NASOGASTRIC

FEEDING

OR

GAVAGE FEEDING
DEFINITION
 Gavage feeding is an artificial method of
giving fluids and nutrients. This is a process
of feeding with the tube (Nasogastric tube)
inserted through the nose, pharynx, and
esophagus and into the stomach.
 PURPOSES
AND
INDICATIONS
To feed the children who are unable to take
feed orally.

Feed the children who are undergoing oral

surgery like - cleft lip or cleft palate,
fracture of jaw, and in condition of
difficulty in swallowing.
When patient is unconscious or
semiconscious

When the condition is not

supportive to take large amount
of food orally e.g.- severe burns,
malnutrition, prematurity, acute
and chronic infections.

Conditions when the patient is

unable to retain the food e.g.
 ADVANTAGES

OF

NASOGASTRIC FEEDING
All types of nutrients including distasteful
foods and medications can be given in
adequate amount.

Without any danger, feeding can be

continued for weeks.
According to need, stomach
can be aspirated at any
time.

Large amount of fluids can

be given with safety.
 PRINCIPALS
INVOLVED
IN
GASTRIC GAVAGE
Tube feeding is a process of giving liquid
nutrients or medications through a tube into
the stomach when the oral intake is
inadequate or impossible.

A thorough knowledge of the anatomy and

physiology of the digestive tract and
respiratory tract. Ensures safe induction of the
tube (avoid misplacement of the tube).
Micro-organisms enter the
body through food and drink.

Introduction of the tube into

the mouth or nostrils is a
frightening situation and the
client will resist every attempt.
Mental and physical
preparation of the client
facilitates introduction of the
tube.
Systematic ways of working
adds to the comfort and safety
of the client and help in the
economy of material. Time and
energy
POLICY
6 fr feeding tube is used for
infants <1000 grams.

6 fr or # 8 fr feeding tube are

used for infants> 1000 grams.

Never force the feeding under

pressure.
If possible, the infant should be
held in semi-up-right
position during the feeding; if
not possible, position infant on
right side or prone as this will
facilitate gastric emptying.

If respiratory rate >70, check

with physician about
withholding feeding.
ARTICLES NEEDED
Mackintosh with towel
Kidney tray for receiving the
waste
Cotton tipped" applicators to
clean the nostrils.
Ryle's tube in a bowel.
Lubricant such as water soluble
jelly or glycerin to prevent
friction
Gauze pieces to clean the
secretions
Scissors and adhesive
plaster or tape
Measuring cup or
glass/ounces glass.
Sterile syringe, about 10-20
ml
Paper bag- to collect the wastes.

Glass of feed in a bowel of warm water to

give the feed at the body temperature.

Tongue blade.

Suction apparatus - to clear the airway,

whenever need.

Bowel with water - to test the location of

tube.

Clamp - to clamp the tube to prevent

leakage of gastric contents
PROCEDUR
E
Nasogastric Tube Position
Evaluation

Observe client to determine response

to procedure.

ALERTS!!! Persistent gagging

prolonged intubation and stimulation of
the gag reflex can result in vomiting
and aspiration
Coughing may indicate presence of
tube in the airway.
 Evaluation Cont.

Note location of external site marking on

the tube
Documentation
Size of tube, which nostril and clients
response.
Record length of tube from the nostril to end
of tube
Record aspirate pH and characteristics
X-ray of misplaced NG tube
 Nursing responsibilities
Following verification by x-ray of tube
placement. The nurse is responsible for
ensuring that the tube has remained in the
intended position before administering formula
or medication through the tube.
Verification of placement is performed before
each intermittent feeding and at least once
every 12 hour shift for continuous feedings and
prior to medication administration.
 Nursing Responsibilities

Identify signs and symptoms of

inadvertent respiratory migration.
Identify conditions that increase
the risk for spontaneous tube
dislocation from the intended
position (retching, vomiting,
nasotracheal suctioning, severe
coughing)
 Testing Placement
Wash hands and put on clean gloves
Draw up 30cc of air into the syringe and
attach to end of the NG tube. Flush tube
with 30cc of air prior to attempting to
aspirate fluid. Draw back on the syringe to
obtain 5 to 10 cc of gastric aspirate.
If unable to aspirate:
Advance tube may be in air space
above aspirate level
If intestinal placement suspected (pH 4-6)
withdraw tube 5 to 10 cm
Have client lie on his/her left side wait 10-
15 mins and attempt aspiration again.
 Testing Placement cont.

