Jyoti`s INDIRA GANDHI SCHOOL AND COLLEGE OF NURSING MUNSHIGANJ, AMETHI, UTTAR PARDESH, 227812. TOPIC NAME - NASOGASTRIC TUBE FEEDING AND INSERTION , SUBTOPIC INCLUDE - INTRODUCTION, DEFENITION, TYPE , PURPOSE, PROCEDURES, ETC.

2. Indira gandhi college of nursing
Nasogastric tube insertion/feeding
Presentedby
Ms jyoti yadav
s

3. CONTENT
Today we will discuss about the –
Terminology
Introduction of NG tube insertion and feeding
Definition of NG tube insertion and feeding
Purpose
Articles
Size of NG tube
Type of NG tube

4. CONT…….
Type of NG tube feeding
Procedure of NG tube insertion
Procedure of NG tube feeding
Care of NG tube
Complication of NG tube Feeding
Summary
Conclusion
Bibliography

5. Terminology
1. Nasogastric Tube-
a) NG- means “Nose to Stomach”
b) Tube- means “It is thin flexible plastic tube
that`s used for temporary medical purpose”
2. Gastric lavage- it is an invasive procedure
involving cleaning and removing stomach
content. It also called gastric pumping or
gastric suctioning.

6. CONT…
3. Dysphagia- it means swallowing difficulty.
4. Polyps - A polyps is an abnormal growth of
tissue projecting from a mucous membrane.
5. Nasal lesions- a fibrous papules of the nose
is common and harmless skin lesion.
6. Gastric gavage- provide a direct feeding into
stomach.

7. INTRODUCTION
Introduction of NG tube insertion-
A tube that is passed through the nose and
down through the nasopharynx and
esophagus into the stomach.
Introduction of NG tube feeding-
A nasogastric tube is a special tube that carries
food and medicine to the stomach through
the nose.

8. definition
Definition of NG tube insertion-
“Small size to be inserted in the stomach
through the nose.”
OR
“Insertion of a small bore tube to the stomach
through the nasopharynx.”
- According To Annmma Jacob

9. Cont……
Definition of NG tube Feeding-
“NG tube feeding is an artificial method of giving
fluid and nutrients through a tube that has been
passed into the esophagus and stomach through
the nose, mouth or through an opening made on
the abdominal wall.”
OR
“A tube is passed through the nose and esophagus
into the stomach. It also called nasal feeding.”
- According To Annmma Jacob

10. purpose
To provide feeding to unconscious client
 Client having mouth surgery
Gastric analysis
Gastric lavage
Decompression o f stomach
After stomach surgery
To administer medication
Dysphagia
Gastric gavage

11. Articles of ng tube insertion/ feeding
 1% soda bicarbonate
 Local anesthesia like 2% or 2% lignocaine jelly
 Kidney trays -2

12. Cont…
 Mackintosh and towel
 Cotton tipped application
 Saline

13. Cont…
 Adhesive plaster or scissors
 Measuring cup or marked drinking cup/ formula
feed
 Bowl with water

14. Cont…
 Large syringe (30 to 60ml)
 Stethoscope
 Clean gloves

15. Cont….
 Suction apparatus
 pen light/ flash light
 Tongue blade

16. Cont…..
 Levine's tube or ryles tube
 Glass of water

17. Cont….
 Clamp

18. Size of ng tube
1. For infant-
a) 8 french (blue color)
b) 10 french (black color)
2. For child-
a) 12 french(white color)
b) 14 french(green color)
3. For infant-
a) 16 french (orange color)
b) 18 french (red color)
c) 20 french(yellow color)

19. Type of ng tube
There are two type of NG tube-
1. Single lumen tube- it is also known as levin
tube. This type of tube has one opening and it is
used only for feeding.
2. Double lumen tube- it is also called salem somp
catheter, which is a large bore NG tube with
double lumen (2 opening) use for stomach
irrigation also.
1. SINGLE LUMEN
TUBE
2. DOUBLE LUMEN
TUBE

