This document provides instructions for nasogastric tube insertion and feeding. Key points include: 1. Nasogastric tubes are inserted through the nose into the stomach for various purposes such as administering medications or nutrition to patients unable to swallow. 2. The procedure involves measuring the tube length from the nose to earlobe to xiphoid process and lubricating and inserting the tube while the patient swallows. Placement is confirmed with an abdominal x-ray. 3. Feeding administration involves checking residual volumes, administering at a slow rate while elevating the head, and flushing the tube before and after with water or saline. Complications like diarrhea, aspiration, clogging and vomiting are

1. Ryles TubeInsertion And
Feeding

2. Nasogastric Tube
Thesearetubesusedtointubated
thestomach.
Thetubesisinsertedfromthenose
tothestomach.

3. Purposes
To decrease the risk of aspiration
To administer medication to client
who are unable to swallow.
To provide nutrition by acting as a
temporary feeding tube.
To irrigate the stomach and remove
toxic substance such as in poisioning.

4. Articles required

5. Procedure
• Follow agency procedures.
• Explain the procedure and its potential discomfort to the
client.
• Position the client in a high Fowler's position with pillows
behind the shoulders
• Determine which nostril is more patent.

6. Procedure
• Measure the length of the tube from the bridge of the nose to the earlobe to the
xiphoid process and indicate this length with a piece of tape on the tube
(remember the abbreviation NEX, which stands for nose, earlobe, and xiphoid
process).
• If the client is conscious and alert, have him or her swallow or drink water (follow
agency procedure).
• Lubricate the tip of the tube with water-soluble lubricant.
• Gently insert the tube into the nasopharynx and advance the tube.

7. Procedure
• When the tube nears the back of the throat (firstblackmeasurement on
the tube),instruct the client to swallow or drink sips of water (unless
contraindicated). Ifresistance is met,slowly rotateand aim the tube
downwardand toward the closer ear;in the intubated or
semiconscious client,flexthe head toward the chest while passing the
tube.
• Immediately withdraw the tube ifany change is noted inthe client's
respiratorystatus.
• Following insertion, obtain an abdominal x-ray studyto confirm
placement of thetube.

8. Procedure
• Secure the tube to the client's nose with adhesive tape and to the
client's gown (follow agency procedure and checkfor in client
allergy to tape).
• Observe the client for nausea, vomiting, abdominal fullness, or
distention and monitor gastric output.

9. 15. Check residual volumes every 4 hours, before eachfeeding,
and before giving medications. Aspirate all stomachcon-
tents (residual) and measure the amount. Reinstillresidual
contents to prevent excessive fluid and electrolytelosses,
unless the residual contents appear abnormal or thevol-
ume is large (greater than 250 mL). Always follow agency
procedure. Withhold a feeding if the residual amountis
more than 100 mL or according to agency or nutritional
consult recommendations.

10. 16. Before the instillation of any substance through thetube
(i.e.,irrigation solution, feeding, medications),aspirate
stomach contents and test the pH (a pH of 3.5 or lower indi-
cates that the tip of the tube is in a gastriclocation).
17. If irrigation is indicated, use normal saline solution .

11. 18. Observe the client for fluid and electrolyte balance.
19. Instruct the client about movement to prevent nasal irrita-
tion and dislodgment of thetube.
20. On a daily basis, remove the adhesive tape that issecuring
the tube to the nose and clean and dry the skin,assessing
for excoriation; then reapply the tape.

12. Administration Of Feeding

13. 4.

14. 5.Always assess bowel sounds; do not administer
any feedings if bowel sounds are absent.
6.Administer the feeding at the prescribed rate or
via gravity flow (intermittent bolus feedings)
with a 50- to 60-mL syringe with the plunger
removed.

15. 7. Gently flush with 30 to 50 mL of water orNS
(depending on agency policy) usingthe irriga-
tion syringe after the feeding.

16. Precautions:
1.Change the feeding container and tubing every 24 hours or per agency policy.
2.Do not hang more solution than is required for a 4-hour period; this prevents
bacterial growth.
3.Check the expiration date on the formula before administering.

17. 5.Aspirates all stomach contents ( residual),measure the amount and
return the contents to the stomach to prevent electrolyte imbalance
(unless the color or characteristics of the residual is abnormal or the
amount is greater than 250ml)
6.Warm the feeding to room temperature to prevent diarrhea andcramps.
7.For bolus feeding maintain the client in a High Fowler’s position for30
minutes after the feeding
8.For continuous feeding, keep the client in a semi-Fowler,s position atall
time.

18. Prevention of Complication
1. Diarrhea
a. Assess the client for lactose intolerance.
b. Use fiber-containing feedings.
c. Administer feeding slowly and at room
temperature.

19. 2. Aspiration
a.Verifytube placement.
b.Do notadminister thefeedingif residualis
morethan100mL(checkHCP'sprescription
andagencypolicy).
c.Keeptheheadof thebed elevated.

20. d.If aspiration occurs, suction as needed, assess respiratoryrate,
auscultate lung sounds, monitor temperature for aspiration
pneumonia, and prepare to obtain a chestradiograph.

21. 3. Clogged tube
a.Useliquid formsof medication,ifpossible.
b.Flush thetubewith 30to50mL of water or NS beforeand after
medicationadministrationandbeforeandafterbolusfeeding
c.Flushwithwaterevery4hoursfor continuous
feeding.

22. 4. Vomiting
a.Administerfeedingsslowlyand,for bolusfeedings,make feeding
lastfor atleast30 minutes.
b.Measureabdominal girth.
c.Do notallowthefeedingbagto empty
.
d.Do notallowairtoenterthe tubing.

23. e.Administer the feeding at room temperature.
f.Elevate the head of thebed.
g. Administer antiemetics as prescribed.