Nutrition

• TPN

  NEVER flush TPN with antibiotics; ONLY use isotonic fluids
• NGT

  Insertion Postion: HIGH FOWLERS
• NGT

  When resistance is met, withdraw and insert it on the other nostril
• NGT

  When the patient coughs and has DOB, withdraw the tube completely and reinsert when the DOB subsided
• NGT

  Purpose of NGT in Increased ICP: Decompression
• Female daily caloric requirement: 2,200 kcal/day
• Male daily caloric requirement:  2,500 kcal/day
• Lactating while pregnant mother daily caloric requirement: still +500 kcal/day
• Pregnant mother daily caloric requirement: still +300 kcal/day
• All GI procedures e.g. NGT are clean technique
• NGT Functions:

  • Gavage
  • Lavage
  • Decompression
  • Medication
• The length of NGT for adults is measured from tip of the nose to earlobes to xiphoid process
• The length of NGT for pedia is measured from the earlobes to nose to xiphoid process
• NGT Insertion

  1. Position: High-fowler's or sitting
  2. Hyperextend upon insertion
  3. Flex neck upon resistance or nasopharynx
  4. Ask to swallow to close epiglottis
• Stay in Semi-fowler's position for at least 30 minutes after NGT feeding
• NGT Removal: Ask patient to hold breath
• Confirmatory for NGT placement: X-ray
• Best way to know NGT placement: Aspirate due to residual volume
• NGT

  Normal gastric pH: 0-4

  Intestine pH: 6-7

  Lung pH: >7
• To maintain NGT patency, flush 30-50 mL of distilled water
• Most common TPN site: subclavian vein
• Insertion and Removal Position for TPN: Trendelenburg to prevent pulmonary embolism
• TPN Feeding Position: Semi-fowler's
• TPN Complication Interventions

  Hyperglycemia (>130 mg/dl): Regular insulin IV
• TPN Complication Interventions

  Hypoglycemia (<70 mg/dl): Dextrose (D10)
• TPN

  Most common complication: Sepsis