Digestive System Gavage and Lavage - a thin flexible plastic tube that is used for

Digestive system temporary medical purposes

- refers to the breakdown of foods we eat into - not only for feeding
tiny parts to give us fuel and nutrients that we
need Types
1. Short nasogastric tubes
How it works? -From nose to stomach
1. Mouth - levin and gastric (salem) sump
- digestion starts - used to remove exess gas, fluid, from upper GI
-Mastication tract or to obtain a specimen of gastric contents
- glands produce saliva -Sometimes used for medications or
feeding(gavage)
2. Esophagus
-Pathway Levin tube
-Food passes to stomach -Single lumen
-French 14-18
3. Stomach -155cm long
-Hydrochloric acid helps in the breakdown of
foods Gastric (salem) sump
-Sometimes some pt produces too much acid -Double lunmn
which causes destroys the lining(mucusa) of the 12-18
stomach and destroys blood vessels 120 cm long
-Decompress stomach, keepd it empty
4. Liver
-Produces bile (breaks down fats/cholesterol) 2. Medium- nasoenteric tube
- used for feeding
5. Pancreas -Dobhoff
-produces enzymes -Placed in doudenum and jejunum by
-Insulin flouroscopy or at clients bedside
-Verified by xray before feeding begin
6. Small intestine -Place client on right side to facilitate passage
- absorption of nutrients Flouroscopy- continouse movement of
- most nutrients are absorbed in jejunum radiation, able to monitor continously
X-ray- single shot
7. Large Intestine
3. Long- nasoenteric tube
8. Anus - nose and passed through esophagus and
-Solid waste passes through the rectum in order stomach into intestinal tract.
to leave the body -Aspirate intestinal contents

