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Promoting Nutrition (Enteral Nutrition)

This document discusses enteral nutrition, which is an alternative feeding method for providing adequate nutrition through the gastrointestinal system using tube feeding. It describes various types of enteral access devices like nasogastric tubes, gastrostomy tubes, and jejunostomy tubes. It also outlines procedures for nasogastric tube insertion and removal, gastric gavage, and gastrostomy/jejunostomy feeding. Common complications of tube feeding like vomiting, aspiration, and diarrhea are also mentioned.

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Yayin Pestaño
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© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
98 views

Promoting Nutrition (Enteral Nutrition)

This document discusses enteral nutrition, which is an alternative feeding method for providing adequate nutrition through the gastrointestinal system using tube feeding. It describes various types of enteral access devices like nasogastric tubes, gastrostomy tubes, and jejunostomy tubes. It also outlines procedures for nasogastric tube insertion and removal, gastric gavage, and gastrostomy/jejunostomy feeding. Common complications of tube feeding like vomiting, aspiration, and diarrhea are also mentioned.

Uploaded by

Yayin Pestaño
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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PROMOTING

NUTRITION
(Enteral Nutrition)
ENTERAL NUTRITION
(Tube feeding)
 An alternative feeding method to ensure adequate
nutrition through enteral (gastrointestinal system)
methods.

 Also referred to as Total Enteral Nutrition (TEN)

 Is provided when the client is unable to ingest food


or the upper gastrointestinal tract is impaired and the
transport of food to the small intestine is interrupted.
Gastric Gavage( Nasogastric Feeding)
 Introduction of nourishment into the stomach by
means of a tube passed through the nose and
mouth.
Purposes
1. To provide feeding.
2. To irrigate stomach.
3. For decompression (drainage of gastric
content.
4. To administer medications.
5. To administer supplemental fluids.
ENTERAL METHODS
ENTERAL ACCESS DEVICES
Nasogastric Tube (NGT)
 Inserted through one of the
nostrils, down the
nasopharynx, and into the
alimentary tract.
 For infants, the tube is
passed through the mouth
and pharynx.
 Used for clients who have
intact gag and cough
reflexes, who have
adequate gastric emptying,
and who require short-term
feedings.
Types of NGT
 Levin Tube
 Salem Sump tube
 Miller Abbott tube
 Sengstaken Blakemore Tube
Types of Nasogastric Tube
1. Levin Tube
 A flexible rubber or
plastic, single
lumen tube with
holes near the tip
 made of plastic
 There are
graduated markings
on the lumen so
that you can see
how far you have
inserted the tube
into the patient.
Types of Nasogastric Tube
2. Salem-Sump
 A double lumen
tube
 drainage lumen
and a smaller
secondary tube
that is open to
the atmosphere it
can be used for
continuous
suction
Types of Nasogastric Tube
3. Miller-Abbott
Tube
 rubber balloon at
the tip of one
tube; the other
tube has holes
near its tip
 After one tube has
passed through
the pylorus the
balloon is inflated
with air.
Types of Nasogastric Tube

4. Cantor Tube
 has one lumen
and a bag on the
end.
 mercury is injected
directly into the
bag with needle
and syringe.
Types of Syringe
1. Asepto
Syringe
 Is a plastic or
glass syringe
with a rubber
bulb.
 Comes in
several sizes
from 30 – 120
ml.
Types of Syringe
2. Rubber Bulb
 Used for
irrigating the
ears.
Types of Syringe
3. Piston
 Has a tip to
which a
catheter
can be
attached.
Types of Syringe
4. Pomeroy
 Metal syringe
commonly used
for ear irrigation.
 Shield near the tip
prevents the
solution from
spraying outward.
ENTERAL ACCESS DEVICES
Nasoenteric Tube
 A longer tube than the NGT (at least 40 inches) is
inserted through one nostril down into the upper
small intestine.
 Used for clients who are at risk for aspiration:
 Decreased LOC
 Poor cough or gag reflexes
 Endotracheal intubation
 Recent extubation
 Inability to cooperate with the procedure
 Restlessness or agitation
ENTERAL ACCESS DEVICES
Gastrostomy and Jejunostomy devices
 Used for long-term nutritional support
(more than 6-8 weeks)
 Conventional tubes are placed
surgically or by laparoscopy through
the abdominal wall into the stomach
(gastrostomy) or into jejunum
(jejunostomy)
 The surgical opening is sutured tightly
around the tube or catheter to prevent
leakage.
 Incision heals (10-14 days)
 Between feedings, a prosthesis may be
used to close the ostomy opening (shaft
3-5 cm or 1 ½ - 2 inches long with
internal and external flanges and a
screw cap)
ENTERAL ACCESS DEVICES
Gastrostomy and Jejunostomy devices
 Percutaneous Endoscopic
Gastrostomy (PEG) or Percutaneous
Endoscopic Jejunostomy (PEJ)
 Using an endoscope to visualize the
inside of the stomach, making a
puncture through the skin and
subcutaneous tissues of the abdomen
into the stomach, and inserting the PEG
or PEJ catheter through the puncture.
 Catheter has internal and external
bumpers and an inflatable retention
balloon to maintain placement.
ENTERAL FEEDINGS
 Intermittent feeding
 Administration of 300 to 500 ml several
times a day.
 Preferred site is stomach feeding
administered over at least 30 mins.
 Monitor closely for distention and aspiration
 Continuous feeding
 Administered over a 24-hour period using an
infusion pump that guarantees a constant
flow rate.
 Feeding is administered in the small
intestine.
ENTERAL FEEDINGS
 Cyclic feedings
 Are continuous feedings that are administered in
less than 24 hours (e.g. 12 to 16 hours).
 Often administered at night and referred to as
nocturnal feedings
 Monitor fluid status and circulating volume
overload (higher nutrient densities and higher
infusion rates than standard continuous feeding)
FEEDING FORMULA
PROCEDURES:
NGT INSERTION
NGT REMOVAL
GASTRIC GAVAGE
GASTROSTOMY/ JEJUNOSTOMY FEEDING
GASTRIC LAVAGE
Nasogastric Tube Insertion
PURPOSES
Provide feeding
Administer medication
Decompression
Irrigation
Supplemental fluids
To obtain specimen for laboratory
analysis
Procedure
1. Inform the
client about
the procedure.
2. Position: High
Fowler’s
position
Nasogastric Tube Insertion

