NURSING SKILLS ENTERAL NUTRITION / NGT Lecturer: Mark Fredderick R.

Abejo RN,MAN _____________________________________________

NASOGASTRIC TUBE is inserted through one of the nostrils, down the nasopharynx and into the alimentary canal

Fr. 12 , 36 inches NG tube

Fr. 8 Opaque, 45 inches, stylet, weighted tip

Inserting a Nasogastric Tube
Purposes: To administer tube feedings and medications to clients unable to eat by mouth or swallow a sufficient diet without aspirating foods or fluids into the lungs (gastric gavage) To establish a means for suctioning stomach contents to prevent gastric distention, nausea and vomiting. (gastric lavage) To remove stomach contents for laboratory analysis To lavage (wash) the stomach in case of poisoning or overdose of medications Equipment - Nasogastric Tube ( Levin Tube ) - Clean gloves - Water soluble lubricant - Non allergic adhesive tape - Glass of water or drinking straw - Asepto syringe - Basin - Stethoscope - pH test strip (optional) - Facial tissue or cloth - Clamp or plug (optional)

Lecture Notes on Enteral Nutrition ( Nasogastric Tube ) Prepared By: Mark Fredderick R Abejo R. Measure the length of NGT to be inserted Rationale To allay anxiety Insert the tube  Put on gloves  Lubricate the tip with water-soluble lubricant.N Clinical Instructor Assessment: Check the patency of nares and intactness of nasal tissue: . gently advance the tube toward the nasopharynx Note: If the tube meets resistance. relubricate it. . using flashlight. which should be acidic Testing pH is a reliable way to determine location of a feeding tube. select the nostril that has greater airflow. .Ask the client to breath through one nostril while occluding the other. To prevent injury It is often easier to swallow in this position and gravity helps the passage of tube NEX technique ( noseear-xiphoid)  Tilt the client’s head forward once the tube reaches the throat and ask the client to swallow or drink water as the tube advances. and insert to the other nostril To reduce friction Hyperextension of the neck reduces the curvature of the nasopharyngeal junction. Assist the client to a high fowler’s position if his/her health condition permits. observe the intactness of the tissue of the nostrils.  Hyperextend the neck. Tilting the head forward facilitates passage of tube into the esophagus rather than into larynx.Ask the client to hyperextend the head.N. Checking the patency  Aspirate stomach contents and check the pH. until the indicated length is inserted. Determine presence of gag reflex Ability to cooperate with the procedure Mark this length with adhesive tape if the tube does not have markings. withdraw it. This length approximates the distance from the nares to the stomach Steps / Procedure Identify and inform the client and explain the procedure.A. Swallowing moves the epiglottis cover the opening to the larynx Measuring the appropriate length to insert the NGT ( NEX technique )  Pass the tube 5-10 cm with each swallow. support head with pillow. M.

Asepto syringe . If an orogastric tube is used. Gastric Gavage) Purposes: To restore or maintain nutritional status.  Ask the client to speak or hum  Observe the client for coughing and choking Note: The most accurate method of assessing the placement of NGT is X-ray study Secure the NGT by tapping it to the bridge of the client’s nose.Lecture Notes on Enteral Nutrition ( Nasogastric Tube ) Prepared By: Mark Fredderick R Abejo R. When assessing the nares.pH test strip (optional) . tube is possibly in the lungs This prevents the tube from pressing against and irritating the edge of the nostril Tape the tube to the area between the end of the nares and the upper lip as well as to the cheek. Wash hands and observe appropriate infection control and provide privacy Rationale To allay anxiety Special Considerations:  Inserting a NGT to Infants and Young Children: Restraints may be necessary during tube insertion and throughout therapy. constipation or dehydration) Steps / Procedure Identify and inform the client and explain. why it is necessary and how he/she can cooperate Assist the client to a fowler’s position in bed or a sitting position in chair. obstruct one of the infant’s and feel for air passage from the other. This positions enhance the gravitational flow of the solution and prevent aspiration of fluid into the lungs .Stethoscope .N.Facial tissue or cloth . Hyperextension or hyperflexion of the neck could occlude the airway.Clean gloves . M. abdominal distention.N Clinical Instructor  Introduce 10-30 ml of air into the NGT and auscultate at the epigastric area. Restraints will prevent accidental dislodging of the tube. measure from the tip of the earlobe to the corner of the mouth to the xiphoid process. Check for allergies to any food in the feeding. dumping syndrome. gurgling sound is heard.A. Place the infant in an infant seat or position the infant with a rolled towel or pillow under the head and shoulders. Measure appropriate NGT length from the nose to the tip of the earlobe and then to the point midway between the umbilicus and xiphoid process. an orogastric tube may be more appropriate. Do not hyperextend or hyperflex an infant’s neck.Water Assessment: Assess for any signs of malnutrition or dehydration.Correct amount of feeding solution .Measuring container or cup .Emesis basis .g delayed gastric emptying. Administering Tube Feeding (NGT Feeding . To administer medications Equipment: . If the nasal passageway is very small or is obstructed. Note: Gastric contents must be re-instill to the stomach to prevent electrolyte imbalances Difficulty in speaking and client is choking and continuously cough. Assess for the presence of bowel sounds Note any problems that suggest lack of tolerance of previous feedings (e. if his/her health condition permits.

