G-tube question.

Thunderwolf, MSN, RN · Jan 18, 2006

Moved thread to General Nursing Discussion forum.

bjs54321 · Jan 18, 2006

g-tube/peg=a tube in the stomach that allows enteral nutrition to be administered into the stomach. Confirm placement through aspiration and auscultation of an air bolus.

jtube=the enteral nutrition is administered into the jejunum of the intestine vs the stomach. You can't confirm placement through aspiration with this tube.

ng=nastrogastric tube. Inserted by a nurse through a nostril and into the stomach. Usually confirmed placement with x-ray after initial placement. Confirm placement through auscultation of an air bolus and through aspiration of stomach contents.

Ok what have I missed? that's enteral....what about parenteral nutrition?

IV, PVN,TPN?

jimthorp · Jan 18, 2006

How about an OG tube. A tube similar to the NG tube but inserted through the oral route and into the stomach.

TexasPediRN · Jan 18, 2006

Just to add another type of feeding 'tube':

(I dont know if this would be considered along the lines of a g-tube or not..)

There are G-buttons- mostly which I have seen with pediatric patients. There are surgicially inserted into the stomach, and stick out about 1/2 inch or so. you hook up the feeding tube directly to them and feed that way.

There are for patients who have problems eating, and so they dont have to have an NG or OG(oral-gastic tube, through the mouth to the stomach instead of the nose) for a long period of time.

There are also G-bards- a different type of button but performs the same functions as above.

Just a different way to feed then the previous poster mentioned :)

suzanne4, RN · Jan 18, 2006

A G-tube is placed by a surgical procedure in the OR with an open incision, same as for a J-tube. The G-tube can be replaced at the bedside if it comes out. The J-tube requires that the patient go back to the OR to have it replaced, that is why they are usually sutured in place.

A PEG tube is placed percutaneously in a GI Lab or radiology by a GI Dr, or surgeon. And EGD is done first, and then this procedure follows. Saves the patient from an actual surgical procedure, other than a stab wound where the PEG actually comes out of the stomach.

***** If a PEG or G-tube ever come out on a patient, please do not wait until the next morning to report it, something needs to be placed in that opening as soon as possible to prevent the hole from closing, and if it is a fairly new insertion, it can and will get smaller overnight. And the patient will need another procedure done to replace it. A Red Robinson catheter can easily be inserted until you can get the proper G-tube replaced.

The children have Gastrostomy tubes placed in the OR. "Mickey" is one of the names that you will see. It has a button closure that can be used when the child is not getting meds or eating, so it also makes it harder for them to grab something and pull it out. They are still G-tubes.

Trick for declogging a J-tube? Coca-cola inserted into the tube and allowed to just sit, it will usually breakdown the blockage. It needs to be actual Coke, Pepsi will not work due to the changes in the acidity between the two. G-tube can also be cleared this way, or just changed out.

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Peripheral IV solutions must contain 10% or less of Dextrose, anything higher requires a central line. TPN usually has 12.5% or higher of glucose as a final concentration.

Remember that you calories are coming from the glucose, as well as proteins that are added, if it is TPN or a peripheral version.

A 5% Dextrose solution in a 1000 ml bag is only going to give 200 calories per bag, so if your patient is just receiving D5/0.45% NS at 125 ml/hour, they are only receiving 600 calories per day. Not enough nutrition if more than a couple of days.

Best type of nutrition? When the patient can actually eat their own food.

Next is a tube feeding, as it is going thru the gut, but is broken down so that it can be digested easier.

TPN is actually the lowest level, and should only be used when the gut cannot be used. It is also very hard on the liver in long term use.

Hope that his helps clarify a few things.

ER Night Owl · Jan 18, 2006

totally tubular.... there are also small bowel feeding tubes - inserted via a nare and passed beyond the stomach into the duodenum or beyond depending on how compromised the enteric pathway is also go by different names Dobbhoff, Miller Fredrick, SBFT (small bowel/small bore feeding tube) these tubes should be sutured in place (to the lip). These are weighted on the end and depending on placement (if the tube is in the distal illeum) maybe "clipped" and allowed to pass 'naturally', never yank it out of the rectum like your patient's a lawnmower there are quite a few nooks and crannies to manuver. Different formulas should be used depending on which part of the bowel you're feeding and same consideration given when administering medications. Some tubes are bi- trifricated to allow gastric (stomach) suctioning and feeding of the small bowel.

And I'm sure the list goes on.

suzanne4, RN · Jan 18, 2006

Dobhoffs, etc., can also be routinely passed just into the stomach and used as a regular feeding tube. It is still an NG tube form. Some facilities only permit a physician to pass them. I have never seen one intentionally cut to allow it to pass. They normally can be pulled out quite easily via the nares, they aren't that long.

Cantor tubes have a weight on the end, are used when medically indicated to try to open up a small bowel obstruction, but they are never permitted to pass thru the intestine. The outer end is secured to the forehead and the tube is allowed ot pass down lower by way of peristalsis to try to open the obstruction.

tinyrita · Jan 18, 2006

Thanks gentlemen for your help most enlightening.