POLICIES AND PROCEDURES MANUAL

TUBE FEEDING (NASOGASTIC)

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SUBJECTS: TUBE FEEDING (NASOGASTRIC)

1. EQUIPMENT:

1. Feeding ordered by physician

2. 50ml of water
3. Absorbent pad
4. Gavage bag with tubing and flow regulator clam (if a gavage bag is
unavailable, us a bulb syringe or a catheter tip syringe)
5. 50ml syringe
6. Stethoscope
7. Gloves
8. Basin
9. Suction source
10. I.V. standard

2. PREPERATION OF EQUIPMENT:

A. After obtaining from the pharmacy, the unopened cans of formula may be
stored and are to be administered at room temperature. Hot formula may
coagulate formula proteins and clog tubing. Heat may change the
chemical composition of the formula. It may burn or irritate gastric
mucosa. Chilling the formula is avoided because it increases viscosity of
the liquid, which may clog the tube. Cold formula may also cause
vasoconstriction, which reduces the flow of gastric digestive secretions,
which may cause cramping, nausea, vomiting and distention.
B. Wash hands
C. Close the gavage-tubing clamp and pour the appropriate amount of
formula into the gavage bag. Squeeze the drip chamber and fill half way.
Remove the cap from the distal end of the tubing. Open the clamp and
run the formula through the length of tubing and clamp the tubing.
D. All air in tubing is removed so that it does not enter the
Individual’s stomach and cause distention and discomfort.

3. PROCEDURE:

NOTE: if Individual shows any signs of respiratory distress discontinue

feeding immediately and re-assess placement of feeding tube and
Individual status.
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TUBE FEEDING (NASOGASTIC)
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NURSING ACTION
A. Approach and identify Individual.
Explain the procedure and provide
privacy
B. Wash hands
C. Bring assembled equipment to
Individual’s room maintaining a clean
technique.
D. Elevate the head of the Individual’s
bed to semi-fowlers or high position
unless contraindicated
E. Place towel or Chux on Individual’s
chest
F. Put on disposable gloves
G. remove cap or plug from distal end
of feeding tube and use syringe to
inject 10-15 ml of air through the tube
while auscultating the Individual’s
stomach with a stethoscope
H. Aspirate stomach contents
I. Re-install the aspirated stomach
contents into the stomach
J. NEVER GIVE A FEEDING UNLESS
YOU ARE SURE THE TUBE IS
PROPERLY POSITIONED IN
INDIVIDUAL’S STOMACH
K. Gavage Bag Feeding
a) Connect the gavage
feeding bag tubing to the
feeding tube. Depending
on the type of tube used
you may need an adapter
to connect the two tubes.
b) Open the regulator clamp
on the gavage bag tubing
and adjust the flow rate.
c) Initially administer feeding
slowly & increase rate as
tolerated.
d) After administering the
appropriate amount of
feeding flush the tubing
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RATIONAL- PRECAUTIONS
A. To gain Individual confidence and
lessen anxiety and embarrassment.
Assure Individual’s identity
B. To avoid cross contamination
C. The equipment need not be sterile.
Since the stomach is not a sterile
cavity, however, clean technique is
necessary
D. Prevent aspiration of feeding by
gastroesophageal reflex and to aid
digestion
E. Protect Individual’s gown from
spillage
F. Prevent cross contamination
G. To check tube patency and
position. To be sure it has not become
displaced. Listen for hissing or gurgling
sound (air passing through the
stomach)
H. Confirm proper position and
patency of the tube
I. To prevent the loss of electrolytes ad
gastric juices
J. Administering a tube feeding
through a misplaced tube can cause
formula to enter the lungs leading to
suffocation and death
K. To prevent air from entering
stomach. Prevents sudden stomach
distention, which can cause nausea,
vomiting, cramps, or diarrhea. Maintain
tube patency by removing excess
sticky formula, which could occlude the
nasogastric tube. To prevent air from
entering the stomach causing gastric
distention.
 POLICIES AND PROCEDURES MANUAL
TUBE FEEDING (NASOGASTIC)
DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
NO. *** ***
*** REVIEW DUE
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with about 100ml of water

