Review of the Use of Common Tubes

Tube or Apparatus Purpose Examples of Use Key Points

Nasogastric (NG) tubes


Levin tube and small-bore feeding tubes
  1. Inserted into stomach to decompress by removing gastric contents and air-prevents any buildup of gastric secretions, which are
  2. Used when stomach must be washed out
  3. Used for feedings when patient is unable to swallow (gavage)

  1. Any abdominal or other surgery after which peristalis is absent for a few days
  2. Overdoses
  3. Gastrointestinal hemorrage
  4. Cancer of the esophagus
  5. Early postoperative care for patient who had a laryngectomy or radial neck dissection

  1. Connect to low intermittent suction
  2. Irrigate prn with normal saline or puffs of air
  3. Clean, but not sterile, procedure
  4. Mouth care needed
  5. Report "coffee ground" material (digested blood)
  6. For overdose, stomach is pumped out as rapidly as possible
  7. For hemorrhage, tepid normal saline may be used to lavage
  8. Critical to make sure tube still in stomach before beginning feeding; listen for air passing into stomach, and if possible aspirate gastric contents; small-bore tubes require placement check x-ray
  9. Follow feeding with some water to rinse out the tube
  10. Clamp tube when ambulating
  11. With larger-bore tubes, determine residuals and withhold feeding if large residuals obtained


Gastronomy tube
  1. Inserted into stomach via abdominal wall
  2. May be used for decompression
  3. Used long term for feedings


Conditions affecting esophagus in which it is impossible to insert a nasogastric tube
  1. Principles of tube feeings same as with Levin nasogastric tube, except no danger that tube is in trachea
  2. If permanent, tube may be replaceable


Miller-Abbott tube Cantor tube

Longer than Levin tube - has mercury or air in bags so tube can be used to decompress the lower intestinal tract
  1. Small-bowel obstrue-
  2. Intussusception
  3. Volvulus

  1. Care similar to that for Levin NG tube - irrigated
  2. Connected to suction, not sterile technique
  3. Orders will be written on how to advance the tube, gently pushing tube a few inches each hour; patient position may affect advancement of tube
  4. X-rays determine the desired location of tube


T-tube

To drain bile from the common bile duct until edema has subsided

Cholecystectomy when a common duct exploration (CDE) or choledochostomy was also done
  1. Bile drainage is influenced by position of the drainage bag
  2. Clamp tube as ordered to see if bile will flow into duodenum normally