Nasogastric Tube Feeding

Nasogastric Tube Feeding Definition: A feeding tube is a medical device used to provide nutrition to patients who cannot obtain nutrition by swallowing. The state of being fed by a feeding tube is called enteral feeding or tube feeding. Placement may be temporary for the treatment of acute conditions or lifelong in the case of chronic disabilities. A variety of feeding tubes are used in medical practice. They are usually made of polyurethane or silicone. The diameter of a feeding tube is measured in French units (each French unit equals 0.33 millimeters). They are classified by site of insertion and intended use. Purpose: • To restore or maintain nutritional status • To administer medication Materials: • Correct amount of feeding solution • 20 to 50 ml syringe with an adapter • Emesis basin • Clean gloves • Large syringe with plunger or calibrated plastic feeding bag with tubing that can be attached to the feeding tube or prefilled bottle with a drip chamber, tubing, and a flowregulator clamp • pH test strip or meter • Measuring container from which to pour the feeding ( if using open system) • Water ( 60 ml unless otherwise specified) at room temperature • Feeding pump as required Procedure

Rationale

1. Assist the client to a These positions enhance the Fowler’s position in bed or gravitational flow of the sitting position in a chair, solution and prevent aspiration the normal position for of fluid into the lungs. eating. If a sitting position is contraindicated, a slightly elevated right side lying position is acceptable. 2. Explain to the client what you are going to do, why it is necessary, and how he r she can cooperate. Inform the client that the feeding should not cause any

Responsible Person Registered Nurse

3. 4. 5.

6.

discomfort but may cause feeling of fullness. For an adult, the usual intermittent feeding will take about 30 min. the exact length of time depends largely on the volume of the feeding. wash hands and observe appropriate infection control procedure Provide privacy for this procedure if the client desires it. assess tube placement. a. attach the syringe to the open end of the tube and aspirate alimentary secretion. Check pH. b. Allow one hour to elapse before testing the pH if the client has received a medication c. Use pH meter rather than pH paper if the client is receiving a continuous feeding or if food coloring has been added to formula. Assess residual feeding contents. a. aspirate all stomach contents and measure the amount before administering the feeding b. if 100 ml (or more than half the last feeding) is

This is done to evaluate absorption of the last feeding; that is, whether undigested formula form the previous feeding remains.

withdrawn, check with the nurse in charge or refer to agency policy before proceeding the precise amount is usually determined by the physician’s order or by agency policy. 7. Administer the feeding. • before administering the feeding: Check the expiration date of the feeding Warm the feeding to room temperature • when an open system is used, clean the top of the feeding container with alcohol before opening it FEEDING BAG (OPEN SYSTEM) •hang the bag from an infusion pole about 30 cm. (12 in.) above the tube’s point of insertion into the client. •clamp the tubing and add the formula bag •open the clamp, run the formula through the tubing, and reclamp the tube. The formula will displace the air in the tubing, thus preventing the installation of excess air into the client’s stomach or intestine. •attach the bag to the nasogastric/nasoenteric tube and regulate the drip by adjusting the clamp to the drop factor on the bag. SYRINGE (OPEN SYTEM) •remove the plunger from the syringe and connect the syringe

An excessively cold feeding may cause cramps This minimizes the risk of contaminants entering the feeding syringe or feeding bag

Pinching or clamping the tube prevents excess air from

to a pinched or clamped nasogastric tube. •add the feeding to the syringe barrel. •insert the feeding to flow in slowly at the prescribed rate. Raise or lower the syringe to adjust the flow as needed. Pinch or clamp the tubing to stop the flow for a minute if the clients feel discomfort. PREFILLED BOTTLE WITH DRIP CHAMBER(CLOSED SYSTEM) •remove the screw on cap from the container and attach the administration set with the drip chamber and tubing •close the clamp on the tubing •hang the container on an intravenous pole about 30 cm (12 in) above the tube insertion point into the client. •squeeze the drip chamber to fill it to one half of its capacity •open the tubing clamp, run the formula through the tubing, and reclamp the tube •attach the feeding set tubing to the feeding tube and regulate the drip rate to deliver the feeding over the desired length of time. Prefilled tube feeding sets can be attached to a feeding pump to regulate the flow. 8. Rinse the feeding tube immediately before all of the formula has run through the tubing • instill 50 to 100 ml of water through the feeding tube. Water flushes the lumen of the tub, preventing future blockage by sticky formula. • be sure to add the water before the feeding solution has

entering the stomach and causing distention.

Quickly administering feeding can cause flatus, cramps, and/or reflux vomiting.

At this height, the formula should run at a safe rate into the stomach or intestine.

drained from the neck of a syringe or from the tubing of an administration set. Before adding water to a feeding bag or prefilled tubing set, first clamp and disconnect both feeding and administration tubes. 9. Clamp and cover the feeding. •clamp the feeding tube before all of the wter instilled •cover the end of the feeding tube with gauze held by an elastic band 10. Ensure client comfort and safety 11. Dispose the equipment appropriately 12. Document all relevant information 13. Monitor client for possible problems

Adding water before the syringe or tubing is empty prevents the instillation of air into the stomach or intestine and thus prevents unnecessary distention. To prevent leakage