This document discusses various gastrointestinal intubation procedures and techniques. It defines gastrointestinal intubation as the insertion of flexible tubes into the stomach or small intestine for various purposes like decompressing the stomach, administering medications, or treating an obstruction. The document describes different types of tubes that can be used including gastric tubes, Levin tubes, sump tubes, and enteric tubes. It provides details on nursing care responsibilities for patients with nasogastric or gastrostomy tubes, including tube insertion and maintenance, assessing for complications, and providing patient education.

1. GASTROINTESTINAL INTUBATION
PRESENTED BY :
V.RAMYA,
TUTOR.

2. DEFINITION
It is the insertion of flexible tube into the stomach
or beyond the pylorus into the duodenum (the first
section of the small intestine )or the jejunum ( the
second section of the small intestine)
The tube may be inserted through the mouth,the
nose, or the abdominal wall.

3. PURPOSE
 Decompress the stomach
 Lavage the stomach
 Diagnose GI disorders
 Administer medications and tube feedings and fluids
 Treat an obstruction
 Compress a bleeding site
 Aspirate GI contents for analysis

4. TYPES OF TUBES
Gastric tubes
Levin
Sump
Enteric tubes

5. NASOGASTRIC TUBE

6. LEVIN TUBE

7. GATRIC SUMP TUBE

8. ENTERIC TUBE

9. Nursing Care of the Patient with a Nasogastric or
Naso enteric Tube
 Patient teaching and preparation
 Tube insertion
 Confirming placement
 Securing the tube
 Monitoring the patient
 Maintaining tube function
 Oral and nasal care
 Monitoring, preventing, and managing complications
 Tube removal

10. Measuring for Nasogastric Tube Insertion

11. Securing the NG Tube

12. Purposes and Advantages of Enteral Feeding
 Meets nutritional requirements when oral intake is in adequate or
not possible, and the GI tract is functioning
 Advantages:–
 Safe and cost-effective
 Preserves GI integrity
 Preserves the normal sequence of intestinal and hepatic metabolism
 Maintains fat metabolism and lipoprotein synthesis
 Maintains normal insulin and glucagon ratios

13. Tube Feeding Administration Methods
 Tubes
 Nasogastric or nasoenteral tubes
 Gastrostomy or jejunostomy tubes for long-term feeding
 Methods
 Intermittent bolus feedings
 Intermittent gravity drip
 Continuous infusion
 Cyclic feeding

14. Bolus Gastrostomy Feeding by Gravity

15. Nasoenteric Feeding by ContinuousControlled
Pump

16. Nursing Process: The Care of the Patient Receiving
an Enteral Feeding: Assessment•
 Nutritional status and nutritional assessment
 Factors or illnesses that increase metabolic needs
 Hydration and fluid needs
 Digestive tract function
 Renal function and electrolyte status
 Medications that affect nutrition intake and function of the GI tract
 Compare the dietary prescription to the patient’s needs.

17. Nursing Process: The Care of the Patient Receiving
an Enteral Feeding: Diagnosis
 Imbalanced nutrition
 Risk for diarrhea
 Risk for ineffective airway clearance
 Risk for deficient fluid
 Risk for ineffective coping
 Risk for ineffective therapeutic regimen management
 Deficient knowledge

18. Collaborative Problems/Potential Complications
 Diarrhea
 Nausea and vomiting
 Gas/bloating/cramping
 Dumping syndrome
 Aspiration pneumonia
 Tube displacement
 Tube obstruction
 Nasopharyngeal irritation
 Hyperglycemia
 Dehydration and azotemia

19. Nursing Process: The Care of the Patient Receiving
an Enteral Feeding: Planning
 Major goals may include nutritional balance,
 Normal bowel elimination pattern,
 Reduced risk of aspiration,
 Adequate hydration,
 Individual coping,
 Knowledge of and skill in self-care,
 And prevention of complications.

20. Maintaining Nutrition Balance and Tube Function
 Administer feeding at prescribed rate and method and according to patient tolerance.
 Measure residual prior to intermittent feedings and every 4-8hours during continuous
feedings.
 Administer water before and after each medication and each feeding, before and after
checking residual, every 4 to 6 hours, and whenever the tube feeding is discontinued
or interrupted.
 Do not mix medications with feedings.
 Use a 30-mL or larger syringe.
 Maintain delivery system as required.
 To avoid bacterial contamination, do not hang more than 4 hours of feeding in an
open system.

