CONTRAINDICATIONS:

Nasogastric tubes are contraindicated or used with extreme caution in people with
particular predispositions to injury from tube placement. These may include:
Patients with sustained head trauma, maxillofacial injury, or anterior fossa skull
fracture. Inserting a NG tube blindly through the nose has potential of passing
through the criboform plate, thus causing intracranial penetration of the brain.
Patients with a history of esophageal stricture, esophageal varices, alkali ingestion
at risk for esophageal penetration.
Comatose patients have the potential of vomiting during a NG insertion procedure,
thus require protection of the airway prior to placing a NG tube.

NASOGASTRIC TUBE FEEDING

Purpose
To feed the patient with fluid diet via a nasogastric tube
Requisites
Tray containing
Ryles tube ,Kidney tray
Measured volume of water
Prescribed feed - Ensure/Glucerna
50ml syringe / 20ml syringe
Blue litmus paper
A Stethoscope
Protective materials - White towel

Procedure
Action
Place the patient in semi to high fowler’s position or a lateral if patient cannot be
propped up.
Rationale
To prevent gastric discomfort or regurgitation of feed.
Remove spigot from the nasogastric tube
Action
Aspirate stomach contents gently with 50ml syringe and with test with blue litmus
paper.
Rationale
To conform the position of the tube and note the residual amount. If the tube is in
the stomach the blue litmus paper change red.
Action
Observe the nature of aspirate for color, volume and presence of blood.
Rationale
To exclude the malabsorption of previous feed and review feeding regime if
necessary.
Action
Attach funnel / Syringe to the tube and hold it to the side, at the level of the
patient’s forehead.
Rationale
If the syringe is held too high, it increases the pressure at which the fluid enters the
stomach.
Action
Fill the funnel/ syringe with the prescribed feed, allowing it to flow in by gravity.
Action
Do not allow the funnel to become empty.
Rationale
To prevent gastric distention during feeding.
Action
Observe the nature of aspirate for color, volume and presence of blood.
Rationale
To exclude the mal absorption of previous feed and review feeding regime if
necessary.
Action
Observe the patient during feed.
Rationale
To detect any adverse reaction to the feeding.
Action
Conclude feed with water.
Rationale
To keep the lumen of tube feeding.
Action
Disconnect the apparatus and spigot the tube.
Rationale
To prevent backflow and leakage.
Action
Record the type and amount of feed and water given.
Gastric lavage
Is the aspiration of stomach contents and washing out of the stomach by means of a
large bore gastric tube

Contraindicated
1. After acid or alkali ingestion
2. Seizure
3. After ingestion of hydrocarbon or petroleum
distillates
4. Dangerous after ingestion of strong
corrosive agent

Purpose:
1. For urgent removal of ingested substance to decrease systemic absorption
2. To empty the stomach after endoscopic procedure
3. To diagnose gastric hemorrhage and to rest hemorrhage.

Equipment
o Large bore levin tube or large bore ewald tube
o Large irrigating syringe with adapter
o Large plastic funnel with a adapter to fit tube
o Water soluble lubricant
o Tap water or appropriate antidote [ milk, saline
solution, sodium bicarbonate solution, fruit juice,
activated charcoal]
o Container for aspirate
o Suction apparatus
o Container for specimen
o Stethoscope
Remove dentures and inspect oral cavity for loose
Teeth -> This will prevent aspiration of