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the introduction of nourishment into the stomach by means of a tube passed through the nose or mouth (naso or oro -gastric) or through a surgically created hole in the person's neck, chest, stomach, or intestines.

To provide nourishment with food and or medication if oral route is inaccessible. Gastrointestinal diseases and surgery Hypermetabolic states (burns,multiple trauma,sepsis,cancer) Certain neurologic disorders(stroke,coma) Following certain types of surgery (head and neck, esophagus)

Indications:
1. 2. 3. 4.

Contraindication: Absent bowel sounds

Nasogastric tube
1.

Tube is placed in either nostril, passed down the pharynx through the esophagus and into the stomach .

2.
3. 4.

(36 to 45 .)
used for those individuals who are unable to ingest nutrients by mouth (for short term feeding ) The Placement must be checked before each feeding. The tube goes directly in the stomach through the skin. It is surgically placed into the abdominal wall. Used for the delivery of long term Enteral nutrition.

Gastrostomy tube
1. 2.

Jejunostomy tube
1.

Is surgically implanted in the upper section of the small intestine called the jejunum which is just below the stomach.
Used to be fed directly into the intestinal tract. The patient must always be fed with an Enteral feeding pump.

2.

1.Bolus It is a normal meal feeding pattern. a syringe is attached to the feeding tube and formula is poured into the syringe, it is allowed to flow into the tube by gravity. 2. Continuous Feeding is administered continually for 24 hours through infusion pump. 3. Cyclical Feeding is administered in the day time or the night time for 8 hours to 16 hours. Feeding given through infusion pump. Feeding at night allows more freedom during the day.

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Change the feeding container and tubing every 24 hours. Do not hang more solutions that will require for 4 hour period to prevent bacterial growth. Check the expiration date on the formula before administering. Shake the formula well before giving. Always assess placement of the tube before feeding. Always assess bowel sounds, do not administer any feeding if bowel sound is absent. Administer feeding at prescribed rate or via gravity flow with 60 ml syringe without the plunger.

` Diarrhea ` Aspiration ` Clogged ` Vomiting ` Tube

tube

displacement ` Electrolyte imbalance

Documentation: 1. Describe and record procedure 2. Time of feeding 3. Type of Gavage feeding 4. Type and amount of fluid given 5. Amount retained or vomited 6. Patients reaction to the procedure

A procedure used to empty the stomach of its contents. Performed using a flexible rubber tube that is passed through the mouth and advanced to the stomach. This procedure includes the instillation of a balanced salt solution into the stomach (via the tube) followed by suctioning the fluid out of the stomach. An effective procedure in the treatment of toxic ingestions.

An alternative for gastric lavage is the oral administration of activated carbon, (50100g) as a single dose to reduce drug absorption , a form of carbon with a large surface area for binding poisons, preventing absorption by the gastrointestinal tract Drugs not adsorbed by activated charcoal (metals, alcohols, acids, alkalis)

1.

2. 3.

4. 5. 6.

Potentially life-threatening poisoning (or history is not available) and unconscious presentation Potentially life-threatening poisoning and presentation within 1 hour Potentially life threatening poisoning with drug with anti-cholinergic effects and presentation within 4 hours e.g. atropine Ingestions of sustained release preparation of significantly toxic drug Large salicylate poisonings presenting within 12 hours Iron or lithium poisoning

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Corrosive ingestions or oesophageal disease in patients at risk of gastrointestinal hemorrhage or for poisons that have an effective antidote.
Poison/Drug Antidote N-acetylcysteine

paracetamol (acetaminophen)

vitamin K anticoagulants, e.g. warfarin vitamin K opioids iron (and other heavy metals) benzodiazepines ethylene glycol methanol naloxone desferrioxamine, Deferasirox or Deferiprone flumazenil ethanol or fomepizole, and thiamine ethanol or fomepizole, and folinic acid

cyanide Organophosphates Magnesium Calcium Channel Blockers (Verapamil, Diltiazem) Beta-Blockers (Propranolol, Sotalol) Isoniazid Atropine Thallium

amyl nitrite, sodium nitrite and sodium thiosulfate Atropine and Pralidoxime Calcium Gluconate Calcium Gluconate Calcium Gluconate and/or Glucagon Pyridoxine Physostigmine Prussian blue

1.

2. 3. 4. 5. 6. 7.

Protect airway (endotracheal intubation) if patient is stuporous or comatose Lie patient on their left side Insert a large bore double lumen orogastric tube Aspirate stomach contents Use a small cycle lavage of 50-100 mL (and then aspirate) Lavage is rarely indicated beyond 5 minutes, unless tablets are still actively being returned It is no longer recommended to have a completely clear return before ceasing gastric lavage

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1. aspiration pneumonia 2. laryngospasm 3. hypoxia 4. bradycardia 5. epistaxis 6. hyponatremia 7. hypochloremia 8. water intoxication

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