PROCEDURE 134 • Knowledge of the anatomy and physiology of the upper and lower gastrointestinal (GI) tract is needed. • The GI tract should be functioning for gastric feedings to be digested and absorbed. Bowel sounds may not be audible, yet the GI tract is functional and enteral nutrition can be instituted safely and effectively and be well tolerated. Gastrointestinal findings that may affect the normal functioning of the tract and preclude gastric feeding are bowel obstruction, paralytic ileus, and some fistulas. • Small-bore feeding tubes are preferable over larger-bore nasogastric tubes during the course of critical illness because the risk for tissue necrosis at the nares and sinusitis is lower. When small-bore feeding tubes are placed postpylorically, there is a reduced risk of aspiration. • The small diameter of the tube allows simultaneous oral intake if the patient is able to consume orally without aspiration. • Both weighted (tubes with an enlarged tip, filled with tungsten) and unweighted (bolus tip) small-bore nasogastric tubes are available. They typically are packaged with guidewires already in the lumen to assist passage of the tube. After successful placement, the guidewire is removed and discarded. The size of tubes range from 7 to 12 Fr. • Unweighted-tip tubes migrate postpylorically into the duodenum more often than tubes with weighted tips. Weighted-tip tubes are harder for the patient with a compromised condition to swallow; ultimately, the unweighted tube may be a more comfortable choice for the patient. • Absolute contraindications for insertion of a nasogastric feeding tube are basilar skull fracture, transsphenoidal surgical approaches, and esophageal varices. Oral insertions are usually appropriate in these situations. Esophageal varices are a contraindication for any tube that transgresses the esophagus. • Small-bore feeding tubes are not designed for drainage of gastric contents. If gastric decompression is desired, the small-bore nasogastric feeding tube should be replaced with a larger-bore nasogastric sump tube. • It is important to review institutional standards regarding insertion of small-bore feeding tubes and complete competency for tube insertion. • Some institutions restrict insertion to physicians and advanced practice nurses. • Small glass of water (bottle or tap, depending on institutional practice)
Small-Bore Feeding Tube Insertion and Care
PREREQUISITE NURSING KNOWLEDGE
EQUIPMENT
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134: Small-Bore Feeding Tube Insertion and Care
