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NASOGASTRIC

FEEDING
OR
GAVAGE FEEDING
Dr. Jayesh Patidar
www.drjayeshpatidar.blogspot.com
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DEFINITION
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Gavage feeding is an artificial method of
giving fluids and nutrients. This is a process
of feeding with the tube (Nasogastric tube)
inserted through the nose, pharynx, and
esophagus and into the stomach.
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PURPOSES
AND
INDICATIONS
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To feed the children who are unable to take
feed orally.
Feed the children who are undergoing oral
surgery like - cleft lip or cleft palate,
fracture of jaw, and in condition of
difficulty in swallowing.
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When patient is unconscious or
semiconscious
When the condition is not supportive to
take large amount of food orally e.g.-
severe burns, malnutrition, prematurity,
acute and chronic infections.
Conditions when the patient is unable to
retain the food e.g. anorexia nervosa and
vomiting.
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ADVANTAGES
OF
NASOGASTRIC FEEDING
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All types of nutrients including distasteful
foods and medications can be given in
adequate amount.
Without any danger, feeding can be
continued for weeks.
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According to need, stomach can be
aspirated at any time.
Large amount of fluids can be
given with safety.
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PRINCIPALS
INVOLVED
IN
GASTRIC GAVAGE
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Tube feeding is a process of giving liquid
nutrients or medications through a tube into
the stomach when the oral intake is
inadequate or impossible.
A thorough knowledge of the anatomy and
physiology of the digestive tract and
respiratory tract. Ensures safe induction of the
tube (avoid misplacement of the tube).
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Micro-organisms enter the body
through food and drink.
Introduction of the tube into the mouth
or nostrils is a frightening situation
and the client will resist every attempt.
Mental and physical preparation of the
client facilitates introduction of the
tube.
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Systematic ways of working adds to the
comfort and safety of the client and
help in the economy of material. Time
and energy
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POLICY
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6 fr feeding tube is used for infants
<1000 grams.
6 fr or # 8 fr feeding tube are used for
infants> 1000 grams.
Never force the feeding under pressure.
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If possible, the infant should be held in
semi-up-right
position during the feeding; if not
possible, position infant on right side or
prone as this will facilitate gastric
emptying.
If respiratory rate >70, check with
physician about withholding feeding.
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ARTICLES NEEDED
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Mackintosh with towel
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Kidney tray for receiving the waste
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Cotton tipped" applicators to clean the
nostrils.
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Ryle's tube in a bowel.
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Lubricant such as water soluble jelly or
glycerin to prevent friction
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Gauze pieces to clean the secretions
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Scissors and adhesive plaster or
tape
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Measuring cup or glass/ounces
glass.
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Sterile syringe, about 10-20 ml
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Paper bag- to collect the wastes.
Glass of feed in a bowel of warm water to give the
feed at the body temperature.
Tongue blade.
Suction apparatus - to clear the airway, whenever
need.
Bowel with water - to test the location of tube.
Clamp - to clamp the tube to prevent leakage of
gastric contents
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PROCEDURE
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Identify the patient.
Explain the procedure to the patient.
Maintain privacy.
Make the patient in comfortable position.
Make the patient sit on chair or place him in
fowlers position.
Arrange the meckintosh and face towel across the
chest and put under the chin to protect the
garments and bed linens.
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Keep the kidney tray ready for receiving the vomit,
if occur.
Remove the dentures and place in a bowl of clean
water.
Clean the nostrils with cotton applicators, if
secretions are deposited.
Arrange all articles near the bed side or on the bed
side looker.
Do the hand washing properly.
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Check the patency of the tube.
Measure the length of the tube by measuring
it from the tip of the nose to ear lobe and
from ear lobe to the tip of the
xiphoid process of the sternum.
Wear the hand gloves.
Lubricate the tube with glycerine- or jelly by
the piece of gauze. It is start from tip to the 6
to 8 inches long.
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Now insert the tube with the right hand
into the left nostril slowly
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Pass the tube slowly backwards and downwards.
When the tube reaches at pharynx, give patient
sips of water and swallow, while swallow insert
the tube about 3-4 inches each time. When it
reaches completely till the mark stop to insert.
Now confirm the placement of tube by aspirating
the gastric contents with the syringe. Other method
is to place the tube end in a bowl of water and
check the bubbles. If bubbles are present it
indicates position in trachea.
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Examine the mouth of patient with tongue
blade and light source
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After this secure the tube with the
adhesive tape at the nasal bridge.
After some time give some water to
expel the air. Give the feed with
feeding syringe or funnel. Give feed
slowly; do not push the feeding
solution with plunger.
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When the feeding is completed, pour a
little amount of water and clamp the tube
firmly to prevent leakage of fluids
When any obstruction occurs while
feeding, remove the funnel and take a
syringe with sterile water. Push the water
slowly, and draw it back from gastric
contents. When fluid starts to enter,
connect the feeding funnel with tube
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Provide oral hygiene every 4 to 6 hours
to prevent infections
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Dispose the waste materials and clean
the articles properly and replace them.
Do the hand washing.
Recording and reporting
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AFTER CARE
OF THE
CLIENT
AND
ARTICLES
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Offer a mouth wash. Clean the face and hands
and dry them
Remove the mackintosh and towel
Make the client comfortable in bed
In case of unconscious or seriously illclients,
apply suction if secretions are collected in the
mouth
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Take all articles to the utility room. Discard the
waste and clean the articles with soap and water.
Dry them. Replace them into their proper places
Wash hands
Record the time, date, amount of feed, the nature of
the feed, the reaction of the client if any, in the
nurses record as well as in the intake and output
chart
Remove the tube when the tube feeding is to be
stopped
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