Term
| Assist the client to a high Fowlers position if his or her health condition permits, and support the head on a pillow. |
|
Definition
| It is often easier to swallow in this position and gravity helps the passage of the tube. |
|
|
Term
| If a small bore tube is being used, ensure stylet or guide wire is secured in position. |
|
Definition
| An improperly positioned stylet or guide wire can traumatize the nasopharynx, esophagus, and stomach. |
|
|
Term
| If a large bore tube, for example, Salem sump tube, is being used, place the two minute basin of warm water will prepare and the client. |
|
Definition
| This allows the tubing to become more pliable and flexible. However, if the softened tube becomes difficult to control, and maybe helpful to place the distal end in a basin of ice water to help hold it's shape. |
|
|
Term
| Use the tube to mark off the distance from the tip of the clients nose to the tip of the earlobe and then from the tip of the earlobe to the tip of the xiphoid. |
|
Definition
| This length approximates the distance from the nares To the stomach. This distance varies among individuals. |
|
|
Term
| Lubricate the tip of the tube well with water-soluble lubricant or water to ease insertion. In some agencies, topical lidocaine anesthetic is used on the tube or in the clients nose to numb the area. |
|
Definition
| A water-soluble lubricant dissolves if the tube accidentally enters the lungs. And oil-based lubricant, such as petroleum jelly, will not dissolve and could cause respiratory complications if it enters the lungs. |
|
|
Term
| Insert the tube, with its natural curve for the client, into the selected nostril. Ask the client to hyperextend the neck, and gently advance the tube toward the nasopharynx. |
|
Definition
| Hyperextension of the neck reduces the curvature of the nasopharyngeal junction |
|
|
Term
| Direct the tube along the floor of the nostril and toward the ear on that side |
|
Definition
| Direct in the tube along the floor avoids the projections (turbinates) along the lateral wall |
|
|
Term
| Slight pressure and a twisting motion are sometimes required to pass the tube into the nasopharynx, and some clients eyes Maywater at this point |
|
Definition
| Tears are a natural body response. Provide the client with tissues as needed. |
|
|
Term
| If the tube meets resistance, withdraw it, relubricate it, and insert it in the other nostril. |
|
Definition
| The tube should never be forced against resistance because of the danger of injury. |
|
|
Term
| Once the tube reaches the oropharynx (throat), the client will feel the tube in the throat and they gag and retch. Ask the client to tilt the head forward, and encourage the client to drink and swallow. |
|
Definition
| Tilting the head forward facilitates passage of the tube into the posterior pharynx and the esophagus rather than into the larynx; swallowing moves the epiglottis over the opening to the larynx. |
|
|
Term
| If the client continues to gag and the tube does not advance with each swallow, withdraw it slightly, and inspect the throat by looking through the mouth. |
|
Definition
| The tube maybe coiled in the throat. If so, withdraw it until it is straight, and then try again to insert it. |
|
|
Term
| Aspirate stomach contents, and check the pH, which should be acidic. |
|
Definition
| Testing pH is a reliable way to determine location of a feeding tube. Gastric contents are commonly pH 1 to 5; six or greater would indicate the contents are from lower in the intestinal tract or in the respiratory tract. Some researchers suggest that a pH greater than four should be followed by further confirmation of two location. |
|
|
Term
| If the stylet has been removed, never reinserted when the tube is in place. |
|
Definition
| The stylet is sharp and could pierce the tube and injure the client or cut off the tube end. |
|
|
Term
| Place a stethoscope over the clients epigastrium and inject 10 to 30 mL of air into the tube while listening for a whooshing sound. Although still one of the methods used, do not use this method as the primary method for determining placement of the feeding tube. |
|
Definition
| This method does not guarantee tube position. |
|
|
Term
| Place the tape over the bridge of the clients nose, and bring the split ends either under and around the tubing, or under the tubing and backup over the nose. |
|
Definition
| Taping in this manner prevents the tube from pressing against and irritating the edge of the nostril. |
|
|
Term
| Attach a piece of Adhesive tape to the tube, and pin to the gown |
|
Definition
| The tube is attached to prevent it from dangling and pulling |
|
|
Term
| If a Salem sump tube is used, attach the anti-reflux valve to the vent port if used and position the port above the clients waste. |
|
Definition
| This prevents gastric contents from flowing into the vent lumen. |
|
|
Term
| When removing the nasogastric tube, instill 50 mL of Air into the tube |
|
Definition
| This clears the tube of any contents such as feeding or gastric drainage. |
|
|
Term
| When removing the nasogastric tube, ask the client to take a deep breath and to hold it. |
|
Definition
| This closes the glottis, thereby preventing accidental aspiration of any gastric contents. |
|
|
Term
| When removing the nasogastric tube, pinch the tube with the gloved hand. |
|
Definition
| Pinching the tube prevents any contents inside the tube from draining into the clients throat |
|
|
Term
| When removing the nasogastric tube, place the tube in the plastic bag |
|
Definition