21. Maintaining Normal Bowel Elimination
 Selection of Tube Feeding formula:
 consider fiber, osmolality, and fluid content
 Prevent contamination of Tube Feeding:
 maintain closed system, do not hang more than 4 hours of Tube
Feeding in an open system.
 Maintain proper nutritional intake.
 Assess for reason for diarrhea and obtain treatment as needed.
 Administer Tube Feeding slowly to prevent dumping syndrome
 Avoid cold Tube Feeding.

22. Reduce Risk for Aspiration
Elevate Head Of Bed at least 30-
45 degrees during and for atleast
1 hour after feedings.
•Monitor residual volumes.

23. Other Interventions
Maintain hydration by supplying additional
water and assessing for signs of dehydration.
Promote coping by support and
encouragement;
Encourage self-care and activities.
Patient teaching

24. Gastrostomy Tubes
Types of tubes:–
Stamm
Janeway
PEG
Low-profile gastrostomy device (LPGD)
Insertion of the PEG tube

25. STAMM TUBE

26. Gastrostomy (PEG) Tubes

27. Nursing Process: The Care of the Patient With a
Gastrostomy: Assessment
Patient knowledge and ability to learn
Self-care ability and support
Skin condition
Nutrition and fluid status

28. Nursing Process: The Care of the Patient With a
Gastrostomy: Diagnosis
Imbalanced nutrition
Risk of infection
Risk for impaired skin integrity
Ineffective coping
Disturbed body image
Risk for ineffective therapeutic regimen management

29. Collaborative Problems/Potential
Complications
Wound infection
GI bleeding
Premature removal of tube
Aspiration
Constipation
Diarrhea

30. Nursing Process: The Care of the Patient With a
Gastrostomy: Planning
Major goals include attaining an optimal level of nutrition,
Preventing infection,
 Maintaining skin integrity,
Enhancing coping skills,
Adjusting to changes in body image,
Acquiring knowledge of and skill in self-care,
And preventing complications.

31. Tube Care and Preventing Infection
Proper use of dressing
Skin care around the tube
Manipulation of the stabilizing disk
to prevent skin breakdown

32. PERCUTANEOUS ENDOSCOPIC
GASTROTOMY Dressing

33. Indications for Parenteral Nutrition
A method to provide nutrients to the body by an IV route
A complex mixture containing proteins, carbohydrates ,
fats, electrolytes, vitamins, trace minerals, and sterile
water is administered in a single container.
The goals of parenteral nutrition are to improve nutritional
status and to attain a positive nitrogen status.

34. Nursing Process: The Care of the Patient Receiving
Parenteral Nutrition : Assessment
 Assist in identifying patients who are candidates for Parenteral
Nutrition
 Nutrition status
 Hydration status
 Electrolytes
 Signs and symptoms of hypoglycaemia / hyperglycemia
 Monitor blood glucose levels.
 Assess for potential complications
 Including temperature every 4 hours or by protocol

35. Nursing Process: The Care of the Patient
Receiving Parenteral Nutrition: Diagnosis
 Imbalanced nutrition
 Risk for infection
 Risk for excess or deficient fluid
 Risk for immobility
 Risk of ineffective therapeutic regimen

36. Collaborative Problems and Potential
Complications
 Pneumothorax
 Clotted or displaced catheter
 Sepsis
 Hyperglycemia
 Rebound hypoglycaemia
 Fluid overload

37. Nursing Process: The Care of the Patient Receiving
Parenteral Nutrition: Planning
Major goals may include attaining an optimal level of
nutrition,
Absence of infection,
Adequate fluid volume,
Optimal level of activity,
Knowledge of self-care, and
Absence of complications.

38. Prevention of Infection
Appropriate catheter and IV site care
Strict sterile technique for dressing changes
Wear mask when changing the dressing.
Assess insertion site.
Assess for indicators of infection.
Proper IV and tubing care

39. Maintaining Fluid Balance
Use infusion pump.
Flow rate should not be increased or decreased rapidly.
If fluid runs out, hang 10% dextrose solution.
Monitor indicators of fluid balance and electrolyte levels.
I&O
Weights
Monitor blood glucose levels.

40. Patient Teaching
Goals and purpose
Components of Parenteral Nutrition
Emergency contact numbers
Demonstrate use of equipment and how to handle and
hang the IV.
Demonstrate dressing changes.
Demonstrate how to flush or heparinize the catheter.
Potential complications and actions to take

41. BIBLIOGRAPHY
 Brunner and Suddarth’s Textbook of Medical- Surgical Nursing ,South Asian
 Edition , Volume 1 , Published by Wolters Kluwer . Page reffered to 817-838.
 Ansari and Kaur, Textbook of Medical – Surgical Nursing 1 , Published by Pee
 Vee 2011 Edition, Page reffered to 810 – 822.
 https://www.slideshare.net/arifasudheer/nasogastric-intubation-151445458