Provide an emesis basin, tissue, rinse-free bath wipe, and a glass of water with a straw for the patient.

Insertion Technique for NG Tube

  • Establish Communication Signals:

    • Create a hand signal with the patient for pausing the procedure if discomfort occurs.

  • Patient Positioning:

    • Assist the patient into a high Fowler's position to facilitate swallowing during the insertion.

  • Insertion Steps:

    • Hyperextend the patient's head slightly, gently insert the lubricated tip, and proceed carefully.
    • Measure the tube length from nose to earlobe, and from earlobe to xiphoid process; mark the tube at these points as a reference for placement.
    • Cue the patient to swallow while advancing the tube, utilizing normal peristalsis to assist in placement.

  • Safety Protocols:

    • If the patient exhibits gagging or feels uneasy, pause and allow them to relax.
    • If complications such as coughing or cyanosis occur, remove the tube immediately.

Verifying NG Tube Placement

  • Methods to Verify Placement:
    • Assess for stomach contents pH—normal is less than 5.5. If unable to detect, reposition the patient and recheck.
    • The most reliable method for confirmation is an X-ray.
    • Safety Alert: Ensure no high pressure is exerted on the naris to avoid ulcers.

Caring for the NG Tube

  • Monitoring and Maintenance:
    • Assess the tube every 2 hours for patency. Look for movement of gastric contents.
    • Monitor suction settings and ensure connections are secure to prevent accidental disconnection.
    • Assess gastric drainage's color, amount, and consistency for abnormalities.
    • Perform mouth care every 2 hours and monitor potassium levels to prevent hypokalemia due to suctioning.

Removing an NG Tube

  • Procedure for Removal:
    • Confirm with the healthcare provider before removal.
    • Prepare a tissue for mucus removal, wear gloves, and protect the patient's clothing.
    • Instill air into the tube to prevent spillage, then gently pull while cuing the patient to hold their breath.
    • Provide post-removal care, including mouth and facial hygiene.

Conclusion

  • Importance of Communication:

    • Clearly explain the procedure steps to the patient beforehand to alleviate anxiety and ensure cooperation during tube insertion.

  • Nutritional Support:

    • Enteral vs. Parenteral: Enteral nutrition is preferable for patients with functional GI tracts, proving a more physiological method to meet nutritional needs.

  • Common tube types:

    • Nasogastric (NG) tubes for short-term use.
    • Nasointestinal (NI) tubes are used for prolonged feeding in patients at risk for aspiration.

Additional Notes: Understand tube lengths, sizes (measured in French size), and purposes including double-lumen capabilities to prevent vacuum pressure from adhering to stomach walls.