Let’s Go Tubing! Understanding GI and GU Tubes! Tracey Siegel MSN RN CNE CWOCN
Objectives: Define various gastrointestinal and genitourinary tubes used in nursing practice. Discuss Evidence Based Care of GI and GU tubes.
Nursing: it's like &quot;totally tubular&quot;
Is your patient &quot;going down the tubes?&quot;
Gastric Tubes Insertion of a flexible tube into the stomach, duodenum or jejunum for the purpose of: Decompressing the stomach Removing gas and fluid Lavaging the stomach and remove toxins Diagnosing Administering food, medications Treating obstructions Stopping bleeding
Gastric Tubes Nasogastric tubes Levin tube Single lumen Short term feeding or suction Inserted nasally or orally Salem sump Dual lumen tube Blue “pigtail” Designed for suction Salem sump Levin
Evidence Based Nursing Care Check placement each shift Gold Standard is x-ray immediately after insertion Aspirate and measure pH (<4) Least accurate- auscultation method Measure length of tube Excellent oral care No ice chips unless ordered Check nostril Assess vital signs Assess lung sounds If suction is used- check drainage each shift- expect some blood tinged immediately after surgery and up to 24 hours Gastric drainage is light yellow to deep green Nurses cannot replace NGT after gastrectomy!
Evidence Based Nursing Care If used for feeding or Medication: placement residual aspiration Crush meds well Don’t crush enteric coated or long acting medications Give at least 15-30 ml of water between each med! Give extra water if allowed Keep HOB at 30 degrees Gloves!!!
Gastric Tubes: small bore nasoduodenal or nasojejunal (Dobhoff) Inserted by physician or specially trained nurse Placement must be verified by x-ray (weighted end) Narrow lumen but less risk for aspiration for patients needing long term feeding Best to use only liquid medications but no always possible so best practice calls for pharmacy to pulverize pills and place in liquid
Read More About It http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2006/Dec3(4)/Pages/23.aspx#bm2 http://www.nursingcenter.com/prodev/ce_article.asp?tid=771094
Percutaneous endoscopic tubes (PEGS or PEJS) Indications Long term nutritional supplementation Nursing Management Residual Placement Length of tube Don’t put dressings under the bumper- can alter position of tube Stabilize the tube!
Nasointestinal Tubes: Miller Abbot or Cantor Small bowel or large bowel obstructions Inserted by physician Patient should be repositioned or allowed to walk to promote tube insertion and peristalsis Not taped until in place and verified by x-ray No placement check needed Attached to suction Short term Mercury or other weight on bottom of tube Rarely used- still see NCLEX questions
Sengtaken Blakemore Tube or Minnesota tube Esophageal Tamponade or compression of esophageal varices to Control hemorrhage Rarely used- no evidence of effectiveness however still may be asked on NCLEX!!!!
Care of patient with Blakemore tube Tube presses on esophagus to stop bleeding therefore AIRWAY is primary Elevate HOB Keep scissors at bedside in case tube needs to be deflated (respiratory distress) Monitor for bleeding, esophageal rupture (severe pain, shock- medical emergency) Placement is verified by x ray Patient will be in critical care!
Care of patient with T-Tube Placed in common bile duct during GB surgery or in radiology Attached to a drainage bag but not sutured in (verify each shift) Bile is caustic to skin (dressing around) Make sure it doesn’t get kinked Normal to drain 700-1200ml/day Patient may be discharged with- can stay in up to 6 weeks
Best Practices and Evidence Based Care of Indwelling Urinary Catheters Catheterize only when absolutely needed Educate personnel on correct catheter insertion technique Hand Washing Secure the catheter Maintain unobstructed urine flow No irrigations unless absolutely necessary (after GU or prostate surgery OK) Don’t routinely change No special care of meatus needed (soap and water OK) Keep drainage bag off floor and below level of bladder
Surgical Drains Hemovac Jackson Pratt Penrose Drain
Immediately following a gastrectomy, a nurse in the recovery room notes blood clots in the patient’s nasogastric tube drainage. What should the nurse do? Clamp the tube Continue to monitor Instill iced saline into the tube Call the surgeon immediately
After abdominal surgery, the client returns to the nursing unit with a nasogastric tube connected to low intermittent suction. The physician has ordered an antiemetic every 6 hours as needed. The client vomits. What is the first action by the nurse? Check the placement of the nasogastric tube. Administer the ordered antiemetic. Irrigate the tube with normal saline. Notify the physician.
A nurse instructs the client who has a nasogastric tube (N/G) after colon resection that the tube will be removed after the client: tolerates fluids. has a bowel movement. has no nausea for two days. passes flatus.
The nurse has inserted a nasogastric tube. How should placement be assessed? Place the end of the tube in a glass of water and check for bubbles. Aspirate contents and check with litmus paper. Inject air and listen over the stomach for gurgling. Irrigate sterile water and listen over the stomach for gurgling.
The nurse is caring for a patient with a T-Tube. The tube has drained 300 ml over the past 24 hours. What should the nurse do? Clamp the tube and call the physician. Attach the tube to low intermittent suction. Irrigate the tube with 50 ml of normal saline. Empty the drainage bag and document the output
A client is being discharged on bolus gastrostomy tube feedings. The nurse would be concerned if which of the following procedures by the client was observed? Checking the residual prior to feeding. Instilling the feeding at room temperature. Lying down and resting after the feeding. Washing around the gastrostomy with soap and water.
A nurse has an order to remove an indwelling urinary catheter (foley). What is the most important nursing action prior to removal? Donning sterile gloves. Deflating the catheter’s balloon. Cleaning the meatus with soap and water. Asking the client to “take a deep breath”.