Week 6: alterations in body systems – tubes

● Nasogastric tubes
○ Intubates the stomach
○ Purpose:
■ Decompresses the stomach by removing fluids or gas
■ Allows surgical anastomosis to heal without distention
■ Decreases risk of aspiration, administers meds without swallowing
■ Provide nutrition by acting as a temporary feeding tube
■ Irrigate the stomach & remove toxic substances such as in poisoning
○ Types
■ Levin tube
● Single lumen NG tube
■ Salem sump tube
● Double lumen NG tube with an air vent
○ irrigation : assess placement before irrigating, instil 30-50 mL of water or NS,
pull back on the syringe plunger to withdraw the fluid to check patency, repeat if
the tube flow is sluggish
○ Removal: ask the pt to deep breath and hold it, remove the tube slowly and evenly
over the course of 3-6 seconds
● Gastrointestinal tube feedings
○ Types
■ Nasogastric - nose to stomach
■ Nasoduodenal-nasojejunal - nose to duodenum or jejunum
■ Gastrostomy - stomach
■ Jejunostomy - jejunum
○ Types of administration
■ Bolus - formula is administered over 30-60 min every 3-6 hrs
■ Continuous - feeding is administered continually for 24 hours
■ Cyclical - administered in the daytime or nighttime for 8-16 hours;
regulated flow by infusion feeding pump
○ Administration
■ Check residual volume - if less than 100mL = administer feeding, if more,
check with provider
■ Assess bowel sounds; put PT in high-fowlers; assess tube placement by
pH
■ Warm the feeding to room temperature
■ Change the feeding container and tubing every 24 hours or per agency
policy
■ Do not hang more solution than what is required for more than 4 hours -
bacterial growth is more likely
 ■ Shake the formula before pouring it into the bag
● Intestinal tubes
○ Passed nasally into the small intestine
○ Types of the tubes include the Cantor tube (single lumen) and the Miller-Abbott
tube (double-lumen)
○ Interventions
■ Position the pt on the right side to facilitate passage of the weighted bag in
the tube through the pylorus of the stomach and into the small intestine
■ Do not secure the tube to the face until it has reached final placement (may
take several hours) in the intestines
■ Assess abdomen during the procedure
● Esophageal and gastric tubes
○ May be used to apply pressure against bleeding esophageal veins to control
bleeding
○ DO NOT use for patients that have had an ulceration or necrosis of the esophagus
or previous surgery of the esophagus
○ Types
■ sengstaken-Blackmore tube - triple-lumen gastric tube with a gastric
balloon
■ Minnesota - most common, 4-lumen gastric tube) for aspirating
esophagopharyngeal secretions
○ Confirtube
○ m placement with an upper abdomen and chest x-ray!
○ Interventions
■ Check patency and integrity of all balloons before insertion, label each
lumen, place the pt in upright or Fowler’s position for insertion, maintain
head elevation
■ Keep scissors at bedtime, monitor for increased blood drainage or
esophageal rupture
● Lavage tubes
○ Used to remove toxic substances from the stomach
○ Lavaculator - large suction lumen and a smaller lavage-vent lumen for continuous
suction
○ Ewald - single-lumen large tube for rapid one time irrigation and evacuation
● Urinary and renal tubes
○ Types
■ Single lumen - straight catheterization; one time emptying of the bladder
or to check residual urine
■ Double lumen - indwelling catheter drainage and balloon inflation
■ Triple lumen - bladder irrigation and drainage is necessary
 ○ Routine urinary catheter care
■ Use gloves and wash the perineal area with warm soapy water
■ Using the non dominant hand, pull back labia or foreskin to expose the
meatus
■ Cleanse along the catheter with soap and water
■ Anchor the catheter to the thigh
■ Maintain catheter bag below the level of the bladder
● Respiratory system tubes
○ Endotracheal tubes
■ Maintains patent airway
■ For mechanical ventilation
■ Cuff is inflated that produces a seal between the trachea and the cuff to
prevent aspiration and ensures delivery of a set tidal volume
■ Types of tubes
● Orotracheal
○ Inserted through the mouth
○ For patients with a nasal obstruction
○ Can be uncomfortable
● Nasotracheal
○ Inserted through a nostril, smaller tube
○ More comfortable than orotracheal tubes
■ Interventions
● Confirm placement through a chest x-ray
● Auscultate both sides of chest and stomach
● Secure the tube
● Monitor the position of the tube at the lip or nose
● Monitor the skin & mucous membranes
● Suction the tube only when needed