Introduce feeding slowly .Ask the client to This facilitate digestion remain in position for at and prevent potential least 30 min. Monitor patient for possible problem and complications on tube feedings Make relevant documentation Feeding Through a Syringe Spoiled feeding cause diarrhea and abdominal pain to the client. . its expiration  Warm the feeding at room temperature Through A Feeding Bag . . check the gastric residual 4-6 hours Administer the feeding  Check the feeding. gurgling sound is heard. Assess residual feeding contents. to prevent instillation of air to the client’s stomach. time it was prepared.Instill 60. .Introduce 10-30 ml of air into the NGT and auscultate at the epigastric area. cramps . Ensure client comfort and safety : . aspiration.A. Through A Syringe (open system) .N. To assess absorption of the last feeding.Pin the tubing to the client’s gown Minimizes pulling of the tube thus preventing discomfort . verify if the feeding will be given.N Clinical Instructor Check the patency of the tube: . Note: If the client is on continuous feeding.Open the clamp.Clamp the tubing and add the formula to the bag. which should be acidic .100 ml of water to NGT after .Hang the bag from an infusion pole about 12 inches above the point of insertion. run the formula to the tube.Lecture Notes on Enteral Nutrition ( Nasogastric Tube ) Prepared By: Mark Fredderick R Abejo R.Clamp the cover of the feeding before all water is instilled Note: Gastric contents must be re-instill to the stomach to prevent electrolyte imbalances To prevent flatulence. Excessively cold feeding may cause cramps . M. .Height of feeding is 12 inches above the point of insertion.Attach the bag to the NGT and regulate the drip.Aspirate stomach contents and check the pH. and reflex vomiting To cleanse the lumen of the tube To prevent leakage and air from entering the tube. if 50 ml or more.

N.Unpin the tube to the client’s gown . Diarrhea 4. and hold and cuddle the child during feedings.N Clinical Instructor Special Considerations:  Administering a Tube Feeding to: Infants Feeding tubes may be reinserted at each feeding to prevent irritation of the mucous membrane.Disposable pad . Hyperglycemia 6. Vomiting 2.A. nasal airway obstruction and stomach perforation. Diarrhea from administering the feeding too fast or at too high concentration may cause dehydration If feeding has a high concentration of glucose.50 ml syringe (optional) . This promotes comfort. Identify and inform the client and explain the procedure.Remove the adhesive tape securing the tube to the nose Remove the Tube  Wear gloves  (optional) Instill 50 ml of air into the tube  Ask the client to take deep breath and hold it  Pinch the tube with he gloved hand  Quickly and smoothly.Disconnect to suction Rationale Common Problems of Tube Feedings 1. withdraw the tube.Lecture Notes on Enteral Nutrition ( Nasogastric Tube ) Prepared By: Mark Fredderick R Abejo R. Abdominal Distention To allay anxiety To collect any spillage of mucous and gastric secretions from the tube . Aspiration 3. M. assess hyperglycemia apparatus if connected .Clean gloves . preventing aspiration of gastric contents This prevent gastric contents inside the tube from draining into the clients throat To prevent possible transfer of microorganism To remove accumulated secretions Removing a Nasogastric Tube Equipment: . provide a pacifier.Disposable bag Steps / Procedure Confirm the physician’s order.  Dispose the tube immediately Provide oral care if desired Assist the client to blow the nose Document relevant information This clears the tube of any gastric contents This closes glottis. Constipation 5. Children Position a small child or infant in your lap. Assist the client into a sitting position if health permits Place the disposable pad across the client’s chest Wash hands Detach the tube: . supports the normal sucking instinct of the infant and facilitates digestion Elders Decreased gastric emptying may necessitate checking frequently fir gastric residual.

Parenteral Nutrition. Lubricate with water soluble lubricant before insertion to prevent friction. Pour 15-30 ml of water into the syringe and allow water to flow into the tube. Because TPN solutions are hypertonic ( highly concentrated in comparison to the solute concentration of blood). To prevent flatulence. M. Assess status of peristomal skin for signs and symptoms of infection. To prevent gastric reflux and possible aspiration. Check the patency of a tube suture in place. remain in sitting position or slightly elevated right lateral position for at least 30 mins. If 50mls or more. Hold the syringe 7-15 cm (3-6 inches) above the ostomy opening.A. verify if the feeding will be administered.N. Administer feeding slowly. Check the residual formula. crampy pain and reflex vomiting Flush the tube with 30 ml. Make relevant documentation Total Parenteral Nutrition (TPN) Intravenous Hyperalimentation (IVH) TPN or IVH. where they are diluted by the client’s blood Clients suggestive for TPN Severe malnutrition Severe burns Bowel disease disorders Acute renal failure Hepatic failure Metastatic cancer Major surgeries ( where NPO is taken for more than 5 days) Procedure: Assess and prepare the client Insert a feeding tube into the ostomy opening 10-15 cm (4-6 inches) if one is not already in place.N Clinical Instructor Administering a Gastrostomy or Jejunostomy Feeding Gastrostomy Tube Feeding After feeding. is provided when the gastrointestinal tract is nonfunctional because of an interruption in its continuity or because its absorptive capacity is impaired. Flushing the tube preserves its patency. .Lecture Notes on Enteral Nutrition ( Nasogastric Tube ) Prepared By: Mark Fredderick R Abejo R. they are injected only into high – flow central veins. is administered intravenously such as through a central venous catheter into the superior vena cava.

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