20. Type of ng tube
1.Single lumen

21. Cont…..
2. Double lumen

22. Part of ng tube

23. Type of ng tube feeding
There are two type of NG tube feeding-
1. Continuous- small amount of feed given in long
time also called regular feeding person place in
semi- fowler`s position during this type of feeding.
2. Bolus feeding- this type of feeding also known as
gravity feeding. In this large amount of feed given in
short time (with in 20 minute)during this feeding
client in fowler`s position. Amount(250-400ml)
Continuous
feeding
Bolus
feeding

24. Route of insertion
1. Nasogastric tube feeding
2. Oro- gastric tube feeding
3. Gastrostomy tube feeding

25. Preliminary assessment
ENVIRONMENT PREPARATION
SELF PREPARATION
ARTICLE PREPARATION
CLIENT PREPARATION

26. Procedure of ng tube insertion
Nursing action Rationale
1. Identify the client. Help in the determining the
appropriate size of the
nasogastric tube for client
2. Check the physician order for
any precautions such as for
positioning.
3. As certain the level of
consciousness and ability to
follow instruction
Avoid the risk of aspiration of fluid

27. Cont…
6. As certain the ability of client
to maintain desired position
during insertion
Facilitates insertion of the
tube
7. Review the client medical
history for any nasal lesions,
bleeding , polyps or deviated
nasal septum
May require change in the
route nutritional support, e.g.
orogastric insertion
8. Give a mouth wash to clean
the mouth
Prevent from infection

28. Cont…..
9. Clean the nostrils if there are
secretions or crust formation of
nasogastric insertion
10. Wash hand Prevent from infections
11. Explain procedure to client Reduce anxiety and fear of
client
12. Place the client in a high
fowlers position (comatose client
in semi flower`s position)
Facilitates insertion of the
tube and reduce risk of
aspiration

30. Cont……
13. Place mackintosh and towel
across the chest
Prevents soiling of client or
client dress
14. Measure the length of the
tube, e.g. – from tip of nose to tip
of the ear lobe and to the tip of
xiphoid process and mark with
tape
The measured length
approximates the distance
from the nose to the
stomach.
15. Cut the adhesive tape 10 cm
long and keep ready to fix the
tube
For easy accessibility
16. Put on clean gloves From prevention of
contaminated secretions.

32. Cont…
17. Lubricate the tip of the tube
about 6-8 inches with water
soluble lubricant, using a gauze
pieces.
Lubrication reduces friction
between mucus membrane
and the tube. Water soluble
lubrication easily dissolves.
18. Insert the tube through the
left nostril to the back of the
throat aiming back to and down
toward the ear.
Natural contours facilitate
the passage of the tube.
19. Flex the clients head towards
the chest after the tube has
passed the nasopharynx.
Reduces the risk of tube
entering the trachea.
20. Encourage client to swallow by
giving sips of water when possible.

33. C0NT……
21. If during insertion respiratory distress occur
the full back the tube a little and wait for subside
the condition and insert it again.
22. Then check the correct placement of the
tube –
•X – ray may be done.
•Place the end of the tube in a bowl of water to
check for continuous air bubbles in water.
•Infuse 10ml air heard its sound over stomach
(whoosh sound).
•Aspirate gastric contents and check ph using
litmus paper if available.
23. Examine the clients mouth using a tongue
blade and flash light/ pen light.
The tube may be
coiled in mouth.

34. CONT…..
24. Secure the tube with tape and
avoid pressure on nares.
- use a 10cm (4 inches ) pieces of tape,
split at one end.
25. Make client comfortable in bed and
provide oral hygiene every 4 - 6 hours.
26. Remove gloves.
•dispose of articles .
•Wash hands .
•Record type of tube placed , aspirate
returned, tolerance.
Helps in communicating
with staff members.

