NASOGASTRIC TUBE FEEDING

TOTAL ENTERAL NUTRITION (TEN) A type of nutrition provided when a client is unable to ingest foods or the upper GIT is impaired and the transport of food to the small intestine is interrupted. TOTAL PARENTERAL NUTRITION (TPN) via blood vessel UPPER GIT mouth esophagus stomach TYPES OF ENTERAL FEEDING 1. Nasogastric Tube (NGT) 2. Gastrostomy Tube 3. Jejunostomy Tube NGT is a type of enteral feeding where tube is inserted through on of the nostrils down the nasopharynx and into the alimentary tract. Infants & newborns are not allowed to use NGT because they are obligatory nose breathers. LOWER GIT small intestine large intestine anus

PURPOSES:
1. To administer tube feeding & medication to clients who are unable to eat by mouth, or swallow a sufficient diet without aspirating foods or fluids into the lungs. 2. To remove stomach contents for laboratory analysis. 3. To prevent nausea & vomiting, gastric distention following surgery. 4. To lavage the stomach in case of poisoning or overdose of medication.

ASSESSMENT OF CLIENTS FOR TUBE FEEDING

1. Any signs of malnutrition & dehydration (ex. Paralyzed pt.) 2. Check for allergies to any food to the feeding solution (ex. Iodine content of seafoods) 3. Check for the presence of bowel sounds. BORBORYGMUS 4. Note any problems that suggest the lack of tolerance of previous feedings. Examples: delayed gastric emptying abdominal distention dumping syndrome constipation/ dehydration

4-5 hours interval of feeding Add 30ml water after feeding to rinse the tube & lubricate the food given.

PLANNING
Before a tube feeding, determine the type, amount & frequency of tube feeding and intolerance of previous feedings

INSERTING A NASOGASTRIC TUBE

PROCEDURE
1. Check the Physicians order for the insertion of NGT. 2. Prepare/Assemble all equipment and bring them to bedside. Nasogastric tube (F 8 or 18) Asepto bulb syringe Stethoscope Small basin with ice and sterile water or warm water Water soluble lubricant Sterile gloves Mouth wipes Waterproof pad/rubber Plaster Penlight Tongue depressor Towel

Remarks

3. Perform hand washing. 4. Explain the procedure to the client.

5. Prepare and place the rubber tubing in a basin with sterile water and ice/plastic tube in a basin with warm water for at least 15 minutes.
6. Place client in sitting or semi-fowlers position. Place water proof pad and towel on the clients chest. 7. Prepare lubricant. Wear sterile gloves. 8. Measure NEX by placing the tip of the tube in the clients nostril then stretch to earlobe and to the tip of the xiphoid process to measure the length of insertion. Mark the length with a tape. 9. Lubricate the tube with water- soluble lubricant. Instruct the client to lift his head and insert tube through the nostril. 10. When the tube reaches the pharynx. Instruct client to swallow. Follow the downward-backward stroke in inserting the NG tube white the client swallows. Stop the insertion if the client begins to gag.

11. Discontinue the procedure if the client becomes cyanotic, starts to cough continuously, gasps for air or become unable to speak. Continue insertions if none of the aforementioned manifestations are observed. 12. Check the location of the tube with a penlight and tongue depressor if the client starts to gag or cough. In case there is resistance, slowly rotate the tube while advancing it. Continue inserting until the marking is reached. 13. Determine if the tube is in the stomach. Introduce a small amount of air and auscultate for sound (borborygmic) in the stomach region) Aspirate fluid from the stomach check for the character of pH of the fluid (pH 4 or less in normal and it indicates that fluid is coming from the stomach). (Smith,2005)

14. Clamp the tube or apply the cover. Secure the tubes with a plaster/tape on the clients cheek and attach it to the clients gown with a tape or safety pin.

15. If the tube will be used as suction (lavage), connect tubing to the suction device. 16. Place the client in a comfortable position. If desired, assist the client in gargling. Wipe secretions from clients nose/mouth if theres any.

17. Wash dry all non-disposable equipment and return them to their proper place. Discard all disposable equipment. 18. Remove gloves and perform hand washing. 19. Document the time of insertion, description of gastric content and clients response to the procedure.

NASOGASTRIC TUBE FEEDING

PROCEDURE

Remarks

1. Check the physicians order for the type, amount and frequency of tube feeding. 2. Prepare all the equipments: Tube feeding prepared at room temperature Asepto syringe/large syringe pH strip meter Water at room temperature Container for measuring the residual gastric content Stethoscope
3. Perfume hand washing. 4. Explain the procedure to the client.

5. Elevate the bed of the client to a 30o angle if possible. 6. Check the expiration date, character, and odor of the prepared feeding solution. 7. Check if the tube is properly located. Introduce a small amount of air, auscultate for sound in the stomach. Attach the syringe to the end of the tube and aspirate a small amount of gastric content to measure the pH. If the tube is in the stomach, aspirate all gastric contents with a syringe. Measure and return the contents immediately through the tube (id this is agency policy as per doctors order) Continue feeding if the residual feeding is less than 100 ml; refer if 100 ml or more is withdrawn.

8. Always guard the free-end of the tube against air entry. 9. Connect the syringe barrel to the freeend of the tube. Slightly elevate the barrel. 10. Pour the prescribed amount of the tube feeding solution. 11. Add 30 ml of water before the end of feeding. Rinse the lumen of the tube. 12. Disconnect the syringe from the tube and close the clamp. 13. Instruct the client to remain in that position for at least 30 minutes after feeding. 14. Observe the clients response to feeding. 15. Wash all dry equipment and return them to their proper places. 16. Wash hands. 17. Record time, amount of feeding and the clients response to feeding.

IRRIGATING A NASOGASTRIC TUBE

PROCEDURE

Remarks

1. Check the physicians order for irrigation identify client.

2. Prepare all equipments: Disposable gloves NSS for irrigation Stethoscope Asepto syringe Disposable pad/bath towel Measuring container

3. Perform hand washing. Wear gloves.

4. Explain the procedure.

5. Assist the client in assuming a semi-fowlers position if indicated. Place disposable pad or bath towel at clients chest. 6. Check placement of the NG tubing. Aspirate fluid if from the stomach, check for the character of the pH of the fluid (pH 4 or less) Introduce a small amount of air and auscultate for sound in the stomach region. 7. Place the tip of Asepto syringe into the tube. Hold the syringe upright.

8. Hold the Asepto syringe upright and pour 30 ml of normal saline solution (or the amount ordered by the physician) and allow the solution to flow because of gravity.
9. If unable to irrigate the tube, reposition the client, try to irrigate again. If after repeated attempts the irrigation still fails, refer to physician.

10. Aspirate the fluid using Asepto syringe, or reconnect the tube to the suction. Observe the movement of the solution. 11. Measure the amount aspirated.

12. Clean equipment and discard all disposable articles according to agency policy.
13. Remove glove and do hand washing. 14. Record the date, time of the irrigation, the description of the drainage, the clients response.