– POSITION: HIGH FOWLER’S


– Assess Nares
– Hyperextend the head
– Check intact – flashlight
– Nostril greater airflow?

– Measure: tip Nose, Earlobe, Xiphoid


Procedure
3. Measure
length: N-E-X
(tip of the
Nose to the tip
of the Earlobe
to the Xiphoid
process)
Procedure
4. Lubricate: water soluble lubricant
5. Hyperextend the neck
Nasogastric Tube Insertion
 Lubricate: Water soluble lubricant

 Hyperextend

 Direct the tube? Floor nostril towards ear

 Slight pressure & Twisting motion

 Meet RESISTANCE? Withdraw, Relubricate, Insert


in the other nostril.
Nasogastric Tube Insertion
• Throat / Oropharynx → May GAG?
• TILT HEAD FORWARD… DRINK…
SWALLOW.

• Client GAGS?
• STOP… REST… SIPS OF WATER…

• PASS the tube 2 to 4 inches with each swallow


Nasogastric Tube Insertion
 Ascertain PLACEMENT?
 X - RAY

 ASPIRATE GASTRIC CONTENTS


pH = ACIDIC = 1 to 5
6 or greater → Lower Intestinal tract or
Respiratory Tract

 STETHOSCOPE – Inject 10 to 30 ml AIR


Common Problems of Tube Feeding
1. Vomiting
2. Aspiration
3. Diarrhea
4. Constipation
5. Hyperglycemia
6. Abdominal Distention
Things to consider if the tube
is inside the stomach
1. Instill some air using the asepto syringe. Using
your stethoscope, listen to the gurgling sounds.
2. Aspirate some acid in the stomach, and take the
laboratory test to know if the pH is acidic or basic.
If it is acidic, then the tube is in place.
Things to consider if the tube
is inside the stomach
3. Get a glass of water and soak the end of the tube.
Ask the patient to exhale and observe some
bubbling into the water.
4. X-ray.
Nasogastric Tube Insertion

 SECURE? Tape BRIDGE NOSE


OILY SKIN? Wipe with ALCOHOL

 ATTACH a piece of adhesive tape to


the tube. PIN the tape to the gown.
Nasogastric Tube Removal
UNPIN the tube from the client’s gown.

REMOVE adhesive tape on the nose.

OPTIONAL: Instill 50 ml of air into the tube.

DEEP BREATH and HOLD!

PINCH the TUBE. SMOOTHLY withdraw.

PLACE tube in a plastic bag.


Gastric Gavage
 Position? High fowlers or semi-fowlers
 Assess PLACEMENT?
 Allow 1 hour to elapse before testing pH
IF received medication.

 Assess RESIDUAL CONTENTS?


 IF 100 ml or MORE THAN HALF of the feeding is
withdrawn → check with RN in charge

 Maintain position for 30mins after feeding


Gastrostomy or Jejunostomy
Feeding
 Assess PATENCY?
 Allow WATER TO FLOW INTO TUBE → NOTIFY
nurse in charge or physician if no free flowing.

 Assess RESIDUAL CONTENTS?


 IF 50 ml or less than of undigested formula is
withdrawn → follow agency protocol.
 IF 150 ml or more of residual content is
withdrawn → HOLD! → Recheck in 3-4 hrs.
Gastrostomy or Jejunostomy
Feeding
 Assess RESIDUAL CONTENTS?
 FOR CONTINUOUS FEEDING:
 Check every 4-6 hrs. →
 IF >2 hr VOLUME → HOLD!
 Recheck in 2 hours → RESTART unless
residual remains large → NOTIFY
PHYSICIAN.
Gastrostomy or Jejunostomy
Feeding
 COMPLICATIONS
 Aspiration
 Hyperglycemia
 Abdominal distention
 Diarrhea
 Fecal impaction
Gastric Lavage or Gastric Irrigation
 Dependent Intervention? VERIFY ORDER

 Position? High or semi-fowlers

 Assess PLACEMENT

 IRRIGATING SOLUTION?
 COLD Normal Saline Solution
 30 ml to 60 ml per instillation
Gastric Lavage or Gastric Irrigation
 Difficulty withdrawing solution? → Inject
20cc of AIR → ASPIRATE again and/ or
REPOSITION patient or NGT.

 IF aspirating difficulty continues?


 Reattach tube in low intermittent suction
NOTIFY nurse in charge or physician
Thank you!

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