What is NGT? Miler-abbot

-12-18 french
-Rubber tube Complications
-One lumen for aspiration -Aspiration and tissue trauma
-Placement of catheter may induces gagging or
Harris vomiting, patient discomfort
-french 14 -Epistaxis (nosebleed)
-Suction and irrigation -Pulmonary complication (when it moves to the
-180 cm lungs)
-Esophageal perforation (if with resistance, stop
Canto tube insertion and remove then report)
- large balloon as distal end
-300 cm long Inserting a NGT tube
-4-5 ml of saline/water Assessment
-Check patency of nares and intactness of nasal
Purpose tissues
-Administration of foods and medication for -Check for hx of nasal surgery or deviated
clients who are unable to eat by mouth or septum
swallow a sufficient diet without aspirating food -Determine presence of gag reflex
or fluids into the lungs -Assess mental status or ability to cooperate
- For people high risk of aspiration with procedure
- establish means for suctioning stomach
contents to prevent gastric distention Planning
- to remove stomach contents for laboratory -Identify the size of NGT to be inserted and
analysis whether or not the tube is to be attached for
- to lavage (wash) stomach in case of poisoning suction machine
or overdose of medication -Recheck physicians order for insertion of NGT
- to drain fluid or air from the stomach Prepare all materials needed for the procedure
- to promote healing after bowel surgery -NGT
- to monitor bleeding in GI tract (more common -Asepto syringe
in peptic/gastric ulcer bleeding) -Sterile gloves
- to help treat an intestinal obstruction -Non-allergenic adhesive tape
-Water soluble lubricant
Contraindication -Facial tissue
Absolute Contraindication -Basin
-Severe mid face trauma -pH test strip
-recent nasal surgery -Stethoscope
-Disposal pad or towel
Relative Contraindication
-coagulation abnormality Implementation
-Esophageal varicose or stricture (esophageal 1. Assist the pt to a high fowler's position if his
stenosis) or her health condition permits and support the
-alkaline ingestion (can also cause stricture) head with a pillow
2. Explain to the client about the procedure and Infants & young children
it's indications. Establish a method for the client -Restraints may be necessary during tube
to indicate distress and a desire for you to insertion and throughout therapy
pause the insertion. Raising a finger or hand is -Place infant in an infant seat or position with a
often used for this. (Pt may experience rolled towel or pillow under the head and
discomfort) shoulder
3. Wash hands and observe other appropriate -Assess nares, obstruct one of infants nares and
infection control measurement feel for an air passage from other
4. Provide client privacy -Measure NGT from nose to tip of earlobe to
5. Re assessment the point midway between umbilicus and
6. Prepare the tube (if silicon, put it in ice (5-10 xiphoid process
mins) to harden, if hard plastic, put it in the -Never hyperextend/hyperflex the neck of
7. Determine how far to insert the tube (nose to infants
earlobe then to the tip of sternum) -Orogastric tube (OGT) (tip of earlobe up to
8. Insert tube. (Dont advance when coughing corner of mouth extended to the tip of xiphoid
may cause respiratory arrest) process)
-Gloves -Secure the end of the nares and upper lip as
-Lubricate tip well on the cheek
-Insert tube
-Ask client hyperextend the neck and gently NGT purpose
advance the tube toward nasopharynx -Restore or maintain nutritional status
-Hydration
Ways how to check the position of NGT. -Administer medications
1. Xray
2. Aspirate and check for pH using pH paper
3. Auscultation
Assessment
-Use cold irrigating solution to constrict blood -Check signs of malnutrition or dehydration
vessels and avoid bleeding. -check for allergies to any food in feeding
-Feeling nasusuka stop and introduce food -Presence of bowel sounds (constipation=+,
-500ml able to tolerate. paralytic ileus=-)
-Give empty bottle for possible vomiting. -Note any problems that suggest lack of
-NGT change every 2 weeks but depends on tolerance of previous feedings
institution
Planning
Inserting Nasointestinal tube -Determine type, amount, and frequency
-Add 3-4 cm(8-10 in.) to the length measured
-Position pt into his right side( enable -Always position pt in high-fowlers position
advancement of tube through p every feeding
-Conduct appropriate follow-up, degree of
client comfort, client tolerance of NGT Gastric Lavage
-refers to therapeutic procedure for washing -Negative
out stomach with sterile water
PARENTERAL NUTRITION
Indication -Life sustaining method of feeding that delivers
-Ingested poison essential nutrients directly into bloodstream via
-Cleaning of stomach before upper GI vein
endoscopy
-To collect sample from stomach for analysis Types
-To remove presssurein blocked intestines Partial Parenteral Nutrition
-Evacuate clots (pernicious anemia) -Given as a supplement to the pt
-Able to eat but not enough
Contraindications -Replace missing nutrition
-Depressed state of loss of conciousness EX:
