Enteral Tube Feeding and the Lopez Valve (Nursing)

by Samantha Rhea, MSN, RN

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    00:00 I'd like to take a moment to talk about enteral tube feeding administration through a nasogastric tube. So when we talk about tube feeding administration, you're really looking at 2 different methods, either bolus or continuous. So I want you to be familiar with the word bolus because you're going to hear this a lot in nursing. Any time you hear the word bolus it really just means a set amount of content at a specific time or maybe even a specific amount of content at intervals. So really just think about it as intermittent feedings. Next, we have continuous which is really just the way it sounds, it is continuous and running all the time to deliver feeding and nutrition to our patient. So, as you can see in this image here, there are 2 different ways to do this. We can do this directly to the tube and use a piston syringe and administer the feeding through that. Well that's typically called a bolus feeding.

    00:59 Now you also see in this image what we see a continuous enteral feeding. We usually do a continuous through what we call a kangaroo pump or specific feeding pump. Now, I want to take a small moment to look at these different sources of nutrition. So depending on your facility, your nutrition may come up something like this. You'll see a large bag of brown liquid.

    01:22 This is a different kind of nutrition that you may see from your pharmacist or your dietitian, for example, and it's especially formulated for your patient. So one key note, do you notice on this bag it says "for tube feeding only." So this is really important because sometimes this can be mistaken for IV fluid, and this is not that. So notice there's a big red label that says "for tube feeding only" and that's for safety purposes. Now sometimes from your dietary or nutritionist may deliver again this tube feeding to your unit. You may also see a bottle for example or it may come in to a small can, kind of like an Ensure can or something like that for example. So one other thing I want you to consider. Now just like us as individuals, every patient may need a special diet. So just really know that tube feeding comes in all types of diets. So, if you're a diabetic, there's a specific type of diabetic nutrition. Also if you have renal or kidney issues, there's a special formula for you as well. So just know that there are different formulas to match your patient's needs. I'm going to introduce you how to give a tube feeding through a nasogastric tube. So first of all, after I've done my hand hygiene, I'm going to put on my gloves. And one thing I want you to remember about this specific skill. Any time that you're working with gastrointestinal feedings or anything GI, remember it is not sterile, so just keep that in mind. Okay, let's take a moment to look at a few of our equipment. So, earlier we talked about different types of feeding. So when we're talking about bolus feeding, typically we're going to give it through what we call a piston syringe, just like so. And a lot of the times when you're doing a bolus feeding, you may use something like, for example, something like this such as the small canister or small can to give that bolus intermittent feeding. So here we've got our feeding, our piston syringe. We also got our canister that's got tap water, because remember we can use tap water here because it's going through the gut so this is not sterile water. Okay, in here we have an example of a continuous type tube feeding. So this has got a bag here and this is just a different way we can do this. And there are different variations of this. So this is our tube feeding bag. So if we have several canisters or something out of a bottle, we can just fill this up through this pout, we can cut this and hang this on a delivery pole for our patient.

    04:09 So it's got a little bitty hook on the back. And then when we're ready, this has a roller clamp much like an IV, we can also make sure that we fill this up and then we can connect this to your patient, and I'll show you that shortly. Okay, so before we get too far, I want to show you one extra piece. So in earlier videos, we talked about some of our equipment. So this is our air vent that you see here. This is what we call the Lopez valve, so this is really helpful.

    04:46 Now, sometimes on your unit you may have this, sometimes you may not, but a lot of the times you can get this from your processing department or your equipment supply department. Now, I want to show you a quick look at a Lopez valve. This goes at the end of a nasogastric tube, sometimes your facility may have this, sometimes they may not, but they're really helpful if they do so check your specific facility. So this attached to the end of the client's nasogastric tube for their tube feeding. Now, notice on here there's a couple of different ports. So if you look at this blue port, this is where the tube feeding is attached and then continuous tube feeding can be administered through here. Now, next see kind of like that Christmas tree stock side, this is the client's port and this is what's going to attach to the nasogastric tube. Now, on some valves, notice there's this medication port.

    05:42 Some of the Lopez valves may have this, some of them may not. But these are really nice because you can put your piston syringe on there, you can give meds, you can add things when the tube feeding is continuously going, you don't have to interrupt it. Now one thing to note, you see the little dial in the middle with the arrows? See on this specific image how the arrows are going in line with both ports. So that's good because that means the flow of the tube feeding is open. So the reason why this is so handy for us? This is a complete separate piece. So if you remember when we insert our NG tube, you may have something like this. Here's our nasogastric tube, you may also have a separate little clip here and this is what we're going to use to connect suction tubing. So we don't need this at this point right now. So I'm going to take this out. But this is open for us and if we need it too, we can attach anything we need in here. But today, we have what we call Lopez valve and this, this kind of Christmas tree top here, this is the piece that's going to go into the nasogastric tube. So we're going to slide this in and nice and tight. So what's amazing and really nice about these things is they're so very helpful when you only have very limited hands. So if you notice on here, this piece typically, like if we have a continuous feeding this is going to go in here. So let me show you that. This has a cap, we can remove it.

    07:17 And this, it's going to go right into this valve. So, if we need continuous tube feeding to go through here, maybe delivered via pump or like a gravity for so, here is a port for you to connect that in. Now, if we do not want to interrupt those feedings and the patient's getting continuous tube feedings and we need to give a medication, we can use this valve right here. So, we can also unclamp this, open this up, and we can place our piston syringe in that while the tube feeding is going. So this is really helpful so we don't interrupt the patient's nutrition. Okay, so I just want to show you those pieces really quick. Now, sometimes the valve may not have this nice medication port, so just know that. So it will just vary depending on your equipment. So for now, I'm going to cap this again. And one last piece to show you, the very important piece. Notice how you've got this stopcock here and it's labeled. So anytime you see this off button in line with your tubing, that means nothing's going to leak out which is really important because you don't want this leaking out on your patient's gastric contents or feeding. Now, if you need to deliver something through that, you just simply turn it to where you see the arrows going the direction of the tubing. So this means now the tubing is open, we can deliver our feeding and our medicine. So this is what we call Lopez valve and really handy to have. Okay, so for now I'm going to turn this back off.

    About the Lecture

    The lecture Enteral Tube Feeding and the Lopez Valve (Nursing) by Samantha Rhea, MSN, RN is from the course Enteral Feeding Tubes (Nursing).

    Included Quiz Questions

    1. Piston syringe
    2. Tube feeding solution
    3. Lubricant
    4. Sterile water
    1. Liquid can go through the port to the client when the arrows on the dial line up with the ports.
    2. The tapered port connects to the nasogastric tube.
    3. All Lopez valves have three ports.
    4. Lopez valves come preattached to most nasogastric tubes.
    1. “Continuous tube feeding is usually administered via a pump.”
    2. “I can administer medications through my client’s nasogastric (NG) tube while they are receiving continuous tube feeding if I attach a Lopez valve to the end of the NG tube.”
    3. “Any procedure involving nasogastric tubes should be sterile.”
    4. “Salem sump tubes cannot be used for tube feeding.”

    Author of lecture Enteral Tube Feeding and the Lopez Valve (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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