Nasogastric tube: decompression of stomach
Salem Sump: for continuous or intermittent suction, prevent traumas to the stomach lining.
Miller-Abbot/Anderson: intestinal suction, reposition client hourly for insertion of the tube and movement into the intestines
Ewald: removal of secretions through the mouth
Sengstaken-Blakemore: for treatment of esophageal variceal, requires intensive care. Not used much because of the trauma and potential complications it causes the client. Significant difficulties are rebleeding, pneumonia, and respiratory restrictions.
Nasogastric Tube Feeding/Suction
Feeding tube Nursing interventions
❏ Assess placement before each feeding and every 4 hours with continuous feeding
❏ Semi-Fowler’s position
❏ Check for residual: always refeed unless the amount increases
❏ Nose and mouth care
❏ Hold for aspiration of > 100 ccs. Recheck in one hour
❏ Replace aspirated contents to prevent metabolic alkalosis
Suction Tube Nursing Interventions
❏ Should drain stomach contents
❏ Over time should see a decrease in the volume of drainage
❏ Continuously rinse with normal saline
- The anterior wall of the stomach is sutured to the abdominal wall, and the tube is sutured in place; skin care is essential.
- Primarily for long-term feeding needs
Percutaneous Endoscopic Gastrostomy
No need to check the placement
- They are primarily placed for long-term feeding needs.
- Preferred over gastrostomy tube because of ease of insertion and care
- Ensure the tube is anchored continuously with a ring at the same number point in the line. This ensures that the stomach is anchored to the abdominal wall and decreases the chance of complications.
Total Parenteral Nutrition (TPN)
This is an intravenous administration of a hypertonic solution of glucose, nitrogen, and other nutrients to achieve tissue synthesis and anabolism; lipids may be given as a supplement; it provides 3,000 – 4,000 calories per day.
Note: glucose concentrations greater than 10% must be given through a central intravenous line.
Indication For Use
- The inability of the gastrointestinal tract to absorb nutrients adequately (malabsorption syndrome, gastrointestinal obstruction, paralytic ileus, bowel resection ulcerative colitis, or gut rest)
- Inability to take food by mouth (coma)
- Excessive nutritional needs that cannot be met by the usual method (burn, multiple fractures, severe infections, carcinoma being treated with chemotherapy or radiation therapy)
❏ Chest X-ray immediately after subclavian line insertion for proper placement
❏ Assess weight, baseline electrolytes, blood glucose, zinc, and copper level before treatment begins
❏ Maintain an aseptic (sterile) technique during dressing changes
❏ Maintain infusion rate, do not increase or decrease rate without order, may cause hyperglycemia or hypoglycemia
❏ Assess weight daily: should maintain or increase weight while receiving TPN
❏ Monitor for complications and tubing changed with every bottle
❏ Air embolism: never open the central line to air. The chance of air embolism is decreased with multiple lumen setups. When the main tube is inserted or opened, have the client perform the Valsalva maneuver and place it in the Trendelenburg position.
❏ Pneumothorax: especially during insertion
❏ Zinc deficiency
❏ Fluids overload
❏ Hyperglycemic, hyperosmolar nonketotic coma
❏ The gradual decrease in the rate of the solution when discontinuing therapy, thereby avoiding hypoglycemia
Continually evaluate the effectiveness of treatment and seek consultation