Nasoenteric-Decompression Tube Care

  • Is inserted by a physician or nurse practitioner nasally and advanced beyond the stomach into the intestinal tract.
  • The patient requires encouragement and support while the tube is in place.
  • Care involves continuous monitoring to ensure tube patency, proper suction, and bowel decompression and to detect complications, such as skin breakdown and fluid electrolyte imbalances.

Contraindications

  • Nasal polyps
  • Deviated sputum
  • Other obstruction that prevents insertions

Equipment

  • Suction apparatus
  • Container of water
  • Intake and output record sheet
  • Mouthwash and water mixture
  • Sponge tipped swabs
  • Water soluble lubricants
  • Cotton-tipped applicators
  • Safety pin
  • Tape or rubber band
  • Disposable irrigation set
  • Irrigant
  • Labels for tube lumens
  • Throat comfort measures

Preparation of equipment

  • Assemble the suction apparatus and set up the suction unit
  • Test the unit to make sure that the suction works

Procedure

  1. Verify the patient’s identity using two patient identifiers, such as the patient’s name and identification number.
  2. Reinforce the explanation of the procedure to the patient and family and answer questions.
  3. After tube insertion, have the patient lie on his right side for about 2 hours to promote the tube’s passage.
  4. After the tube advances past the pylorus, the physician or nurse practitioner can advance it 2” per hour.
  5. After it advances to the desired position, coil excess external tubing and secure it to the patient’s gown or bed linens; secure the tubes position by taping it to the patient’s face.
  6. Maintain slack in the tubing so the patient can move safely in bed.
  7. Remind the patient to call for assistance when getting out of bed.
  8. After securing to the tube, connect it to the tubing on the suction machine to begin decompression.
  9. Check the suction machine every 2 hours to confirm proper function.
  10. Empty the drainage container or mark the drainage level with the time and date every 8 hours. Record output.
  11. After decompression and before extubation, provide a clear-to-full liquid diet and monitor bowel function.
  12. Record intake and output to monitor fluid balance.
  13. Normal saline solution is preferred over water as an irrigant.
  14. Monitor the patient for signs and symptoms of pneumonia since he may be unable to clear his pharynx.
  15. Be alert for fever, chest pain, tachypnea, or labored breathing, and diminished breath sounds over the affected area.
  16. Observe the characteristics of the drainage.
  17. Provide mouth care frequently and encourage the patient to brush his teeth.
  18. Lubricate the patient’s lip with petroleum jelly.
  19. Monitor patient for peristalsis.

Nursing Interventions

  1. For Miller-Abbot tube, clamp the lumen leading to the mercury balloon and label it “Do not touch”.
  2. Label the other lumen “suction.” Marking the tube may help prevent the accidental instillation of irrigant into the wrong lumen.
  3. Irrigate the tube with the irrigation set to clear the obstruction.
  4. If the tube connects to a portable suction unit, the patient may move short distances while the patient moves about.
  5. For throat irrigation, offer mouth wash, gargles or lozenges.
  6. Reinforce the explanation of the purpose of the procedure and advise the patient about what to expect during and after insertion
  7. Remind the patient of the signs and symptoms to report.

Complications

  • Fluid and electrolyte imbalance, pneumonia, mercury poisoning, and intussusception of the bowel.

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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