What is a lumen in relationship to the different types of tubes?
A lumen is a tube:
- some lumens can have multiple tubes
- each tube has a separate function
What is the difference between a single, double, and triple lumen?
- a single lumen has 1 tube
- a double lumen has 2 tubes
- a triple lumen has 3 tubes
What is a (nasogastric) NG tube and what is its function?
A nasogastric tube is inserted in the nose and placed in the stomach.
The function of an NG tube is:
- to remove fluids or gas (called decompression)
- to give meds and nutrition (called tube feedings)
What is the difference between NG tube feedings and total parenteral nutrition (TPN)?
NG tube feedings and TPN both give nutrients to the client but in completely different ways:
- NG tube feedings put liquid food into a tube that goes directly into the stomach
- TPN are nutrients that go directly into an IV
Is the insertion of an NG tube a sterile or non-sterile procedure?
NG tube insertion is a non-sterile procedure and clean gloves are used.
The nose, mouth, stomach, and colon are not sterile.
How is an NG tube measured before insertion?
NG tube measurement: NEX (Nose, Earlobe, Xiphoid process):
Measure the length of the tube from:
- the bridge of the nose
- to the earlobe
- to the xiphoid process
That is the length of tubing that will be inserted.
What are the steps of an NG tube insertion?
Steps for NG tube insertion:
- place client in high-Fowler's position
- measure tubing (NEX)
- lubricate tip
- insert tube and have client swallow water while head is bent forward
- secure tube to nose with tape
What test is done to confirm placement of an NG tube before being used for the first time?
NG tube placement is confirmed by x-ray.
This is to make sure the tube didn't accidentally go in the lungs, brain or get coiled in the back of the throat.
How is NG tube placement confirmed before meds or a feeding?
Before meds or starting a feeding, check the pH of gastric secretions by aspirating a small amount:
- pH < 3.5 indicates the tube is in the stomach
What is assessed before starting tube feedings?
Before starting tube feedings assess:
- residual amount of fluid in the stomach by using a syringe to aspirate
- bowel sounds to make sure they are not hyperactive
When should a tube feeding be held?
Hold tube feedings if:
- the residual is > 100 mL
- there are no bowel sounds
Healthcare providers have different preferences on when it is appropriate to hold an NG tube feeding.
Why should residual fluid from an NG tube always be replaced back into the stomach?
Residual fluid from an NG tube is replaced in order to prevent fluid and electrolyte imbalances.
What is the difference between a bolus feeding and continuous tube feeding?
Bolus feeding: NG tube feedings are given quickly at once and several times throughout the day
Continuous feeding: NG tube feedings are continuously given throughout the day
What position is a client placed for bolus and continuous NG tube feedings?
Bolus feedings: high-Fowlers for 30 minutes afterward
Continuous feedings: semi-Fowler's at all times
These positions are to prevent aspiration.
What is used to flush before and after NG tube med administration and NG tube feedings?
Flush NG tubing with water or normal saline before and after meds and feedings.
Flushing is to assure that the client received all the meds or feeding and to prevent blockage in the tube.
How should meds be given through an NG tube?
When giving meds through an NG tube, crush meds one at a time and give one med at a time.
This prevents interactions between crushed meds.
Which types of meds should NOT be crushed?
Do NOT crush extended-release or enteric-coated meds.
These meds are designed to be released over a longer time. Crushing the meds causes the client to receive too much of the med too quickly.
What are the steps to remove an NG tube?
Steps to remove an NG tube:
- tell the client to take a deep breath and hold it
- gently pull the NG tube out while coiling it around the hand
What is a G-tube and J-tube?
They are both long term feeding tubes:
- G-tube: gastrostomy tube - placed in the stomach
- J-tube: jejunostomy tube - placed in the small intestine
Does placement need to be checked with a G-tube or J-tube?
No! The tube is permanently placed and comes out through the abdominal wall.
How often is a bolus tube feeding and water bolus done?
Both tube feeding and water boluses are administered about every 4 hours during the day.
Why do water boluses also need to be given for tube feedings?
To prevent dehydration.
How often is the tubing that connects to the NG tube be replaced?
Replace the tubing that is connected to the bag every 24 hours.
This is to prevent bacterial growth.
What is a lavage tube?
A lavage tube is used to pump out stomach contents very quickly.
It is usually used when a client has ingested poisons.
What is an esophageal Minnesota tube?
An esophageal Minnesota tube is used to place pressure against esophageal veins in order to control bleeding.
It is used for those with complications of cirrhosis.
What should be kept at the side of the bed for a client with an esophageal Minnesota tube?
Keep scissors at the bedside.
This is in case of respiratory distress. The tube is cut to relieve the pressure.
What is a Foley urinary catheter?
A foley urinary catheter is inserted through the urethra to continuously drain the bladder when the client is unable to urinate.
Is the insertion of a urinary catheter a sterile or non-sterile procedure?
Sterile: the tube is entering the sterile cavity of the bladder.
What are the steps to insert a Foley urinary catheter?
Steps to insert a Foley urinary catheter:
- wash hands
- clean perineal area with soap and water
- open catheter kit (it's sterile inside)
- apply sterile gloves
- lubricate catheter
- attach syringe to ballon port
- clean perineal area with cotton balls or swab sticks
- insert catheter until urine drains into bag
- inflate ballon and secure tubing
What is a straight cath?
A straight cath is a urinary catheter that has one lumen. It is only used once to either:
- empty the bladder
- obtain a sterile urine specimen
- drain residual urine after a client voids