A patient with acute pancreatitis has NG tube for low intermittent suction to prevent
ANT Feb 2016 CE.pdf Show
Feeding tubes are used for various indications in patients with either acute or long-term needs. Critical care, acute care, long-term, and home care nurses provide nutrition and hydration via feeding tubes to patients with inadequate oral intake. Enteral nutrition, which delivers nutrients directly to the GI
tract, is linked to fewer complications than I.V. parenteral nutrition and is preferred in patients with functioning GI tracts. However, tube feedings can lead to mechanical, infectious, and metabolic complications. The most common mechanical complications—those affecting nutrient delivery to patients—are tube dislodgment with complete tube loss, tube displacement, and clogging. Less common mechanical complications include knotting and breakage of the enteral tube and buried bumper syndrome
(BBS), associated with percutaneous endoscopic gastrostomy (PEG) tubes. Tube dislodgmentAny feeding tube can become dislodged. Patient factors linked to dislodgment include confusion or delirium, which can lead the patient to dislodge or remove the tube manually. Nasal or orally placed tubes are especially prone to patient removal because they may cause nares discomfort and a tube sensation in the pharynx. Tube displacement or migrationPatients may accidently pull at an NG or nasointestinal tube, causing displacement rather than complete tube removal. As with dislodgment, patient
activity and transport can cause tube displacement. So can coughing and gagging. Tube cloggingClogging (occlusion) of a feeding tube interrupts nutrient and medication administration. Clogging incidence ranges from 10% to 35%. The most common cause is medication delivery. PreventionPreventing clogs caused by medications necessitates multiple interventions. If the patient can swallow medications and has a working GI tract, the oral feeding route is preferred. Some patients with enteral feeding tubes can swallow medications in liquid form; others can swallow medications with
something other than water, such as thickened liquids. If you’re unsure of your patient’s aspiration risk, consult a speech therapist to determine the safest method of oral medication administration. Drugs that shouldn’t be crushedCrushing
certain medications for feeding-tube administration isn’t recommended. Some medications are potentially carcinogenic, teratogenic, or cytotoxic. Crushing them could expose you to adverse health risks if the powder becomes aerosolized or contacts your skin. InterventionsWhen a feeding tube becomes clogged, first withdraw any formula remaining in the tube. Then try to flush it with warm water and clamp for 5 minutes. Use a back-and-forth motion with the plunger of a 30- to 60-mL syringe as you instill water and try to aspirate. Repeat this several times. Tube knotting and breakageFeeding-tube
knotting and breakage most often occur with small-bore, nasally placed tubes. A small-bore tube may become knotted when repositioned or removed; knotting prevents administration of feeding formula with a syringe. If the patient has a feeding pump, expect to detect high pressure or occlusion. Buried bumper syndromeBuried bumper syndrome (BBS) occurs when the internal bumper (bolster) of a PEG tube migrates from the gastric lumen and lodges in the gastric mucosa or abdominal wall. Excessive traction on the internal
bumper slowly pulls the bumper into the gastric wall, with eventual mucosal overgrowth. BBS occurs in approximately 1% to 8% of patients with PEG tubes; it’s rare with balloon-type gastrostomy tubes. New enteral connectorsNew regulations to prevent accidental infusion of enteral nutrition into an I.V. line have led to development of new enteral connectors. Enteral nutrition administration sets, syringes, and feeding tubes are being updated with a unique patient access connector. If the end of a patient’s feeding tube has the new connector, a new compatible delivery system is needed. Prevention is keyPreventing mechanical complications of feeding tubes helps ensure your patient receives proper nutrition and hydration intake. Important interventions include monitoring tube location frequently, securing the tube, flushing the tube regularly, and using proper medication administration technique. Marilyn Schallom is a research scientist and critical care clinical nurse specialist at Barnes-Jewish Hospital in St. Louis, Missouri. Selected
references Why is an NG tube used for pancreatitis?NG tube (nasogastric tube).
It can be used to remove fluid and air and give your pancreas more time to heal. It can also be used to put liquid food into your stomach as you heal.
What should NG tube suction be at?Starting between 40-60 mmHg is recommended. The suction level should not exceed 80 mmHg. Observe for the gastric content to flow into the tubing and then the canister.
Can tube feeding cause pancreatitis?Abstract. Context Percutaneous endoscopic gastrostomy (PEG) feedings are generally considered safe with few serious complications. Acute pancreatitis is a rare complication associated with replacement percutaneous endoscopic gastrostomy tubes.
What are the potential complications of acute pancreatitis?Complications. Kidney failure. Acute pancreatitis may cause kidney failure, which can be treated with dialysis if the kidney failure is severe and persistent.. Breathing problems. ... . Infection. ... . Pseudocyst. ... . Malnutrition. ... . Diabetes. ... . Pancreatic cancer.. |