4. The administration of a nutritionally adequate
hypertonic solution consisting:
● Carbohydrates (Glucose/dextrose)
● Protein (amino acids)
● Fats (lipids)
● Minerals
● Vitamins
● Water and electrolytes
● Trace elements
● Through indwelling catheter into the
superior vena cava or other vein.
● Fat is also provided in a three in one
solution or “piggy backed”
CHO
CHON
Fat
Wit
Min
02/elec
7. INDICATIONS
TPN may be the only feasible option for patients who do not have a
functioning GI tract or who have disorders requiring complete bowel
rest, such as the following:
● Some stages of Crohn's disease or ulcerative colitis
● Bowel obstruction
● Certain pediatric GI disorders (eg, congenital GI anomalies,
prolonged diarrhea regardless of its cause)
● Short bowel syndrome due to surgery
-
8.
9. Administration
BEGINNING OF ADMINISTRATION
● Aseptic technique must be used during insertion and maintenance
● Central line should not be used for any other purposes
● External tubing should be change every 24 hours
MONITORING
● Weight, CBC, electrolytes, BUN should be monitored daily
● Glucose level should be monitor q6 until level is stable
● IF POSSIBLE, blood test SHOULD NOT be done during infusion
&
W
O
14. NASOGASTRIC TUBE (NGT)
● It is the insertion of a tube into the esophagus and
stomach through the nose
● It is defined as the passage of single or double lumen
tube through the nose or mouth to stomach for the
purpose of the drainage, instillation, decompression,
lavage or performance of diagnostic tests
16. INDICATIONS
● Patient who cannot eat (GIT functioning normally)
○ Comatose patient
○ Mechanically ventilated
● Patient who will not eat
○ Patients who refuse to eat
■ Elderly
■ Disoriented patients
○ Patients who cannot maintain adequate oral nutrition
■ Patients with infection, trauma, cancer etc.
■ Surgery
17. CONTRAINDICATIONS
● Gastric surgery
● Ulcers
● Tracheoesophageal fistula
● esophageal surgery
● Polyps in nose , recent nasal surgery, facial surgery
● Deviated nasal septum
● Patient on anticoagulant therapy
23. ASSESSMENT:
● Remove dentures to avoid aspirations
● Assess patency of the nares
● Assess for patient history
● Assess for gag reflex
● Assess for mental status
24. PROCEDURE:
● Verify doctor’s order
● POSITION : High Fowler’s position
● Measure the length of the NGT to be inserted
● Do not forcefully push the NGT
● Offer water with straw
● Check if properly placed
● Marked the NGT
● secure
25. METHODS TO CONFIRM PROPER
PLACEMENT OF NGT
● X-RAY
○ confirmatory
● ASPIRATE
○ Check pH and color of gastric content
● IMMERSE
○ Check for the presence of bubbles
● AUSCULTATE
○ Check for gushing (borborygmi) sound
29. Loading…
NGT FEEDING
NGT feeding is the
delivery of foods/
nutrients or medications
from the nasal route into
the stomach via a feeding
tube
Osterized Food OF
Nutrition UN
30. PURPOSE
● To Provide Adequate Nourishment to Patient Who Cannot Feed
Themselves
● For medication administration
● To Provide Nourishment to Patients Who Cannot Be Fed Through
Mouth. Such as
○ Surgery In Oral Cavity ,
○ Unconscious Or Comatose State
31. EQUIPMENT
● Prescribe feeding formula
● Non sterile gloves
● Stethoscope
● Additional PPE if needed
● Asepto syringe
● Clamp
● Water for irrigation
● pH paper
● Tape measure
32. PROCEDURE
● Prepare the exact feeding formula; its amount, concentration and expiration before
entering to the patient’s room
● POSITION: Semi to high fowlers
● Check for the proper placement of the NGT
● Check the amount of residual before giving the enteral feeding
● Return residual after checking
● Flush 30 ml of water into the tube for primary irrigation
● Pour the feeding into the asepto syringe and slowly regulate
● Add 30 -60 ml water after the feeding is almost complete
● Clamp and secure the tube
● Have patient remain in upright position for at least 1 hour after feeding
&
Lame
35. Removing Nasogastric Tube
● When the NG tube is no longer necessary for treatment, the physician will order the
tube to be removed.
● The NG tube is removed as carefully as it was inserted, to provide as much comfort
as possible for the patient and to prevent complications.
● When the tube is removed, the patient must hold his or her breath to prevent
aspiration of any secretions or fluid left in the tube as it is removed.
36. PROCEDURE
● POSITION: semi to high fowlers
● Attach syringe and flush 10 ml of water
● Clamp the tube and carefully removed the NGT
● Ask the patient to hold his/her breathe while removing the NGT
● Offer mouthcare
● Measure the amount of NGT drainage
● Record
39. Indications
● Neurological swallowing disorders such as cerebral palsy, MS
● Esophageal stricture or atresia
● Esophageal cancer
● Gastric outlet or small bowel obstruction
● Major neck surgery
● Conditions that requires prolonged tube feeding for > 4 weeks
40.
41.
42. Care of GT
● Inspect the insertion site
● If there is pain, offer analgesic as
prescribed
● Keep the site clean to avoid infection
● Avoid adjusting the external disk for
the first few days of placement
● Keep the site dry
● Leave the site open to air unless there
is drainage
