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Enteral Feeding Tube Insertion, Postpyloric Introduction Nasal or oral insertion of an enteral feeding tube into the small bowel allows a patient to receive nourishment if the patient can't do so orally. A postpyloric feeding tube is most appropriate for a patient with gastric outlet obstruction, severe gastroparesis, or a known history of reflux and aspiration of stomach contents. An enteral feeding tube also allows a patient with high nutritional requirements, such as a patient with extensive burns, to receive supplemental feedings. The preferred enteral feeding tube insertion route is nasal, but the oral route may be used for a patient with a condition such as a head injury, a deviated nasal septum, or another nasal injury. An enteral feeding tube is intended for short-term use in a patient who's expected to require enteral nutrition for up to 6 weeks. Contraindications Contraindications to enteral feeding tube insertion include mechanical obstruction of the GI tract, uncorrectable coagulopathy, and bowel ischemia. Traumatic injuries to the head, neck, and face and recent transsphenoidal pituitary surgery may prevent nasal insertion. Relative contraindications include recent GI bleeding, hemodynamic instability, ascites, respiratory compromise, and certain anatomic anomalies. Equipment Disinfectant pad Enteral feeding tube (with or without guidewire) Enteral syringes Fluid-impermeable pad or towel Gloves Indelible marker Securement device, tape, or semipermeable transparent dressing Skin cleaning wipe Stethoscope Water-soluble lubricant or water for lubrication Optional: alcohol pad, capnography equipment, cup of water, enteral feeding pump, measuring tape, other personal protective equipment, penlight, pH testing equipment, prokinetic agent, protective padding, skin preparation product, straw, water for flushing the tube Preparation of Equipment Inspect all equipment and supplies. If a product is expired, is defective, or has compromised integrity, remove it from patient use, label it as expired or defective, and report the expiration or defect as directed by your facility. The practitioner typically orders an enteral feeding tube with the smallest bore that will allow free passage of the liquid enteral formula. Read the instructions on the tubing package carefully because tube characteristics vary according to the manufacturer. Examine the enteral feeding tube to make sure that it's free from defects, such as cracks and rough or sharp edges. Run water through the enteral feeding tube if indicated by the manufacturer's instructions to check for patency, activate the coating, and facilitate guidewire removal. Implementation Verify the practitioner's order. Review the patient's medical record for contraindications. Confirm informed consent if required by your facility. Gather and prepare the necessary equipment and supplies. Perform hand hygiene. Confirm the patient's identity using at least two patient identifiers. Provide privacy. Explain the procedure to the patient and family (if appropriate). Assess the patient's GI status for baseline comparison and risk of aspiration. Position the patient with the head of the bed elevated at least 30 degrees. Administer a prokinetic agent if prescribed. Put on gloves and other personal protective equipment as needed. Assess the patient's nares (if applicable) to determine the best naris for insertion. Determine the proper insertion length of the enteral feeding tube. Lubricate the curved distal tip of the enteral feeding tube and the tube guidewire (if present). Insert the tube nasally or orally, guiding it toward the esophagus. Continue advancing the enteral feeding tube until you reach the predetermined insertion length. Use at least two bedside methods to verify enteral feeding tube location. Confirm placement by X-ray before initial use. Secure the enteral feeding tube using a securement device, tape, or semipermeable transparent dressing. Document the procedure. Special Considerations Consider using a nasal bridle to reduce displacement for tubes at risk for dislodgement. Monitor the external length of the enteral feeding tube before use and at least every 4 hours. Follow The Joint Commission's sentinel event alert guidelines to prevent tubing misconnections. Complications Complications may include aspiration, coiling of the tube in the esophagus or posterior pharynx, misplacement, pneumothorax, coughing and dyspnea, and tearing of the esophagus. . #nasogastric #medical #video #videos #learning #learn #learning #educationalvideo #education #educational #educationalvideos #students #study #student #studywithme #study #studymusic #studymotivation