A Nurse Is Inserting A Small Bore Feeding Tube

A Nurse Inserting a Small-Bore Feeding Tube: A Comprehensive Guide

Inserting a small-bore feeding tube (SBFT) is a common procedure performed by nurses to deliver nutrition and hydration to patients who are unable to ingest food orally. This comprehensive guide delves into the intricacies of this procedure, covering various aspects from pre-procedure preparations to post-procedure care. We'll explore the different types of SBFTs, the insertion process step-by-step, potential complications, and crucial nursing considerations to ensure patient safety and optimal outcomes.

Understanding Small-Bore Feeding Tubes

Small-bore feeding tubes are thin, flexible tubes designed for nasogastric (NG), nasoduodenal (ND), or nasojejunal (NJ) placement. Their small diameter minimizes discomfort and the risk of nasal trauma compared to larger bore tubes. These tubes are typically used for short-term nutritional support, ranging from a few days to several weeks.

Types of SBFTs

Several types of SBFTs exist, each with its own characteristics and applications:

• Nasogastric (NG) Tubes: These tubes are inserted through the nose and into the stomach. They are the most commonly used type of SBFT and are suitable for patients requiring short-term nutritional support.

• Nasoduodenal (ND) Tubes: These tubes are passed through the nose and into the duodenum, the first part of the small intestine. ND tubes are preferred for patients at risk of aspiration, as they bypass the stomach.

• Nasojejunal (NJ) Tubes: These tubes pass through the nose and into the jejunum, the middle part of the small intestine. NJ tubes are indicated for patients with impaired gastric emptying or a high risk of aspiration. They offer the safest route for nutrition delivery in these situations.

Choosing the appropriate type of SBFT is crucial and depends on the patient's specific clinical condition and needs. A physician's order is always required before inserting any type of feeding tube.

Pre-Procedure Preparations: Ensuring Patient Safety

Thorough preparation is paramount to ensure a safe and successful SBFT insertion. This involves several key steps:

1. Obtaining Informed Consent: The cornerstone of ethical practice.

Before initiating the procedure, the nurse must obtain informed consent from the patient or their legal guardian. This involves explaining the procedure, its benefits, risks, and potential complications in a language they understand. The patient’s questions should be answered thoroughly, ensuring they fully comprehend the process before agreeing to it.

2. Verifying Physician’s Orders: A mandatory step.

The nurse must carefully verify the physician's orders, including the type of feeding tube, the formula to be administered, and the feeding schedule. Any discrepancies must be clarified before proceeding. This prevents errors and ensures the right procedure is performed.

3. Assessing the Patient: Identifying potential risks.

A comprehensive assessment of the patient’s condition is crucial. This includes evaluating their respiratory status, level of consciousness, ability to cooperate, and any existing nasal or esophageal pathologies. Patients with severe nasal injuries or bleeding disorders may not be suitable candidates for SBFT insertion.

4. Gathering Necessary Supplies: Meticulous preparation is key.

The nurse should gather all the necessary supplies beforehand, including the selected SBFT, measuring tape, lubricant, pH testing strips (to confirm placement), syringe, gloves, antiseptic solution, and appropriate personal protective equipment (PPE). Having everything readily available streamlines the process and minimizes delays.

The SBFT Insertion Procedure: A Step-by-Step Guide

The insertion process requires precision and careful attention to detail. The following steps outline the typical procedure:

1. Positioning the Patient: Comfort and accessibility.

The patient should be positioned comfortably in a high-Fowler's position, allowing for optimal visualization and access to the nasal passages. This positioning helps to facilitate the smooth passage of the tube.

2. Measuring and Preparing the Tube: Accuracy is crucial.

The length of the tube needed is measured from the tip of the nose to the earlobe, and then to the xiphoid process. This measurement helps to ensure proper placement of the tube in the stomach or intestine. The tube is then lubricated to ease insertion.

3. Inserting the Tube: Gentle and controlled insertion.

The lubricated tube is gently inserted through the nostril, advancing it along the posterior nasal passage. The patient may experience some discomfort, and the nurse should provide reassurance and support throughout the process. Advancement should be slow and steady, pausing if the patient experiences significant discomfort or resistance.

