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m Common types of tubes used in the clinical setting

m Assessment points related to the specific type of


tube
m Procedures for insertion of a particular tube
m Standard (universal) precautions
m Handling infectious materials
m @erifying correct placement and procedures for
administering medications or feedings, if
appropriate
m Interventions related to the care of the client
m Interventions associated with complications or
emergencies that may occur
m Client/family education regarding care at home
m
I TION
„ rt t s s t i t t t stc
„ I srt fr t s t t stc
m  IN
„ i l l  s stric t 
„ s t r stric c t ts i i tritt t s cti
r t ri  t  f i s
From Monahan, F. & Neighbors, M. (1998). Medical-surgical nursing: Foundations for
clinical practice, ed 2, Philadelphia: W.B. Saunders.
m   
„
l l s stric t it  ir  t
„ s fr crssi it c ti s scti
„ ir  t is t t  cl  is t  kt  t
ll f t stc
„ If lk  ccrs tr  t ir  t, i still 30 l f ir
i t t ir  t  irri t t i l it rl
sli  (N)
From Monahan, F. & Neighbors, M. (1998). Medical-surgical nursing: Foundations for clinical
practice, ed 2, Philadelphia: W.B. Saunders.
m lc t cli t i i  lr¶s siti
m sr fr ti f s t rl t xii
rcss t tri  t l t f i srti 
rk it t
m rict t t 3 i cs it  tr sll
jll  l (il sll is t s ), t r t t
l t f   i if t t cci  tll
slis i t t r cs
m I strct t cli t t  t  frr , ic
clss t i lttis   s t s s
m I srt i t stril,   c ckr  tr 
t sr x
m  t cli t tk  si f tr    c
t s t cli t slls
m
 t frc t t
m If t cli t xri cs   rsirtr istrss
(c i r cki ) ri i srti , ll ck
 t t  it  til t istrss ssi s
m   c  til t rk is rc  t i lc
 crrct lc t is c fir
m If f i s r rscri , x r c firti
sl    rir t i ititi f i s
m W stri tsti l (GI) ts r ttc t
scti , scti   c ti s r i tritt t,
it  rssr t xc i 25  s
rscri  t sici
From Perry, A. & Potter, P. (2002). Clinical nursing skills and techniques, ed 5, St Louis: Mosby.
m The most reliable method to determine
placement is by ray
m Assess placement every 4 hours and before
administering feedings or medications
m Assess placement by aspirating gastric
contents and measuring the pH, which should
be 4 or less (pH values greater than 6 indicate
intestinal placement)
m Inserting to 1 ml of air into the tube and
listening for the rush of air over the stomach
with a stethoscope is an alternative method for
assessing placement, but is not as reliable as
an ray or checking gastric pH
m ck rsi l ls r rs, fr
c f i ,  fr ii  icti s
m sirt ll stc c t ts (rsi l) 
sr  t
m i still rsi l f i t r t xcssi fli
 lctrlt lsss  lss t rsi l l
rs  rl
m rfr r rs t cck t t c f
t t
m ssss lc t fr irri ti
m G tl i still 30 t 50 l f tr r rl sli 
(N) (  i    c lic) it 
irri ti sri 
m ll ck  t sri  l r t it r t
fli t cck t c rt if t ri s
sl is
m sk t cli t t tk   rt  l
m  t t sll   l r t
crs f 3 t sc s (cil t t r t
 s it is i r )
m TUBES
„ ëasogastric
„ ëasoduodenal or naso e unal
„ astrostomy
„ Je unostomy
From Perry, A. & Potter, P. (2002). Clinical nursing skills and techniques, ed 5, St Louis: Mosby.