| Placing the tube immediately into the bag prevents the transference of microorganisms from the tube to other articles or people |
|
|
Term
| After removing the nasogastric tube, assist the client as required to blow the nose. |
|
Definition
| Excessive secretions may have accumulated in the nasal passages. |
|
|
Term
| After removing the nasogastric tube, Dispose of the equipment appropriately |
|
Definition
| Correct disposal prevents the transmission of micro organisms |
|
|
Term
| When administering a tube feeding, assist the client to a Fowlers position in bed or a sitting position in a chair, the normal position for eating. If a sitting position is contraindicated, a slightly elevated right side lying position is acceptable. |
|
Definition
| These positions enhance the gravitational flow of the solution and prevent aspiration of fluid into the lungs. |
|
|
Term
| When administering a tube feeding, if the tube is placed in the stomach, aspirate all contents and measure the amount before administering the feeding |
|
Definition
| This is done to evaluate absorption of the last feeding; that is, whether undigested formula from a previous feeding remains. If the tube is in the small intestine, residual contents cannot be aspirated. |
|
|
Term
| When administering a tube feeding, if 100 mL, or more than half the last feeding, is withdrawn, check with the nurse in charge or refer to agency policy before proceeding. The precise amount is usually determined by the primary care providers order or by agency policy. |
|
Definition
| At some agencies, the feeding is delayed when the specified amount or more of formula remains in the stomach. |
|
|
Term
| When administering a tube feeding, re-instill the gastric contents into the stomach if this is the agency policy or primary care providers order. |
|
Definition
| Removal of the contents could disturb the clients electrolyte balance. |
|
|
Term
| When administering a tube feeding, warm the feeding to room temperature. |
|
Definition
| An excessively cold feeding may cause abdominal cramps. |
|
|
Term
| When administering a tube feeding, if an open system is used, clean the top of the feeding container with alcohol before opening at. |
|
Definition
| This minimizes the risk of contaminants entering the feeding syringe or feeding bag. |
|
|
Term
| When administering a tube feeding, hang the labeled bag from an infusion Pole about 30 cm, 12 inches, above the tubes point of insertion into the client. |
|
Definition
| At this height, the formula should run at a safe rate into the stomach or intestines. |
|
|
Term
| When administering a tube feeding, open the clamp, run the formula through the tubing, and reclamp the tube. |
|
Definition
| The formula will displace the air in the tubing, thus preventing the installation of excess air into the clients stomach or intestines. |
|
|
Term
| When administering a tube feeding through a syringe, remove the plunger from the syringe and connect the syringe to a pinched Or clamped nasogastric tube. |
|
Definition
| Pinching or clamping the tube prevents excess air from entering the stomach and causing distention. |
|
|
Term
| When administering a tube feeding through a syringe, permit the feeding to flow and slowly at the prescribed rate. Raise or lower the syringe to adjust the flow as needed. Pinch or clamp the tubing to stop the flow for a minute if the client experiences discomfort. |
|
Definition
| Quickly administered feedings can cause flatus, cramps, and/or vomiting. |
|
|
Term
| When administering a tube feeding, if another bottle is not to be hung immediately, flush the feeding tube before all of the formula has run through the tubing. |
|
Definition
| Water flushes the lumen of the tube, preventing future blockage by sticky formula. |
|
|
Term
| When administering a tube feeding, be sure to add the water before the feeding solution has drained from the neck of a syringe or from the tubing of an administration set. |
|
Definition
| Adding the water before the syringe or tubing is empty prevents the installation of air into the stomach or intestines and thus prevent unnecessary distention |
|
|
Term
| After administering a tube feeding, ask the client to remain sitting upright in Fowlers position or in a slightly elevated right lateral position for at least 30 minutes. |
|
Definition
| These positions facilitate digestion and movement of the feeding from the stomach along the alimentary tract and prevent the potential aspiration of feeding into the lungs |
|
|
Term
| After administering a tube feeding, check the agencies policy on the frequency of changing the nasogastric tube and the use of smaller lumen tubes if a large bore tube is in place |
|
Definition
| These measures prevent irritation and erosion of the pharyngeal and esophageal mucous membranes. |
|
|
Term
| When administering a gastrostomy or jejunostomy feeding, remove the syringe plunger. Pour 15 to 30 mL of water into the syringe, remove the tube clamp, and allow the water to flow into the tube. |
|
Definition
| This determines the patency of the tube. If water flows freely, the tube is patent |
|
|
Term
| When administering a gastrostomy or jejunostomy feeding, just before all of the formula has run through and the syringe is empty, add 30 mL of water. |
|
Definition
| Water flushes the tube and preserves it's patency |
|
|
Term
| After administering a gastrostomy or jejunostomy feeding, assess the status of peristomal skin. |
|
Definition
| Gastric or jejunal drainage contains digestive enzymes that can irritate the skin. |
|
|