4. Verifying Tube Placement: Essential to prevent complications.

Once the tube is inserted to the measured length, its placement must be verified. This typically involves aspirating gastric contents and checking the pH of the aspirate. A pH below 5.5 usually indicates gastric placement. X-ray confirmation is considered the gold standard for verifying tube placement, especially for ND and NJ tubes.

5. Securing the Tube: Maintaining proper placement.

After verifying the placement, the tube is secured to the patient's nose or cheek with tape to prevent accidental dislodgement. The tape should not be too tight to avoid causing skin irritation.

Post-Procedure Care: Maintaining Patient Well-being

Post-procedure care is vital to ensure patient comfort, prevent complications, and maintain the integrity of the feeding tube. This includes:

1. Monitoring for Complications: Vigilance is crucial.

The nurse must closely monitor the patient for potential complications, such as aspiration, dislodgement, tube blockage, infection, and diarrhea. Regular assessment of respiratory status, bowel sounds, and the feeding tube itself is essential.

2. Administering Feedings: Following physician's orders.

Feedings are initiated according to the physician's orders. The feeding formula should be gradually introduced to allow the patient’s gut to adapt. The nurse should carefully monitor for tolerance, paying attention to any signs of nausea, vomiting, or abdominal distention.

3. Maintaining Tube Patency: Preventing blockages.

Regular flushing of the tube with water helps to prevent blockages. The nurse should follow the prescribed protocol for flushing the tube to maintain its patency.

4. Providing Oral Hygiene: Maintaining patient comfort.

Maintaining good oral hygiene is important to prevent oral infections and discomfort. Regular mouth care should be provided to keep the patient’s mouth clean and moist.

5. Patient Education: Empowering the patient.

The patient or their caregiver should be educated on the purpose of the feeding tube, the care requirements, potential complications, and when to seek medical attention. Clear and concise instruction empowers them to actively participate in their care.

Potential Complications and Nursing Interventions

While SBFT insertion is generally a safe procedure, several potential complications can arise:

• Aspiration: This occurs when the feeding enters the lungs, leading to pneumonia or respiratory distress. Careful tube placement verification and monitoring are crucial to prevent this complication.

• Dislodgement: Accidental removal of the tube can interrupt nutrition delivery and may necessitate reinsertion. Securing the tube properly and monitoring for dislodgement signs are necessary.

• Tube Blockage: The tube can become blocked by thickened feeding formula or medication residues. Regular flushing is essential to prevent blockages.

• Infection: Infection can occur at the insertion site or along the length of the tube. Meticulous aseptic technique during insertion and ongoing monitoring for signs of infection are important.

• Nasal Irritation and Trauma: Prolonged tube placement can irritate the nasal mucosa. Lubrication, proper tube placement and regular assessment can minimize the risk.

• Diarrhea or Constipation: Changes in bowel habits may occur as a result of changes in the diet. Careful monitoring of bowel movements and adjusting the feeding regimen can address this.

Nursing interventions for these complications include:

• Immediate removal of the feeding tube if aspiration is suspected.
• Reinsertion of the tube if dislodged.
• Flushing the tube with warm water to clear blockages.
• Administering antibiotics if infection is diagnosed.
• Applying appropriate treatment for nasal irritation or trauma.
• Adjusting the feeding regimen to manage diarrhea or constipation.

Conclusion: A Collaborative Approach to Patient Care

Inserting a small-bore feeding tube is a crucial nursing skill that requires proficiency, precision, and a strong understanding of patient-centered care. The procedure necessitates meticulous preparation, careful execution, and vigilant post-procedure monitoring. By adhering to standardized protocols and remaining acutely aware of potential complications, nurses can ensure the safe and effective delivery of nutrition and hydration to patients who require it. Remember, a collaborative approach, involving physicians, dieticians, and other healthcare professionals, is crucial for optimal patient outcomes. This comprehensive understanding equips nurses to provide high-quality care and contribute to improved patient well-being.