From Perry, A. & Potter, P. (2002). Clinical nursing skills and techniques, ed 5, St Louis: Mosby.
m TYPES F FEEDIë S
„ Bolus
„ Continuous
„ Cyclical
m O
„ sls rl l f i ttr s
„    i istr i  sri  r i  i tritt t
f i
„ Wit  i tritt t f i , rxitl 300 t 00 l
f frl is  i istr r  30 t 0 i t ri
r 3 t rs
From Perry, A. & Potter, P. (2002). Clinical nursing skills and techniques, ed 5, St Louis: Mosby.
m ONTINO
„  i istr c ti sl fr 2 rs
„  i fsi  r lts t fl
m YI
„  i istr itr i t ti r i tti fr 8 t
rs
„  i fsi  r lts t fl
„  i s t i t ll fr r fr  ri t 
From Perry, A. & Potter, P. (2002). Clinical nursing skills and techniques, ed 5, St Louis: Mosby.
m siti t cli t i i  lr¶s   t ri t
si  if cts
m Wr f i t r trtr t r t
irr  crs
m sirt ll stc c t ts (rsi l), sr
t  t,  rtr t c t ts t t
stc t r t lctrlt il cs
m ck sici ¶s r r    c lic
r r i rsi l  ts sll if t rsi l
is lss t 00 t 50 l, f i is
 i istr  if rtr t 50 l, l t
f i
m Assess tube placement by aspirating gastric
contents and measuring the pH (should be 4 or
less)
m Assess bowel sounds hold feeding and notify
the physician if bowel sounds are absent
m Use a feeding pump for continuous or cyclical
feedings
m For bolus feeding, leave the client in a high
Fowler¶s position for minutes after feeding
m For a continuous or cyclical feedings, keep the
client in a semi Fowler¶s position at all times
m   t f i c ti r  ti r 2
rs
m
 t  r slti t ill  rir fr
 r ri t r t ctril rt
m ck t xirti t  t frl rir t
 i istri
m k t frl ll rir t i srti i t
c ti r
m ls ssss lc t f t t rir t
f i
m ls ssss l s s  t  i istr
  f i s if l s s r s t
m If  strcti ccrs, tr flsi it tr,
sli , cr rr jic, i r l, r cl, if t
c tri ict , ftr ccki lc t
m   r f tli  l t t f i ,
rticlrl it cli ts    trcl r
trcl ts ssct trcs l fistl
 l stric c t ts r i trcl
xcrti  if tis is t , tif t sici
i itl
m  i istr f i t rscri rt, r i
rit fl (i tritt t, ls f i s) it 
0 l sri  it t l r r
m G tl fls it 30 t 50 l f tr r rl
sli  (  i    c lic) it t
irri ti sri  ftr t f i
m Aspiration
m @omiting
m Diarrhea
m Clogged tube
m @rif t lc t
m
 t  i istr f i if rsi l is rtr
t 50 l
m K t  f t  lt
m If sirti ccrs, scti s   , ssss
rsirtr rt, scltt l s s,  itr
trtr fr sirti   i, 
rr t ti cst r i r
m  i istr f i s sll,  fr ls f i s,
k t f i lst fr 30 i ts
m
 t ll f i t r r
m
 t ll ir t  tr t ti
m  i istr f i t r trtr
m lt t  f t 
m  i istr  titics s rscri
m If cli t its, lc i si  li siti
m s fir c ti i f i s
m  i istr f i sll  t r
trtr
m s lii frs f  icti , if ssil
m ls t t it 30 t 50 l f tr r N
(  i    c lic) fr  ftr
 icti  i istrti  fr  ftr
ls f i
m ls it tr r rs fr c ti s
f i
m rs  icti s r s lixir frs f
 icti s ssr tt t  icti r r
c  crs r tt t csl c   
m
issl crs  icti r csl c t ts
i 5 t 0 l f tr
m ck lc t  rsi l rir t i stilli
 icti s
m
r  t  icti i t  cttr ti sri ,
clr xcss ir,  i srt  icti i t t
t
m ls it 30 t 50 l f tr r N (  i
   c lic)
m l t t fr 30 t 0 i ts (  i
  icti    c lic)
m
ITION
„ ss sll i t t sll i tsti 
„ s t crss t l r t r i tsti l
c t ts
„ trs t sll i tsti  tr  t lric si ctr
cs f t i t f  sll  f rcr t t

m Cantor and Harris tube
m Miller Abbott tube
m i l l t it  rsrir fr 5 t 0 l f
rcr lct t its ti, l t ll f t
ri   ls
m rcr is i srt fr t t is ss
tr  t s, ki t rc r
 cfrtl
m T rris t is ls s fr l  
scti
From Monahan, F. & Neighbors, M. (1998). Medical-surgical nursing: Foundations for clinical
practice, ed 2, Philadelphia: W.B. Saunders.
