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NGT Feeding Checklist Definition: Purpose/s: Assess:

Equipment Sterile rubber or plastic catheter, rounded tip, size 5-12 french Clear, calibrated reservoir for feeding fluid 5-10 ml syringe Stethoscope Sterile water or normal saline Tape-hypoallergenic Feeding fluid, room temperature pacifier Rationale This position allows for easy passage of the catheter, facilitates observation, and helps avoid obstruction of the airway. Remarks

Nursing action Preparatory phase 1. Position child on side or back with a rolled diaper placed under shoulders. A mummy restraint may be necessary to help maintain this position 2. Measure the distance from the tip of the patients nose to ear to xiphoid process of sternum and mark the length on the feeding tube with tape. 3. Have a suction apparatus readily available Performance phase 1. Lubricate catheter with sterile water or normal saline. 2. Stabilize the patients head with one hand; use the one hand to insert the catheter. a. Insertion through nares: Slip the catheter into the patients nostril and direct It towards the occiput in a horizontal plane along the floor of the nasal cavity. Do not direct the catheter upward. Observe for respiratory distress. b. Insertion through the

Premeasuring the catheter provides a guideline as to how far to insert the catheter.

Suctioning clears the airway and prevents aspiration if regurgitation occurs. Do not use oil because of danger of aspiration

This direction will allow the nares passageway into the pharynx. Positioning in nares may cause partial airway obstruction. Avoid this route if there is critical compromise

mouth: Pass the catheter through the patients mouth toward the back Of his throat. With his head tilted slightly forward. 3. If the patient swallows, passage of the catheter may be synchronized with the swallowing. Do not push against resistance.Gently try rotating the tube if resistance is met 4. If there is swallowing, insert the catheter smoothly and quickly 5. In the infant, especially, observe for vagal stimulation ( bradycardia,and apnea)

6. When the catheter has been inserted to the premeasured length, tape the catheter to the patients face

Swallowing motions will cause the esopharyngeal peristalsis, which opens the cardiac shincter and facilitates passage of the catheter. Perforation may occur with very little pressure . Because of cardiac sphincter spasm, resistance may be met at this point. Pause a few seconds , then proceed The vagus nerve pathway lies from the medulla through the neck and thorax to the abdomen. Above the stomach , the left and right branches unite to form the esophageal plexus. Stimulation of these nerve branches with the catheter will directly affect the cardiac and pulmonary plexus This prevents movement of the catheter from the premeasured, preestablished correct position. Alternative method: loop narrow tape around the tube just below the nostril, then secure it above lip or nose with tape.

7. Test for correct position of the catheter in the stomach: a. Inject 3-5 ml air, via the catheter, into stomach. At same time, listen for the typical growling stomach sound with a stethoscope placed over the epigastic region. b. Aspirate injected air from the stomach. c. Aspirate small amounts of stomach content. Aspirate could be tested for acidity.

a. Aids in ensuring proper location of catheter

b. This prevents abdominal distention. c. Failure to obtain aspirate does not indicate improper placement;

there may not be any stomach content or the catheter may not be in contact with the fluid.

d. Observe and gently palpate the abdomen for the tip of the catheter. Avoid inserting the catheter into the infants trachea. (an infants anatomy makes it relatively difficult to enter the trachea because the esophagus is behind the trachea. e. Further secure the tube to the patients cheek by using tape. Avoid using paper tape, which loosens if exposed to secretions or formula. 8. The feeding position should be right side lying, with the head and chest slightly elevated. Attach the reservoir to catheter and fill with feeding fluid. Encourage the infant to suck on a pacifier during feeding. Hold the infant when possible 9. The flow of the feeding should be slow. Do not apply pressure. Elevate the reservoir 6-8 inches (15-20 cm) above the patients head. a. Feedings given too rapidly may interfere with peristalsis, causing abdominal distention, regurgitation and possibly emesis. b. Feeding time should be approximately as long as when a corresponding amount is given by nipple, 5 ml/5-10 minutes or 15-20 minutes total time 10. When the feeding is completed, the catheter may be irrigated with a clear water.

d. If improper placement occurs and the catheter enters the trachea, the patient may cough, fight and become cyanotic. Remove the catheter immediately and allow the patient to rest before attempting to insert the tube again.

e. Adhesive should not loosen easily and should be washable, because it may be exposed to secretions. This position allows the flow of fluid to be aided by gravity. The use of the pacifier will relax the infant, allowing for easier flow of fluid as well as provide for normal sucking needs. Sucking will help develop muscles and provide a positive association between sucking and relief of hunger. The rate is controlled by the size of the feeding catheter; the smaller the size, the slower the flow. If the reservoir is too high, the pressure of the fluid itself increases the rate of flow. a. The presence of food in the stomach stimulates peristalsis and causes the digestive process to begin.

Clamp the catheter before air enters the stomach and causes abdominal distention. Clamping

Before the fluid reaches the end of the catheter, clamp it off and withdraw it quickly or keep in place for the next feeding. Follow up phase 1. Burp the patient. (The patient may not burp if air was aspirated from the tube following the feeding) 2. Place the patient on his right side for at least 1 hour. 3. Observe the patients condition after feeding; bradycardia and apnea may still occur. 4. Note vomiting or abdominal distention

also prevents fluid from dripping from the catheter into the pharynx, causing the patient to gag and aspirate Adequate expulsion of air swallowed or ingested during feeding will decrease abdominal distention and allow for better tolerance of the feeding. To facilitate gastric emptying and minimize regurgitation and aspiration. Because of vagal stimulation .

5. Note the infants activity

Due to overfeeding or too rapid feeding. Regurgitation of 1-2 ml may occur in the premature infant as the musculature of the sphincter of the GI tract is relaxed and allows easy reflex. Fatigue or peaceful sleep offers insight as to tolerance of the feeding. Observe for readiness of the infant to feed by nipple-note sucking activity and sleep wake cycle in relation to feeding.

6. Accurately describe and record procedure, including tome of feeding, type of gavage tube feeding, type and amount of feeding fluid given, amount retained or vomited, how the patient tolerated feeding and activity before and after feeding.

Demonstrated by:_____________________________________________________________

Demonstrated to: _____________________________________________________________ Date: _______________________________________________________________________