GI procedures:
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Endoscopy
Endoscopic retrograde cholangiopancreatography (ERCP)
Colonoscopy & sigmoidoscopy
Endoscopy
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Evaluate upper GI concerns (ulcers, stomach pain, obstruction)
Flexible tube w/light and camera passed thru digestive tract to visualize esophagus, stomach,
upper small intestine
Endoscopic retrograde cholangiopancreatography
o View pancreas and gallbladder
o Evaluate jaundice, pancreatic ducts, bile ducts, pancreatitis, pancreatic tumors, bile duct
stones
o Can be used for treatment (place stent for obstruction, remove stones)
o Complications: pancreatitis
NPO for 8 hrs, local anesthetic to numb throat/pharynx, IV sedative
Complications: perforation, sedation rxn (need to monitor VS), infection, bleeding
Colonoscopy & sigmoidoscopy
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Evaluate lower GI concerns
Flexible fiberoptic scope used to visualize the entire colon and rectum (sigmoidoscopy is just of
sigmoid colon)
May detect polyps, ulcers, inflammation, tumors/cancer
Definitive diagnosis of colon cancer, Crohn’s disease, ulcerative colitis using biopsy
Preparation:
o Colon cleansing required
o Clear liquid diet for 1-3 days before procedure
o Avoid red/purple colored drinks or gelatin
o Bowel prep w/ combination of laxatives
o Bowel prep causes diarrhea  goal = clear liquid stool before procedure
o Bowel prep may include enema
Positioning:
o Initially in left lateral position w/knees bent
o Position may change during procedure to enhance visualization of different segments of
colon
o Air is inserted into colon to help visualize
Post-procedure:
o Recovery from anesthesia/sedation
o Cramping abdominal pain and/or bloating during 1st hour
o Passing increased flatus
o Need to have a ride home – no driving for 24 hrs
o Full recovery and return to normal diet the next day
Complications: Bleeding, Perforation, Abdominal pain, Reaction to sedation
Parenteral (TPN) – delivered thru vein
Enteral Feedings (any method that uses GI tract to deliver food/caloric requirements)
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Safe and cost effective
Preserves GI integrity
Preserves normal sequence of intestinal and hepatic metabolism
Maintains fat metabolism and lipoprotein synthesis
Maintains normal insulin and glycogan ratios
Routes:
o Nose/oral
o Gastrostomy
o Jejunostomy
Nasogastric tube
o Inserted thru nose into stomach
o Either for decompression or short-term feedings (<4 wks)
o Make sure it’s secured (taped + pinned) and in the right place before usage (x-ray)
Gastrostomy vs. jejunostomy
o Long-term enteral feedings
o Gastrostomy - Percutaneous endoscopic gastrostomy (aka PEG or G-tube) placed in
the stomach
o Jejunostomy - Similar to g-tube but placed in the jejunum
Bolus vs cycled vs continuous feedings
o Bolus (intermittent) – closest to “normal”
 By gravity, syringe w/o plunger
 Tube must be flushed before and after, clamped between feedings
o Cycled (periodic) – over 8-16 hours
 Infusion pump needed
o Continuous – always going, only stopped to give meds
 Infusion pump needed
Nursing considerations:
o Pt. education/preparation/counseling
o Tube placement confirmation before usage
o If pulled out = contact physician
o If partially pulled out = d/c, check position w/x-ray
o Clearing tube obstructions/maintaining tube function (use water)
o Administering medications (use liquid meds or dissolve pills in liquid, do not
administer enteric coated meds, do not crush extended release meds, flush with
water)
o Monitoring nutritional status, weight, fluid balance, albumin levels
o Monitoring for, prevent, treat complications
Potential complications:
o Diarrhea
o N&V
o Gas/bloating/cramping
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o Dumping syndrome
o Aspiration pneumonia
o Tube displacement
o Tube obstruction
o Infection at site
o Hyperglycemia
o Dehydration
o Tooth decay
o Thrush
Prevention and management of complications:
o Diarrhea
 Selection of TF formula, consider fiber, osmolality, fluid content
 Assess other possible underlying reasons for diarrhea
 Change TF bag/tubing q24hr or per policy
o N&V
 Administer feeding at prescribed rate and method and according to patient
tolerance
 Dilute at first, then increase to meet nutritional requirements
o Gas/cramps/bloating
 Avoid cold TF
o Dumping syndrome
 Administer TF slowly, monitor after advancement of diet orders
o Aspiration
 HOB 30-45 degrees during feeding (semi-fowlers)
 Measure gastric residual volumes (GRV) per hospital policy
 Use syringe to pull back and check how much gastric content left
 Monitor for signs of feeding intolerance: nausea, vomiting, decreased bowel
sounds, abdominal discomfort, abdominal distension
 Monitor for s/s of aspiration: coughing, SOB, difficulty breathing, cyanosis
o Tube obstruction:
 Always flush with water after feeding and meds
 If becomes clogged, can use warm water or carbonated soda
o Infection:
 Inspect tube site & incision for s/s of infection (redness, swelling, drainage,
pain)
 Clean site at least daily, monitor discharge, bleeding, skin breakdown
(common ulcer site!)
o Hyperglycemia
 Monitor blood glucose level
 Monitor s/s of hyperglycemia (“hot and dry”, increased urine output, thirst,
increased temperature, dry skin, hypovolemia)
o Dehydration
 Administer water as ordered
 Also before and after meds and feeds
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 When tube feeds is d/c or interrupted or clamped between feeds
Tooth decay/thrush (d/t decreased saliva production  dry mouth)
 Meticulous oral care at least BID
 Antifungal meds (Nystatin)