35. Procedure of ng tube feeding
Nursing Action Rationale
1. Identify patient and explain
procedure to client and that feeding
will take around 10 to 20 minute to
complete. Also explain that client will
experience a feeding of fullness after
feeding
2. Assess for food allergies, time of
last feed, bowel sound and lab values
Proper assessment will
prevent risk of complication
3. Place container with feed in warm
water
High temperature may
damage the tube and cold
feed may cause discomfort
to client

36. Cont…..
4. Assist client to fowlers position
(35 to 45 degree) at least
Fowlers position enhance
gravitational flow of feed
through tube and prevents
risk of aspiration
5. Wash hand Reduce risk of transmission
of microorganism
6. Spread towel and mackintosh
over client chest
Protects client and bed
linen from soiling
7. Don gloves and attach syringe to
nasogastric tube

38. Cont….
8. Aspirate stomach contents.
If there is doubt about tube
placement inform physician
and obtain an order for X – Ray
If residual gastric contents
exceed 100ml for intermittent
tube feeding or greater than 1.5
times the hourly rate for
continuous feeding, with hold
feed and notify physician
9. If residual content are
within normal limits and
placement of the tube has
been confirmed, return gastric
content to stomach through
syringe using gravity to
regulate flow
Returning gastric contents to
stomach prevents fluid and
electrolyte imbalance

39. Cont…
10. If tube placement is
confirmed in stomach pinch the
feeding tube and attach barrel of
feeding syringe to tube
Pinching of feeding tube
prevents air from entering
the stomach and causing
distension
11. Fill syringe barrel with water
and allow fluid to flow in by
gravity, by raising barrel above
level of client head
Water clears the tube and the
rate of flow is regulated by
raising or lowering the
syringe

40. Cont…
12.Pour feed into syringe barrel and
allow it to flow by gravity. Keep on
pouring feed formula to barrel when it
is three quarters empty. Pinch tube
whenever necessary t stop when
pouring.
Prevents air from
entering tube
13. After feeding is completed , flush
tube with at least 30cc of plain water.
Prevent clogging of
feeding tube
14. After tube is cleared closed end of
feeding tube.
Prevents leakage
15. Rinse equipment with warm water
and dry. Replace every 24 hours as per
policy.
Prevents bacterial
concentration

41. Cont….
16. Keep head of bed elevated for 30
to 60 minute after feeding.
Prevents aspiration
17. Wash hand
18. Document type and amount of
feeding, amount of water given and
tolerance of feed
19. Monitor for breath sound and
other complication of client.
20. If client to having any
complication inform immediate to
nurse.
May indicate intolerance
of feeding

42. Care of ng tube
1. Check placement before every feeding by
aspiration or auscultation method.
2. Check residential volume before every feed
normal amount 100ml if more than 100 ml
hold next feeding
3. Change feeding every 4 hourly
4. Change of feeding container every 24 hourly
5. Change the NG tube every 7 days or
according to hospital policy

43. Complication of ng tube feeding
a) Vomiting
b) Diarrhea
c) Infection
d) Pressure sore
Removing of NG tube-
Deep breath and hold, remove the
tube 3 to 6 second.

44. summary
In today demonstration class we discussed about-
Terminology
Introduction of NG tube insertion/ feeding
Definition of NG tube insertion/ feeding
Purpose and articles
Size of NG tube
 Types of NG tube and feeding
Procedure of Ng tube insertion and feeding
Care of NG tube
Complication of NG tube feeding

45. conclusion
The class is able to understand about topic
‘ NG tube insertion/ feeding ’ and able to
follow the procedure as demonstrated for
providing NG tube insertion/ feeding in future.

46. bibliography
1. Jacob. Annamma. R. Rekha etc. clinical nursing
procedure- the art of nursing practice. III ed.
Jaypee brothers publication . Pp- 167 – 169
2. Nancy Sr. principles and practice of nursing-
nursing art procedure. III ed. Volume- I
Indore road: publishing house pp 230
3. TNAI. Chawla Satish. Foundamentals of
nursing. A procedure manual. Published by
TNAI. Pp 536.