Tube feeding

What is NG tube insertion?

• Nasogastric intubation refers to the
insertion of a tube through the nasopharynx
into the stomach.
 purposes of nasogastric
intubation
• Administer medications and feeding directly
into the G.I tract.(gavage)
• Irrigate the stomach for active bleeding or
poisoning.(lavage)
• Remove fluids and gas from stomach.
(decompression)
• Prevent or relieve nausea and vomiting after
surgery by decompressing the stomach.
• Obtain a specimen of gastric contents for
laboratory studies.
 Meaning.
Gastric gavage is an artificial
method of giving fluids and nutrients
through a tube that has passed into
the esophagus and stomach through
the nose or mouth when oral intake
is inadequate or impossible.
 Indications.
1. When the client is unable to take food
by mouth. eg :unconscious patients.
2. In clients who refuses food. eg :client
with psychosis.
3. When conditions of the mouth or
oesophagus makes the swallowing
difficult or impossible. eg :jaw
fractures.
4. When the client is too weak to swallow
food or when a condition makes it
difficult to take a large amount of
food orally. eg :severe burns.
5. When the client is unable to retain the
food. eg :anorexia nervosa.
 Advantages.
 An adequate amount of all types of
nutrients including distasteful foods and
medication can be given.
 Large amount of fluid can be given.
 The dangers of parenteral feeding
(eg :venous thrombosis) are avoided.
 It can be continued for several weeks.
 The stomach can be aspirated at any
time.
 Overloading of the stomach can be
prevented by the drip method.
 Principles in gastric
gavage.
1. 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.
2. A thorough knowledge about the anatomy and
physiology of digestive tract and respiratory
tract, ensures safe induction of the tube (avoid
displacement of the tube).
3. Micro-organisms enter the body through food
and drink.
4. 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.
5. Systematic ways of working adds to the
comfort and safety of the client and helps
in the economy of material, time and
energy.
Method of differentiating the
placement of a naso -gastric
tube.
Digestive tract Respiratory tract
1. During insertion, the Client may experience
client experiences no dyspnea, violent cough
distress in breathing. and cyanosis.
2. Client has no difficulty Unable to talk if tube has
in talking. passed through the vocal
cord.
3. Listen to the distal A whistling sound is
end of the tube. No heard.
sound is heard.
4. Dip the distal end of A steady stream of air
the tube into a glass of bubbles indicate that the
water. There is presence tube is in the respiratory
of a few bubbles initially tract.
or no bubbles.
5. Attach a syringe to No fluid can be
the distal end of the withdrawn.
tube and aspirate. Some
gastric fluid is
withdrawn.
6. Listen over the No sound will be heard.
stomach with a
stethoscope while
injecting a small
amount(10 ml) of air into
• Aspirate stomach contents, and
check the pH, which should be acidic.
Rationale: Testing pH is a reliable
way to determine location of a
feeding tube. Gastric contents are
commonly pH 1 to 5.
• nasogastric tubes are radiopaque, and
position can be confirmed by x-ray.
Very much reliable method
 General instructions.
☻ Tube feeding is only given by a doctor’s
order.
☻ If the client is conscious, explain the
procedure and reassure the client to win
his confidence and cooperation.
☻ Remove dentures if any, to prevent it
from dislodging and blocking the
respiratory tract.
☻ Lubricate the tube with a water soluble
jelly.
☻ All equipment used for feeding should
be clean.
☻ Make sure that the tube is in the
stomach by aspirating a small amount of
stomach contents, each time before
giving a feed.
☻ While removing the tube, pinch the
tube and pull it out gently and quickly.
☻ During the introduction of the tube,
never use force as it may cause injury
to the mucus membrane.
☻ Avoid introducing air into the stomach
during each feed.
☻Apply restraints if necessary.
☻Feedings may be given at intervals
of 2, 3, or 4 hours and the amount
should not exceed 150 to 300 ml
per feed. The total amount in 24
hours is 2000 to 3000 ml.
☻ Intake and output is recorded
accurately.
☻ Watch for complications (nausea,
vomiting, distention, diarrhea,
aspiration pneumonia etc…)
☻ Frequent mouth care should be
given to prevent complications of a
neglected mouth.
 Nurse’s responsibility in
administering a tube feeding.
Preliminary assessment :
1. Identify the client with name, bed no,
o.p no etc…
2. Check the doctor’s order for any
specific orders.
3. Check the level of consciousness and
the ability to follow instructions.
4. Check the ability for self care, ability
to move and maintain a desired position
during the insertion.
5. Check whether the feed is ready at
hand.
6. Check the articles available in the
client’s unit.
Preparation of the articles.
Articles Purposes
A tray containing :
1. Mackintosh and to protect garments
towel and bed linen.
2. Kidney tray to discard waste.
3. Cotton tipped to clean the nostrils.
applicators
4. Ryle’s tube
5. Water soluble jelly to lubricate the tube
6. Adhesive plaster to fix the tube in
and scissors position.
7. Rag pieces in a to wipe secretions.
container
8. Paper bag to collect dry wastes.
9. Clean syringe to aspirate gastric
contents and to give
feed.
10. A glass of feed in to keep the feed
a bowl of warm water warm.
11. Ounce glass to measure the fluid.
12. A bowl with water to test the location
 Preparation of the client
and unit.
 Explain procedure to the client.
 Provide privacy.
 Provide a safe and comfortable position.
Make the client sit in fowler’s with the
help of back rest and pillows.
 Place mackintosh and towel across the
chest and under the chin to protect
garments and bed linen.
 Keep the kidney tray next to the
client, ready to use if he vomits.
 Remove dentures if any and place it
in a bowl of clean water.
 Arrange the articles conveniently on
the bed-side locker.
 give a rag piece to the client to wipe
the face and lips when necessary.
 Clean the nostrils, if there is any
secretions or crust formation.
 Procedure.
Procedure Rationale
1. Wash hands to prevent cross
infection.
2. Apply clean gloves Reduces transmission of
microorganism