-Seizure -Amino Acid
-Corrosive poisoning -Lipofundin
-Acid and alkali poisoning
-Ingestion of hydracarbon or petroleum Total Parenteral Nutrition
distillates -Complete nutrition
-Gastric perfuration/bleeding -Glucose, protien, amino acid, lipids, etc.
-Run for 36hrs only (more than 36hrs=spoilage)
Materials
-NGT Access
-Irrigating solution/NSS -Should be placed on central lines
-Asepto syringe -Midline catheter- PPN only
-Stet -Cephalic vein
-KY Jelly -Subclavian vien
-Basin -Subcutaneous port
-20/30/50 ml syringe -Internal jugular vein
-Gloves
-Suction equipment Composition
-Water
Complication -Carbohydrate
-Aspiration pnuemonia -Protein
-laryngospasm -Fats
-hypoxia and hypercapnia -Vitamins (organic compounds from plants and
-SOB animals) Ex. ABCD K
-Mechanical Injury -Mineral (inorganic from soil, water that is
being absorb by plants and animals)
Procedure
-semi fowlers Indications
-Abdominal surgery
Atrophate sulfate -Chemotherapy
-Intestinal Ischemia (presence of tumor- it -Promote enterocyte atropy leading to loss of
compresses stomach or intestine, it will kill the gut barrier function
muscle =less absorption)
-Small or large intestinal obstruction Complications
-Prolong ilues (no movement of gastric content) -Catheter related blood stream infection
-GI bleeding(NPO=gets nutrition in TPN) -Localized infection at entry site
-Radiation enteritis (gets from radiation -Air embolism
therapy=can destroy lining) -Hyperglycemia
-extremely premature birth -Refeeding syndrome (severely malnutrition,
-Necrotizing enterocolitis (severely premature prolonged NPO, when feeding pt PO/NGT may
infants= cause arrythmia and death=small meals)
-Prolonged diarrhia -Fluid excess
-Inflammatory bowel disease (Chrone's -Pulmonary edema (if central line puncture
disease=ulcerative colitis mouth to nose) plueral space)
-Short bowel syndrome
-Persistent chyle leak
-Graft-versus-host disease of the gut
(autoimmune dissease)
-Trauma
-Burns (PLRS)
-Sepsis NSG Intervetions
-Check dr orders properly
Contraindication
-Functional and accessible GI tract Catheter related blood stream infection
-Pt is taking oral diet -Adherence to aseptic technique
-Risk exceeds benefits -Avoid hyperglycemia
-Closely monitor VS
Advantages -Proper administration of IV antibiotic
-Ease to administration -Monitor WBC count
-easier correction of fluid and electrolyte -Replace IV tubing frequently as per agency
imbalances policy (replaced every 24 hrs)
-Nutrition in setting of mucositis
-Allows nutrition support when GI intolerance Localized Infection at entry site
prevent oral support -aseptic technic during insertion
-Assess for CVC site redness
Disadvantages
-High financial cost Pnuemothorax
-Catheter associated infections (phlebitis, -Aplly oxygen
dislodgement of IV cannula, blockage, swelling) -Notify pphysicaon
-Fluid over load -Require removal of central line and possiblr
-Hyperglycemia chest tube insertion
-Catheter associated thrombosis
Air Embolism -Infection near at th incision
-Make sure all connection are clamped and -Pain
closed -Stomach leackage around the tube
-Clamp catherter immediately
Contraindication
Hyperglycemia -Sepsis
-Monitor blood sugar -Hemodynamic instability
-Regulate TPN -Severe ascites
-Monitor pt for early signs of hyperglycemia -Peretonitis
(hunger, thirst -Abdominal wall infection at the site of insertion
-Interposed organs
Refeeding syndrome -Total gastrectomy
-Propper tagging -Lack of informed concent for the procedure
-Blood test may be done frequently (weekly) -Failure to apposition the anterior gastric wall
NSG responsibilities
Fluid excess or pulmonary edema pre
-Secure consent and check for its completeness
-Pt NPO 8 hrs before operation
-Hold anti-platelet and anti-coagulant
ENTERAL FEEDING medication (stopped 7 days before operation)
-Ensure the procedure is explained by the
Percutaneous Endoscopic Gastrostomy (PEG) doctor properly.
-Minimally invasive procedure to place a
feedingtube through the abdomen through the Post
stomach -Adequate pain control
-Orient pt and watcher on proper care of tube
Percutaneous endoscopic Jejunostomy (PEJ)
-Extended to the jejunom Stoma
-For faster absorption of nutrients Chrons Disease
-starts from rectum upward
Procedure -ileustomy/jejuneustomy
1. Sedation & Anesthesia (General -Proctocolectomy (all of colon)
Anesthesia=propofol)
2. Endoscope insertion Ulcerative Colitis
3. Stomach inflation -Regional inflammation
4. Guidance -colectomy
5. Tube placement
Colorectal cancer
Risk and complications -Abdomino-perineal
-Accidental tube dislodgement -rectal and sigmoid removed
-Aspiration
-Bleeding and perforation
Colon Cancer
-Hemicolectomy (partial parts)

Stoma Monitoring
-Reddish, edematous
-A few days=pinkish/pinkish red
-Blue= no circulation/wrong procedure
-1/2 to 1/3 inch, if more than it is prolapse

Irrigation
-enema (to promote peristaltic movement)
initial
-only done in colostomy
-No need for ileustomy

Ileustomy
-RLQ

Foods to avoid
-Stinky foods
-Cabbages
-Cauliflower
-Yogurt
-parsley

*Add charcoal to bag to lessen bad odor