Salem Sump (central lumen with separate air vent lumen)
Describe a levin tube?
Single lumen
made of plastic or rubber
14-18 fr in size
has circular markings for insertion guides
connected intermittent suction (low intermittent 80-120 mm Hg)
Describe a salem Sump tube?
double lumen-central for gavage/lavage, sump for air vent
made of plastic
12-18 fr in size
small inner tube (blue pigtail) vents the larger suction-drainage tube to the atmosphere by way of an opening at the distal end of the tube
low continuous or intermittent suction OK
What is the rule for the air vent on the salem sump tube?
Never clamp off, connect to suction, or use for irrigation.
What is the Anti-reflux valve for?
To prevent the reflux of gastric contents out of the vent lumen.
What should you do if leakage from vent lumen is noted and why?
1. instill 10 ml of air into vent
2. irrigate suction lumen with normal saline
Reason:Reestablishes a buffer of air between the gastric contents and the valve
What do you need to assess for in the patient before inserting a NGT?
Condition of the nares, which is the best naris.
Why the client needs a NGT.
Has the cline had NGT before.
whats the clients LOC
The MD order
Type and size of tube and whether it will be on suction
What are some expected outcomes for inserting an NGT?
decompression of the stomach
comfort
adequacy of fluid volume
adequacy of nutrition
prevent complications r/t NGT intubation
What are some key points while inserting?
have suction equipment, emesis basin, and towel ready
stand on client's right side if right handed, vice versa
teach the client a way to establish communication
What should you do if you feel resistance while inserting?
Never FORCE
use gentle downward pressure
try to rotate tube slowly
pull back slightly and try again
remove, relubricate, retry
True/false. If the patient eyes start to water up quickly stop and remove quickly.
False. watery of the eyes is a natural body response.
What is the best way to verify placement?
Xray
what are the ways to verify placement?
ask client to speak
check to see if tube is coiled in posterior pharynx
aspirate gastric fluid to check ph
air insufflation
What are the ph levels for placement?
Gastic = 4 or less
intestinal = greater than 4
respiratory= greater than 5.5
How do you use air insufflation?
Instill 30 ml of air and listen to the upper left quadrant of the abdomen for a "whoosing" sound.
When should you verify placement?
For intermittent feedings=before feedings, medication, and fluid
For continous feedings=every 4-12 hours and before meals
When and what should you elvaulate for?
Evaluate every 2-3 hours
For: BS (must turn off suction)
abdominal distention/pain
discomfort in the abdomen, thorat, or nasal
color and amount of drainage
position and patency of NGT and air vent
oral and nasal mucosa
What should the height of the head of the bed be at all times?
HOB 30 or greater
What should you do if the tube is placed into the respiratory tract?
remove tube and report it to the doctor
obtain order for reinsertion
What should you do if stomach contents were aspirated into the respiratory tract with s/sx of regurgitaion with coughing, dyspnea, cyanosis, or decrease in O2?
postion patient on side to protect airway
suction nose and mouth to remove aspirated substance
report to MD
What should you do if stomach contents were aspirated into the respiratory tract with s/sx of crackles or wheezes in lungs, dyspnea, or fever?
report changes to MD
request CXR, if one not already done
prepare to initate antibiotics
What are the reasons to remove the NGT?
no longer needed for decompression of stomach
gastric or intestinal motility resumed
How do you determine if a patient is ready to be DC from the tube if all gastric and intestinal motility resumed and no abdominal discomfort or distention?
Turn off suction for 4 hours and client tolerates it by no vomiting, no distention, and has BS. It's okay.
What are some expected outcomes when removing NGT?
Minimizing discomfort caused by the removal
BS active and bowel function is normal
What do you evaluate for after removing tube?
Clients LOC
any decrease BS
any problems while DC
If abdominal disetention/nausea/discomfort returns
Why do you irrigate a NGT?
to maintian patency
What are signs that show that the tube may not be patent?
Decreased volume of gastric secretions
Abdominal distention
Abdominal pain
nausea/vomiting
What type of fluid do you use to irrigate with?
sterile water for neonates, before and after meds, critically ill, and immunocompromised patients.
What are the steps in irrigation?
1. place a towel over client chest
2. DC suction/ turn off feeding
3. verify placement
4. kink tube
5. slowly instill 30 ml of fluid keeping syringe tip down
6. aspirate fluid
7. reconnect NGT to suction
8. instill 10 ml of ain into air vent (if necessary)
What should you do if you are unable to instill the fluid to irrigate?
repostion patient on left side and try again
notify md
may need to be removed
What should you do if you have red or brown color fluid that is aspirated which means new or old blood in GI tract?
Notify MD
What should you do if patient develops severe respiratory distress?
stop feeding
Notify MD
obtain CXR
What should you do if fluid and electrolyte imbalance develops?