Observe appearance of aspirate:

From client with enteral feeding
appearance of curdled enteral feed
From nasointestinal bile stained
From stomach (non feed) green, tan,
bloody, brown.
Pleural fluid pale yellow and serous
Gently mix aspirate in syringe
 Testing Placement cont.

Note:
In a study by Metheny et al (1994)
the gastric aspirate of 880 clients were
examined:
> gastric aspirate ranged in color from green
to yellow, tan/brown or bloody
> respiratory aspirate was described as tan
or yellow/green (Best 2005)
 Testing Placement Cont.

Measure pH of aspirated GI contents by

dipping pH strip into the fluid or by applying
a few drops of the fluid to the strip.
Compare the color of the strip with the color
on the chart.
Gastric fluid from a client who has fasted for
at least 4 hours usually has a pH range from
1 to 4 but may be increased if the client is
receiving acid inhibiting medications (pH 4-
6)
 Testing Placement Cont.
Fluid from nasointestinal tube of fasting
client usually has a pH greater than 6.
intestinal contents are less acidic than
stomach.
Clients with a continuous tube feed may
have a pH of 5 or higher.
Pleural fluid from the tracheubronchial tree is
generally greater than 7.
National Patient Safety Association(2005a)
recommend a pH of less than 5.5 feedings
can be initiated (Best, 2005)
 Testing Placement Cont.

Measure the length of the tube from nostril to tip.

If after repeated attempts, it is not possible to

aspirate fluid from a tube that was originally
established by x-ray examination to be in the
desired position and there are NO risk factors for
dislocation, tube has remained in original position
and the client is NOT experiencing any difficulty
the nurse may assume the tube is correctly
placed.
 Enteral Nutrition

What is it:
The administration of nutrients directly
into the GI tract. The most desirable and
appropriate method of providing nutrition
is the oral route, but this is not always
possible.
Nasogastric feeding is the most common
route
Nurses are the main healthcare
professional responsible for intubation
 Administering Enteral
Feeds
Indications:
Clients who are unable to maintain
adequate oral intake to met
metabolic demands
Surgical cases
Ventilated clients
Neuromuscular impairment
Clients requiring bowel rest.
Generally these clients have been
referred to the Dietician.
 Administering Enteral
Feeds
Contraindications:
Clients with diffuse peritonitis.
Severe pancreatitis
Intestinal obstruction
Severe D&V
Paralytic ileus.
 Nursing Care

Confirm satisfactory tube positioning

before starting tube feed and Q shift
(aspirate for pH and color)
Residual volume aspirate with syringe
min Q shift (usually q4h). If residual
volume is greater than 100cc notify
physician.
Right product, right time, right client,
right rate..check and chart.
Monitor intake and output
 Nursing Care Cont.
Flush tube with a min of 30-50cc water prior to
initiating feed, when feed is finished, before and
after the administration of medications and q4-6h
around the clock.

For immune compromised clients use sterile

water
For non-immune compromised use tap water
(refer to policies of the institution

Change feed bag and tubing q24h, need to label

and chart
Elevate the HOB to 30 degrees to prevent
aspiration.
Note blood values BUN, creatinine, lytes,glucose.
 Nursing Care Cont.
Monitor blood glucose q6h until
maximum infusion rate has been
increased and maintained for 24h
Keep tube feeding formulas at room
temperature.
A Registered Dietician determines the
caloric requirements for each client and
orders the formula to be use, the rate
and the appropriate amount of water to
be used to flush the tube.
 Complications
Clogged Tube- most common
Flush tube with 30-60 cc q4h if continues feed.
Use liquid meds when possible. Flush tube
after giving medication.
Dumping Syndrome: solution with high osmolality-
water moves into stomach and intestines from the
fluid surrounding the organs and vascular system
causing dehydration, hypotension and tachycardia
Aspiration : ensure head of bed is elevated at least
30 degrees while feeds are being administered
 Complications Cont.

Dehydration- diarrhea is a common

problem.
Electrolyte imbalance: hyperkalemia
and hypernatremia
Oral mucosal breakdown
Nasal irritation
References

Perry & Potter(2002). Clinical Skills & Techniques(5th

ed.). United States: Mosby
Smeltzer,S.C., Bare,B.G. (2004). Brunner &
Suddarths textbook of medical surgical nursing.
Philadelphia: Lippincott.
Best, C. (2005). Caring for the patient with a
nasogastric tube. Nursing Standard. 20,3,59-65.
Retrieved September 5 2006, from ProQuest
database.