3. Measure the distance acts as a rough guide to

on the tube from the determine the
bridge of the nose to the approximate length of
ear lobe plus the distance the tube to reach the
from the ear lobe to the stomach.
tip of the xiphoid
process. Mark the
4. Lubricate the tube 6 lubrication reduces
to 8 inches from the tip friction.
5 .Hold the tube coiled in nasal septum is little
the right hand and deviated into the right
introduce the tip into the side.
left nostril
6. Pass the tube gently stop if there is marked
but quickly backward and resistance and inspect
downwards. If there is posterior cavity for
slight resistance, coiled tubing.
withdraw the tube about
1 inch, rotate it side to
side and gently advance
the tube.
7. When tube reaches deep breathing relaxes
the pharynx, the client the pharynx. A brief
may gag. Allow him to pause may prevent
rest for a while and vomiting.
advice to take deep
breaths
8. Advice client to swallowing facilitates
swallow and advance the easy passage of the tube.
tube 3 to 4 inches each Mark on the tube
time, till it reaches indicates that tube has
previously designated reached the stomach.
mark.

9. Check placement of helps to prevent

tube in the stomach displacement of tube.
10. Once the tube is in careful fixing prevents it
place, tape it to the side from being displaced. A
of the face and wait for few minutes rest helps to
sometime before giving prevent nausea and
the feed. vomiting.
11. Give the feed and clamping the tube helps
medications. When the to prevent entry of air
feed is over, pour a little into the stomach.
water and clamp the tube
firmly just before all the
water goes in.
 After care of the client and
articles.
 Clean and dry the face.
 Remove the mackintosh and towel.
 Make the client comfortable in bed.
 Do suction of secretions incase of
unconscious patients.
 Take all articles to the utility room,
discard the wastes, clean the articles
and dry and replace them.
 Wash hands.
 Record the time, date, amount of feed,
nature of feed, reaction of client if any
in the nurse’s record.
 Record in the intake-output chart.
 Remove the tube when tube feeding is
to be stopped.
 Removal of tube.
1. Protect the garments with a towel placed
under the chin.
2. Remove the tape which is fixing the tube.
3. Clamp the tube firmly to prevent the fluid
within the tube from escaping and being
aspirated by the client.
4. Instruct the client to take a deep breath and
exhale slowly to relax the pharynx.
5. While the client exhales, pull out the tube
in one continuous motion.
6. Place tube in the kidney tray and take it
to the utility room.
7. Use a small amount of ether solution to
remove the adhesive marks from the
client’s skin.
8. Clean and dry the face.
9. Provide oral and nasal hygiene.
10. Record the date and time the tube was
removed in the nurse’s record.
 Gastrostomy/
Jejunostomy feeding.
Here, a part of the stomach
or small intestine is brought to the
abdominal wall and an opening is made
into it through the abdominal wall.
Foods given through the gastrostomy
are same as those given by
nasogastric tube and the same
amounts are given at the same
intervals.
 Indication.
 Used when tumors, fistulas or
operations on the upper alimentary
tract make it impossible for the
food to reach the stomach and
intestine by the normal route.
 Preliminary assessment.
 Identify the client with name, bed no, o.p
no etc…
 check the doctor’s orders for any
specific precaution.
 Check the ability for self care, ability to
move and to maintain a desired position.
 Check the articles in the client’s unit.
 Preparation of the
articles.
1. Disposable feeding container.
2. 30 ml or larger syringe.
3. Formula/feed.
4. Infusion pumps.
5. pH indicator strips (scale 0.0 to 14.0)
6. Stethoscope.
7. Clean gloves.
 Preparation of the
patient and unit.
 Explain the procedure to the client
to gain his confidence and
cooperation.
 Provide privacy.
 Assist the client in sitting upright
in a chair or bed.
 Procedure.
Steps Rationale

