small bore feeding tubes

[Spider Cat]

Can someone give a quick and easy explanation on small bore feeding tubes? Should placement be checked by instilling air, should residual be checked by drawing back (I guess in the same manner as a peg tube would be), and how often should you do this with both a continuous or intermittent feeding administration. I have been told to very carefully instill air to check for placement and don't draw back to check for residual because the tube is so small it could easily be drawn out of place. I guess some are checking for residual though because an amount is documented. But I think I have read you should do both. Hoolahan had a very good reply somewhere here about feeding tubes but it was a very long and kind of complicated reading for someone new and confused like myself !!

[CoffeeRTC, BSN, RN]

Ng tubes...verify placement first with Xray. Always check placement before giving meds, food, flushes first. Air auscultation is what we use. Do they still do the litmus things in acute? Most have orders for checking for residuals q 4 hrs, so really you are checking placement q 4 hrs. Keep a close eye on position of tube and the taping. We rarely see ng tubes in LTC any more. Most come with a gtube already. They are not fun to place in anyone let alone confused elderly.

Ohh...when they are not inplace make sure you are still flushing them...They will clog as quickly and you can blink!

[pricklypear]

A small bore tube would be a Dobhoff, different than an NG tube. The Dobhoff is intended to float to the duodenum, an NG is placed in the stomach. Residual can be checked through a Dobhoff, but can be difficult because of the small bore and soft tubing (it tends to collapse). Some people check for placement with an air bolus, but it really is not necessary, or recommended. Once placement has been confirmed as being in the duodonem, it should stay there unless pulled out. If in doubt, a CXR will reveal placement. The tube has a weighted end, which can come off with a forceful air bolus. I usually mark mine at the nare to keep track of it. If, for some reason it does get pulled out some, a new one usually should be placed with a stylet since the tube is so flexible it shouldn't be advanced without a stylet. I have been taught to never place a stylet back into an existing Dobhoff to readvance.

[Spider Cat]

Sorry this is a late reply - but how about checking for residual on these??

[suzanne4, RN]

It is very hard to get a residual on these, especially if there placement is already in the small intestine, where you actually prefer it. As stated above, confirmation by x-ray to check placement, small mark made with tape as to where the insertion point is, and then leave it alone.

The only time that it is fairly easy to get a residual is with an infant, because of the length of the tube.

The reason for placement in the small intestine is to help prevent aspiration as the feeds are already going in below a valve, and many times they can be better tolerated when they are already past the stomach. The stomach acids are not needed because you are using a formula that is easily broken down. If you are worried about residual, then you would need something that would be checking the stomach and for that you can always put in something like a small bore Salem sump. In PICU we use both at the same time because they are used for two different things.

[bobnurse]

Any tube, whether its a dubhoff or salem slump, if its used for feeding, should be verified with a CXR prior to its use........This is the standard.

[Tweety, BSN, RN]

Any tube, whether its a dubhoff or salem slump, if its used for feeding, should be verified with a CXR prior to its use........This is the standard.

Oddly enough, not here. We check salem sump's (is it slump or sump?) by instilling air and listening, and aspirating gastric contents.

However, for some odd reason we check dubhoff's with a CXR. Many years ago I was told that dht's go into the duodenum and are so small you can't hear or aspirate with certainty.

I understand that more facilities check salem's with CXR's than not. Maybe I should read the literature and make a recommendation to my employer.

[pricklypear]

We don't check NGs (salem-sumps) with CXR unless we don't get gastric contents when first inserted (this is our policy).

[bobnurse]

We don't check NGs (salem-sumps) with CXR unless we don't get gastric contents when first inserted (this is our policy).

Even if your using it for feeding?

[pricklypear]

Even if your using it for feeding?

We almost never (I can think of once or twice) use them for feeding, but no, not if gastric contents can be aspirated when inserted.

[bobnurse]

We almost never (I can think of once or twice) use them for feeding, but no, not if gastric contents can be aspirated when inserted.

we never insert them just for feeding, but usually, when say a patient has an ileus, and you have them to suction.....you'll try them back on feeding at some point, instead of pulling that one, we use it for feeding.......So if they dont tolerate it, we can put them right back to suction.

[zacarias, ASN, RN]

I did a research paper in nursing school on NG/feeding tubes and it was quite enlightening. The research states that the auscultatory method (with air) is not really useful for checking placement. However, most nurses do it this way.

The research I did was a couple years ago but they talked about 'bilirubin' strips that would be useful for making sure it's not in the lungs because current methods outside of X-ray are not 100%.

Of course an initial X-ray after insertion is always indicated.