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Perioperative Mx (Ryles Nasogastric Tube (Method (Size tube by measuring…

- - - - Wide-bore
      - Stiffer
      - Radio-opaque line
      - Metal tip
        
        Acts as lead point to facilitate advancement of NGT
        
        Weights the NGT down in the stomach
        
        Radio-opaque on x-ray aiding visualisation
- - - - Catabolic: sepsis, burns, major surgery
      - Coma/ITU
      - Malnutrition
      - Long-term feeding
      - Dysphagia: stricture, stroke
  - - - Nasal trauma
      - Malposition: airway, cranium (CI in basal skull #s)
      - Blockage
    - - Refeeding syndrome
      - Electrolyte imbalance
      - Feed intolerance → diarrhoea
- - - - Used to prevent VTE
      - All patients undergoing surgery
      - All immobile pts
    - - Available in different sizes
      - Width: widest point of calf
      - Length: heel to buttock fold
      - Often used in conjunction c¯ LMWH
- - - - Unable to swallow: e.g. oesophageal Ca
      - Prolonged obstruction or ileus (>7d)
      - High output fistula
      - Short bowel syndrome
      - Severe Crohn’s
      - Severe malnutrition
    - - Delivered centrally as high osmolality is toxic to veins
        
        Short-term: CV catheter
        
        Long-term: Hickman or PICC line
    - - Standard
        
        Wt., fluid balance and urine glucose daily
        
        Zn, Mg weekly
      - Initially
        Blood glucose, FBC and U+E 3x /wk
        LFTs 3x /wk
      - Once stable
        Blood glucose, FBC and U+E daily
        LFTs weekly
    - - 2000Kcal: 50% fat, 50% carb
      - 10-14g nitrogen
      - Vitamins, minerals and trace elements
    - - Line-related
        
        Pneumothorax / haemothorax
        
        Cardiac arrhythmia
        
        Line sepsis
        
        Central venous thrombosis → PE or SVCO
      - Feed-related
        
        Villous atrophy of GIT
        
        Electrolyte disturbances: e.g. refeeding syndrome
        
        Hyperglycaemia and reactive hypoglycaemia
        
        Vitamin and mineral deficiencies
- - - - Gelofusin
      - Volplex
      - Haemaccel
      - Voluven
    - - Albumin
      - Blood
    - - Fluid challenge
      - Hypovolaemic shock
      - Burns: Muir and Barclay
    - - Anaphylaxis
      - Volume overload
  - - - 0.9% NaCl = 9g/L
        
        154mM NaCl
        
        Use: normal daily fluid requirements + replace losses
    - - 50g dextrose /L
      - Use: normal daily fluid requirements
    - - 4% dextrose = 40g/L
      - 0.18% NaCl = 31mM NaCl
      - Use: normal daily fluid requirements
    - - Na: 131mM
      - Cl: 111mM
      - K: 5mM
      - Ca: 2.2mM
      - Lactate / HCO3: 29mM
      - Use: Trauma, Burns (Parkland)
    - - 3L dex-saline c¯ 20mM K+ in each bag
      - 1L NS + 2L dex c¯ 20mM K+ in each bag
      - Each bag over 8h = 125ml/h
    - - Give 1L NS → ~210ml remaining IV
      - Give 1L D5W → ~70ml remaining IV
      - Acidosis or electrolyte disturbances
      - Fluid overload