GI/GU: Other ways of providing fluids and nutrition
Content Reviewers:Lisa Miklush, PhD, RNC, CNS, Gabrielle Proper, RN, BScN, MN
Contributors:Talia Ingram, MSMI, CMI, Alaina Mueller, Sam Gillespie, BSc, Antonia Syrnioti, MD
There are many reasons why a client might encounter problems with eating or drinking. It could be due to difficulties with chewing, swallowing, or digestion as a result of trauma, surgery, or various medical conditions.
Several alternative methods of providing them the nutrients and fluids they need are available, and a nursing assistant should be familiar with them.
Okay, let’s start with intravenous, or IV, therapy. This consists of a pre-filled IV bag that delivers fluids, one drop at a time, through a drip chamber and a tube into a catheter that goes directly into a vein, most commonly on the back of the hand or the arm.
The tube also possesses a clamp that can adjust or pause the flow. Some IV sets are also connected to an electronic pump that regulates the flow rate.
Now, IV therapy cannot replace normal nutrition, but it’s typically used to provide water as well as glucose, vitamins, and minerals. It’s also a good way to administer IV medications, like antibiotics or pain relievers or even blood!
What’s most important for you to remember about clients on IVs is to notify the nurse immediately if the catheter is out of place. In this case, the fluid may leak into the surrounding tissue, which is known as infiltration.
The client will likely report a burning or tight sensation around the IV catheter insertion site, and there’ll be swelling, blanching, and cooling of the skin in the area.
Also, make sure to let the nurse know if the dressing over the IV site is loose or soiled, the IV bag is empty, the fluid is not flowing into the drip chamber, or blood has flowed back into the IV catheter.
Some IV pumps may also make an alarm sound if there’s something wrong, like air in the catheter, low battery in the pump, blocked flow due to kinks in the tubing, or the client laying on top of or pulling on the IV line.
Next, some clients might receive enteral nutrition, otherwise known as “tube feeding.” This means nutrition is delivered through a tube directly into the gastrointestinal, or GI, tract.
And this might be especially helpful for those who can’t properly chew or swallow as a result of head or neck trauma; surgery; coma; dementia; nervous system disorders; or tumors of the head, neck, or esophagus that block the passage of food.
Now, there are various ways the feeding tube can go into the GI tract. The most common one is a nasogastric tube connected to a feeding bag or delivered through a pump; it goes through the nose and down into the stomach.
A nasointestinal tube also goes through the nose but ends in the small intestines. These tubes can irritate the client’s throat and nose, and the clients will often dislodge the tubes.
Next, tubes can be inserted through a surgical opening, or stoma, in the abdominal wall and into the stomach, known as a gastrostomy tube.
Tubes can also be inserted into a part of the small intestine called the jejunum, which is known as a jejunostomy tube.
A common type of gastrostomy tube is the percutaneous endoscopic gastrostomy tube, or PEG tube for short.
Here, an endoscope, or a tube with a light, camera, and guidewire, is inserted through the mouth and into the stomach. The endoscope lets the doctor see where the surgical incision should be made.
Next, a guidewire is inserted through the incision and pulled up and out through the mouth along with the endoscope.