1. Assess the client’s identifies whether

need for enteral tube tube feeding still needs
feeding to be continued.
2. Auscultate for bowel absence of bowel sound
sounds before feeding indicates risk for
abdominal distention
due to absence of
peristalsis.
3. Wash hands prevents cross
4. Assess gastrostomy infection, pressure
site for breakdown, from tube or gastric
irritation or drainage secretions can cause
skin breakdown.
5. Connect tubing to
container.
6. Shake formula well
and fill the container
with the formula
7. Wear gloves and
verify tube placement.
8. Aspirate tube with delayed gastric
a syringe and check emptying may be
the pH and indicated by 100 ml
appearance of the or more of the
secretion. return the previous food
aspirated content to remaining in the
the stomach unless client’s stomach.
the volume exceeds
>100 ml. If volume is
>100 ml, stop feed and
notify the physician.
9. Initiate feeding…,
 Syringe feeding:
• pinch proximal end prevents excessive
of the tube, remove air from entering the
the plunger and
stomach.
attach the barrel to
the end of the tube
and fill the syringe
with the feed.
• release tube,
elevate syringe and
allow syringe to gradual feeding by
empty gradually by gravity reduces the
gravity. Refill until
risk of diarrhea
prescribed amount
induced by bolus tube
has been given.
 Continuous drip
method:
• Verify that volume
in container is
sufficient for the
length of feeding.
• Hang container on allows for gravity
the IV pole and
flow of formula.
thread tubing into
pump.
• Connect tubing to
the gastrostomy
tube.
• Begin infusion.
10. When feed is prevents air entry
getting over, pinch and flushes the tube
the tube and instill 10 from the feed.
to20 ml of water.
11. Cap or clamp the prevents air entry
proximal end of the into the stomach.
gastrostomy tube.
 After care of the
patient and articles.
1. Rinse container and tubing with warm
water.
2. Dispose supplies and wash hands.
3. Assess skin around tube site and apply
water-proof ointment such as zinc oxide
to prevent irritation.
4. Keep the site clean and dry always.
5. Inspect stoma site for signs of impaired
skin integrity.
 PARENTERAL
NUTRITION.
Meaning:
Parenteral nutrition is a form
of specialized nutrition support in
which nutrients are provided
intravenously.
 Indications.
 For clients who are unable to digest
or absorb enteral nutrition.
 Clients in highly stressed
physiological states such as sepsis,
head injury or burns.
 Sites used.
1. Jugular vein (internal and external).
2. Axillary vein.
3. Saphenous vein.
4. Femoral vein.
5. Inter-costal vein (right posterior).
6. Subclavian vein.
 Initiation of parenteral
nutrition.
1. Verify the doctor’s order and inspect
solution for particulate matter.
2. An infusion pump is used and a rate of 40
to 60 ml per hour is recommended.
3. Rate is gradually increased until the
complete nutrition needs are supplied.
4. Once infusion is over cork the catheter
to prevent air entry.
The goal of TPN is to move clients
from PN to enteral and oral nutrition.
Once the clients are meeting 1/3rd to
1/2 of their kcal needs per day, PN is
usually decreased to half the original
volume. EN feedings should then be
increased to meet the needs. When
75% of daily energy needs are
consistently met with tube feeding,
PN may be discontinued.
Complications
• Pul. Aspiration
• Diarrhea
• Constipation
• Tube occlusion
• Tube displacement
• Abdominal cramping
• Electrolyte imbalance
• Fluid overload
• Hypo/hyperglcemia
 “Thank
you”