fundamentals of nursing

1. NG Tube Feeding
- MS. KHYATI CHAUDHARI

2. Introduction
Patients in the hospital, as well as home care settings, often require nutritional
supplementation with enteral feeding.
Enteral feeding can be administered via nasogastric, Naso-duodenal and Naso-
jejunal means.
The focus of this clinical practice guideline is on the nursing management of
nasogastric tube feeding.
Nasogastric tube feeding may be accompanied by complications. Thus, it is
important for the practitioner to be aware of how to prevent it.

3. Definition
Nasogastric tube feeding is defined as the delivery of nutrients from the nasal
route into the stomach via a feeding tube.

4. Purposes
1. To provide adequate nourishment to patients who cannot feed themselves.
2. To administer medication.
3. To provide nourishment to patients who cannot be fed through mouth, e.g.
surgery in oral cavity, unconscious or comatose state.

5. Indications
1. Head and neck injury
2. Coma
3. Obstruction of esophagus or oropharynx.
4. Severe anorexia nervosa.
5. Recurrent episodes of aspiration.
6. Increased metabolic needs- burns, cancer, etc.
7. Poor oral intake.

6. Articles
A tray containing
– Mackintosh and towel
– 50cc syringe/ feeding tube and 5cc syringe
– Stethoscope
– Bowel with water
– Adhesive with scissors
– Feeds and water
– Ounce glass
– Kidney tray

7. Preliminary assessment
Identify the correct patient
 Check the doctor’s order
 Check the level of consciousness
 Check whether feed is ready at hand
 Articles available in the unit

8. Preparation of patient and environment
Explain the sequence of procedure
Provide adequate privacy
Position (sitting or semi fowlers)
Place mackintosh and towel around the neck
Arrange the articles at the bed side locker
Clean the mouth by providing mouthwash

9. Procedure
Wash hands
Ensure the tube is in the stomach
Remove plunger from syringe…………..Pinch tube to prevent air
entry……….Remove spigot….connect syringe to the tube.
Aspirate stomach contain & discard it in kidney tray.
Keep syringe about 12 inches above patients head.
Start feed with small measured amount of water and allow feed to follow
slowly and steadily through tube in such a way, that air does not enter tube

10. Do not force fluid, allow to flow by gravity
At end of feed flush tube by pouring small measured amount of
water…..remove syringe and replace spigot

11. After care
Remove towel
Place the patient in comfortable position
Replace the articles to utility room, clean it and replace it
Record the procedure in nurses record and intake out-put chart.

12. Gastrostomy/ jejunostomy feeding

14. Gastrostomy feeding :
A feeding is given through an artificial
opening made surgically into the
stomach through the abdominal wall
for feeding purpose when the patient
is not able to swallow through
esophagus.

15. Jejunostomy feeding
Jejunostomy is the surgical creation of an opening (stoma) through the skin at
the front of the abdomen and the wall of the jejunum(part of the small
intestine)
A jejunostomy is an alternative to a gastrostomy .
The advantage over a gastrostomy is its low risk of aspiration due to its distal
placement

17. Purpose
To maintain nutritional status of a patient whose upper GI Tract is bypassed.

18. Articles
1. Disposable gavage bag and tubing
2. 60 ml syringe
3. Stethoscope
4. Feed
5. IV stand
6. Administration set

19. Procedure
Identify the patient need that is the type & timing of feed needs to be planned.
Assess patient for allergies. So, it prevents patient from developing localized or
systemic allergic responses.
Auscultate for bowel sounds before feeding. Bowel sounds indicate presence
of peristalsis & ability of GI Tract to digest nutrients.
Verify physician’s order for formula, rate & frequency. To reduces error in the
feeding process.
Assess gastrostomy site for skin breakdown, irritation or drainage.
Wash hands to prevent cross infection.

20. Prepare bag and tubing to administer feed.
a) Connect tubing & bag.
b) Fill bag & tubing with feed.
- Administering of feed through tubing prevents excess air entering GI Tract.
Explain procedure to patient to gain trust & co-operation.
Place the patient in fowler’s position or elevate head of bed 30 degrees.
Elevating patient’s head helps to prevent chances of aspiration.
 check placement of gastric tube.
- Aspirate the gastric secretions & check gastric residual contents.

21. Initiate feeding
1. Bolus or intermittent feeding
- Pinch proximal end of gastrostomy tube.
- Attach syringe to end of tube & elevate to 18 inches above the patient's
abdomen.
- Fill syringe with formula. Allow syringe to empty gradually & refill it until
prescribed amount has been delivered to the patient.
- If gavage bag is used, attach bag to the end of the feeding tube & raise bag
18 inches above patient’s abdomen. Fill bag with prescribed amount of feed,
allow bag to empty gradually over 30 minutes.

22. 2. Continuous drip method
- Hang gavage bag to IV pole.
- Connect end of bag to the proximal end of the gastrostomy tube.
- Connect infusion pump & set rate.
 Continuous drip method is designed to deliver a prescribed hourly feeding.
 This method reduces the risk of diarrhea.
 Patient who receive continuous drip feedings should have residual gastric
contents checked every 4 hours.

23. Infusion pump

24. When the tube feeding are not being administered, clamp the proximal end of
the feeding tube.
Administer water via feeding tube as ordered, with or between feedings.
Rinse bag & tubing with warm water after bolus feedings.

25. After care
Change gastrostomy site dressing as needed.
Dispose off supplies & wash hands.
Evaluate patient tolerance of feeding by checking the amount of aspirate every
4 hours.
Monitor intake output.
Weigh patient daily.
Observe laboratory values.

26. Observe stoma site for skin integrity.
Documentation & record that is amount and type of feeding, status of
gastrostomy tube & any untoward effects.