NASOGASTRIC
TUBE
FEEDING
Definition
Ø Nasogastric- the passage through
the nose, down the throat and
esophagus, and into the stomach.
Ø Nasogastric tube- insertion of the
tube that passes through the nose,
down the throat and esophagus,
and into the stomach.
Definition
•
For most patients who cannot attain an adequate oral intake from food, oral
nutritional supplements, or who cannot eat and drink safely, they may be given
proper nutrition via nasogastric tube feeding.
•
The goal is to improve every patient’s nutritional intake and maintain their
nutritional status.
•
Nasogastric tube or NG tube is used in patients suffering from dysphagia due
to their inability to meet nutritional needs despite food modifications and
because of the possibility of aspiration.
Types of Tube
• Tubes that pass from the nostrils into the duodenum or jejunum are
called Nasoenteric tubes.
• The length of these tubes can either be medium (used for feeding) or
long (used for decompression, aspiration).
• Gastrointestinal tubes
-Orogastric tubes
-Nasogastric tubes
q Single lumen
q Double lumen/
Salem pump
Types of Tube
• Levin tube- is a single-lumen multipurpose plastic tube that is
commonly used in nasogastric intubation.
• Salem sump tube. A double-lumen tube with a “pigtail” used for
intermittent or continuous suction.
Types of Tube
Types of Tube
Indications
•
Gastric decompression-connected to suction to facilitate decompression by
removing stomach contents.
ü Indicated for bowel obstruction and paralytic ileus and when surgery is
performed on the stomach or intestine.
•
Aspiration of gastric fluid content- Either for lavage or obtaining a specimen for
analysis. Also allow for drainage or lavage in drug overdosage or poisoning.
•
Feeding and administration of medication
•
Prevention of vomiting and aspiration.
ü In trauma settings, NG tubes can be used to aid in the prevention of
vomiting and aspiration, as well as for assessment of GI bleeding.
Contraindications
• Recent nasal surgery and severe midface trauma
ü Due to the possibility of inserting the tube intracranially. An
orogastric tube may be inserted, in this case.
• Coagulation abnormality, esophageal varices, & recent banding
of esophageal varices.
Supplies & Equipment
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Working gloves
Face shield (optional)
Feeding pump (if ordered)
Feeding solution (as ordered)
Asepto Syringe
Stethoscope
Water
Measuring cup/ syringe without needle
Other optional equipment
ü (disposable pad, pH indicator strips, paper towels)
Supplies & Equipment
v Feeding solution (as ordered)
ü Osterized Feeding- combination of foods then blended.
ü Pure milk
-such as Glucerna, Ensure, Nutren, Peptamen, Glucobest, Nepro
-milk can be powder form (dissolve in water) & also
has a ready to drink.
Procedure
1. Assembles equipment; check the amount, concentrate, type and
frequency of tube feeding on client's chart.
Ø Formula preparation:
ü Check expiration date
ü Shake thoroughly
ü For powdered formula, mix according to the instructions on the package.
-Prepare just enough for the next 24 hours and refrigerate unused
formula. Allow formula to reach room temperature before using. Formula
loses its nutritional value & can be contaminated if kept for more than 24
hours. Cold formulas can cause abdominal discomfort.
Procedure
2. Washes hands before the procedure.
3. Warms the prescribed nourishment to room temperature.
4. Verify the patient (Name and Birthday), then Introduce yourself.
5. Explains the procedure to the patient or to the responsible party .
6. Closes door or put curtains around the bed.
7. Places patient in a high Fowler's or semi-sitting position with the head
of bed elevated at least 30 to 40 degrees.
Procedure
8. Checks to see that the gastric tube is properly located in the stomach.
Thru any of the following:
8.1. Aspirating stomach contents with a syringe-indicates that the tube is in its proper
place in the stomach. This contents are returned to the stomach because they contain
valuable electrolytes and digestive enzymes.
1. Connect syringe to end of feeding tube.
2. Pull back on plunger carefully.
3. Determine amount of residual fluid (clamp tube if it is necessary to
remove the syringe).
4. Return residual to stomach via tube and continue with feeding if amount
does not exceed agency protocol or physician’s orders.
Procedure
Procedure
8.2. injects about 10 ml of air into the tube and simultaneously auscultates the
stomach with the stetoscope.
ü A whooshing or gurgling sound usually indicates that the tube is in the stomach.
1. Connect syringe filled with air to tube.
2. Inject air while listening with stethoscope over left upper quadrant.
8.3 Places the end of the tube in a glass of water.
ü bubbles indicate that the tube is in place.
Procedure
v Additional:
8.4 Measuring the pH of aspirated gastric secretions
ü Gastric contents are acidic, and a pH indicator strip should reflect a range of 1
to 4. Pleural fluid and intestinal fluid are slightly basic in nature.
8.5 Taking an x-ray or ultrasound
ü This may be needed to determine tube placement. X-ray visualization is the only
method that is considered positive/ confirmatory test to determine tube
placement.
Procedure
9. Attaches an asepto syringe or 30 cc syringe and introduces the prescribed amount
of feeding formula.
10. Starts to feed the patient:
10.1 permits the feeding to flow in slowly. Raise or lower the asepto/syringe to
adjust the flow as needed.
10.2 pinches or clamps the tubing to stop the flow for a minute if the client
experience any discomfort.
11. Do not let the asepto/syringe become empty while introducing nourishment.
12. Flushes water into the tube at least 60 ml or as prescribed by the doctor after the
nourishment is introduced.
Procedure
13. Clamps the gastric tube after feeding.
14. Let the patient remain in sitting / upright, or in Fowler's positions or slightly
elevated at right lateral position for at least 30 mins after feeding.
15. Does after care of the equipment used.
16. Accurately records the following:
16.1 Procedure done
16.2 Amount of the solution introduced (include water, feeding formula, etc.)
16.3 Time of administration
16.4 Any untoward manifestations observed during and after the feeding
17. Answers related questions to procedure performed.
Nursing Consideration
1. Provide oral and skin care
-Give mouth rinses and apply water-soluble lubricant to the patient’s lips and nostril
because the client’s nose may become irritated and dry.
2. Verify NG tube placement
3. Wear gloves
4. Face and eye protection
5. Change the Nasogastric tube according to Institution Policy