NG TUBE FEEDING Definition Administration of feed directly into the stomach through a tube passed into the stomach

through the nose (nasogastric) or mouth (orogastric). Purposes To provide adequate nourishment to patients who cannot feed themselves To administer medications To provide nourishment to patients who cannot be feed through mouth , e.g. surgery in oral cavity Indication Same as NG tube insertion Articles A clean tray containing 1. 2. 3. 4. 5. 6. 7. 8. 9. Fomula feed (or any feed) in a glass or container Large syringe (30 to 60ml) Small syringe (5 to 10 cc) Water in a container or glass Kidney tray Towel with mackintosh Clean gloves Bowl containing gauze pieces Stethoscope

Procedure 1 Procedure Identify the patient and explain procedure to patient and that feeding will take around 10 to 20 minutes to complete. Also explain the patient will experience a feeling of fullness after feeding Assess the time of last feed and bowel sounds Rationale Proper explanation relieves anxiety and ensures cooperation

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Assessment of time of feed avoids excessive feeding and prevent complications Assist the patient to fowlers position (35 to 45 This position facilitates the gravitational flow of feed degree) and prevent aspiration of feed Perform hand hygiene Spread towel and mackintosh over the patients chest Put the gloves Confirming the position of tube: Remove the plunger and attach the 5cc or 10 cc syringe barrel to nasogastric tube after pinching It reduces the risk of bacterial contamination Protects patient and bed linen from soiling

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To protect the nurse hand from contamination and to confirm the tube is in proper place

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it or folding it and aspirate the stomach or residual contents Or Push 2cc of air into the stomach through tube and place the stethoscope diaphragm over the epigastric area and hear gushing sound. It confirms the tube placement Re instil the gastric contents into the stomach if this is the agency policy or primary care provider's order or discard the aspirate content into the kidney tray If the tube placement is confirmed in stomach, pinch the feeding tube and attach barrel of (30 to 60 cc) feeding syringe to tube. Fill the syringe barrel with water and allow fluid to flow in by gravity, by raising barrel above the level of patients head Pour warm feed into syringe barrel and allow it to flow by gravity. Keep on pouring feed/ formula to barrel when it is three quarters empty After feeding is completed, flush the tube with at least 30cc of plain water after tube is cleared close end of the feeding tube Rinse equipment with warm water and dry Keep head end elevated for 30 to 60 minutes after feeding Wash hands Document type and amount of feeding, amount of water given and tolerance of feed Monitor for breath sounds, bowel sounds, gastric distension, diarrhoea, constipation and intake and output Instruct patient to notify nurse if he/she experiences sensation of fullness, nausea or vomiting Feeding bag system Hang the labelled bag from an infusion pole about 30 cm (12 in.) above the tube's point of insertion into the client. Clamp the tubing and add the formula to the bag. Open the clamp, run the formula through the tubing, and reclamp the tube.

Removal of the contents could disturb the client's electrolyte balance.

Pinching of feeding tube prevents air from entering the stomach and causing distension Water clears the tube and rate of flow is regulated by raising or lowering the syringe Prevents air from entering tube and An excessively cold feeding may cause abdominal cramps.

Prevents clogging of feeding tube Prevents back flow of the feeding content Prevents bacterial growth Prevents aspiration Reduce the risk of transmission of micro organism Documentation act as an evidence Evaluate for aspiration effects on gastro intestinal system and therapeutic effect of feeding May indicate intolerance of feeding

The formula will displace the air in the tubing, thus preventing the instillation of excess air into the client's stomach or intestine.

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Attach the bag to the feeding tube and regulate the drip by adjusting the clamp to the drop factor on the bag (e.g., 20 drops/mL). (sometimes it may attached to infusion pump) Repeat 13 to 18 steps

Infusion pump or clamp regulates the flow

Special considerations/ general instruction: Tube feeding given only by doctors order Change NG tube according to hospitals policy Maintain Intake Output chart Remove the dentures to prevent from dislodging or blocking the respiratory tract Lubricate the tube 4 to 8 inches to avoid friction Before giving feed aspirate to make sure tube is in stomach Avoid air entry and try to not push any air into stomach Give mouth wash frequently Pour little water before and after feeding to prevent occlusion Document after the procedure