m  l l t
m O  l is fr t i stillti f rcr  c
t t is i t stc,  t tr is fr
irri ti r ri  
From Monahan, F. & Neighbors, M. (1998) Medical-surgical nursing: Foundations for clinical
practice, ed 2, Philadelphia: W.B. Saunders.
m I  NTTION
„ ssss sici ¶s r rs    c lic fr
  c t  rl f t
„ siti cli t  t ri t si  t fcilitt ss  f t
rcr i ts iti t t tr  t lrs f
t stc  i t t sll i tsti 
„
 t scr t t t t fc it t  til it s
rc fi l lc t ( tk srl rs) i t
i tsti s
„ X r is rfr t rif sir lc t
m I  NTTION
„  itr ri   fr t t
„ If t t cs lck , tif t sici   sll
 t f ir i jct i t t l   rscri
t clr t t
„ ssss t    sr  i l irt
m I  NTTION
„ T r t t, t rcr  ir r r
fr t ll rti f t t it  5 l sri 
t t is r ll r ( i cs r r) s
rscri  t sici
„
iss t rcr i t rrit  r s r
  c lic
m
ITION
„ s t l rssr  i st s l i s t
c trl l i
„ Nt s if t cli t s lcrti r crsis f t
s s r  ris s l sr r
m TYPES
„ Sengstaken Blakemore tube
„ Minnesota tube
m Tril l stric t it  i fltl
s l ll ,  i fltl stric ll ,
  stric sirti l
m T stric ll lis rssr t t
cr is l j cti t irctl crss
stric rics  t crs l fl t
s l rics trcti is li t i ti
t stric ll i lc
m T s l ll irctl crsss
s l rics
m If l i is t st it i flti f t
stric ll , t s l ll is i flt
t 25 t 5 
m  x r f r    cst c firs
lc t
m Gstric c t ts r sirt  stric l  r
i tritt t scti i t stric sirti rt
m  s stric t is ls i srt i t sit
ris t cllct scrti s tt cclt 
t s l ll
From Monahan, F. & Neighbors, M. (1998), Medical-surgical nursing: Foundations for
clinical practice, ed 2, Philadelphia: W.B. Saunders.
m r l stric t
m   ifi  stk lkr t it 
 iti l l fr sirti
s r l scrti s
m I  NTTION
„ ck t c  i t rit f ll ll s rir t
i srti
„ l c l
„ lc t cli t i t ri t r lr¶s siti fr
i srti
„ rr fr x r i itl ftr i srti t rif
lc t
„ i ti  lti  c t t is i lc
m I  NTTION
„
l cl t ll rts t r t ir lks
„ K scissrs t t  si  t ll tis  itr fr
rsirtr istrss  if it ccrs, ct ts t flt
ll s
„ ls s l rssr s rscri  r
  c lic t r t lcrti r crsis f t
s s
m I  NTTION
„  itr fr i crs l  ri  , ic 
i ict rsist t l i
„  itr fr si s f s l rtr, ic i cl s 
r i l rssr, i crs rt rt, r ck 
r  i l i
„ s l rtr is  r  c  st 
rrt t t sici i itl
m
ITION
„ s t r txic sst cs fr t stc
m @TO
„  r stric t it  lr  scti l  
sllr l / t l tt ri s c ti s
scti
„ Irri ti slti  trs t l  l il stc
c t ts r r tr  t scti l
m W
¶
„ sl si l l lr  t s fr ri   ti
irri ti  cti
From Monahan, F. & Neighbors, M. (1998). Medical-surgical nursing: Foundations for
clinical practice, ed 2, Philadelphia: W.B. Saunders.