e) Close the regulator clamp
on the gavage bag
tubing.
L. Catheter Tip Syringe L. Prevent excess air form entering the
f) Attach the syringe to the stomach, causing gastric distention and
feeding tube discomfort. Prevent air from entering
g) Fill the syringe with stomach. NOTE: No more than 500 cc
formula and allow formula of fluid is given at one time.
to flow through. The
height at which you hold
the syringe will determine
flow rate. When the
syringe is ¾ empty, pour
more formula into it.
h) Disconnect the syringe
from the feeding tube and
plug off nasogastric tube
M. “Kangaroo Pump” Place amount of
formula in Kangaroo Pump gavage
bag. Check patency of tube following
N.P. 328. Set up pump to rate as
ordered by Physician.
N. Observe Individual & respiration
throughout the procedure
O. Cover the end of the feeding tube O. To prevent leakage and tube
with its plug or cap. Then release the contamination
tubing or clamp on the tubing. Secure
tubing.
P. Leave the Individual in semi- or P. To prevent gastroesophageal reflux
high-fowlers position for at least 30 and to aid digestion. To prevent
minutes aspiration and suffocation.
Q. Rinse all re-usable equipment with Q. To prevent bacterial growth
warm water and store in a brown paper
bag labeled with the Individual’s name.
R. Change feeding/equipment every R. to prevent bacterial growth
24 hours
S. Wash hands S. To prevent infection

SPECIAL CONSIDERATION RATIONAL-PRECAUTIONS

A. When ready to administer, shake
the can well immediately before
opening. Once opened, dispense the
prescribed volume and discard any
unused formula.
A. Agitation corrects separation, which
could alter the content of the planed
feeding and potentially clog the tube.
Immediate use and discard ensures the
formula is not a vehicle for microbial
contamination/growth.
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B. Aspirate stomach contents 2 or 3
hours
C. During continuous feeding, assess
the Individual frequently for abdominal
distention.
D. If diarrhea occurs, notify the
physician so that the underlying cause
can be determined and corrected, e.g.,
alternating the prescribed medications,
changing the formula and/or
administration rate/volume, switching to
a fiber containing formula,
administering antidiarrheal medication,
or correcting a low serum albumin. Also
ensure that proper infection control and
equipment practices are being
followed.
E. If constipation occurs, notify the
physician so that the underlying cause
can be determined and corrected , e.g.,
altering the formula, adding fluids,
ordering a bulk forming laxative,
increasing Individual activity, or
changing a medication.
F. Assess hydration and increase fluid
intake as necessary if fluids are not
contraindicated.
G. Drugs may be administered through
the feeding tube, except for enteric-
coated drugs. Crush tablets or open
and dilute capsules in water prior to
administering. Flush the tubing with
water after administering drugs.
H. Monitor blood glucose to assess
glucose tolerance. Also monitor serum
electrolytes and other blood studies as
ordered by the physician.
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B. a) To verify adequate gastric
emptying and decrease vomiting
and aspiration .
b) To maintain acid-base balance.
c) The nutritionist will be able to
calculate the caloric intake
accurately by knowing the amount
of feeding returned.
C. Distention may cause nausea,
vomiting and is uncomfortable.
D. Diarrhea is the most common
complication. Common causes are: too
high infusion rate or volume, lack of
fiber, altered gastrointestinal flora (e.g.
due to medication or contamination),
hypoalbuminemia, or hyperosmolar
solutions (Isotonic formulas are best
tolerated.)
E. Irregular bowel movements can
result from the low fiber content of the
formula, inadequate fluids, medication
or lack of activity. The feeding should
be stopped and evaluated if obstruction
is suspected.
F. Dehydration may cause
constipation
G. Avoid need for discomfort of I.M.
Injections
H. To determine response nutritional
support.
 POLICIES AND PROCEDURES MANUAL
TUBE FEEDING (NASOGASTIC)
DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
NO. *** ***
*** REVIEW DUE
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4. DOCUMENTATION:

A. Document the feeding on the Medication Administration Record (MAR)

including:
1. The time the food product was opened & administered
2. The amount and type of formula given
3. The amount of water given
4. The time(s) that the tubing was changed
B. Record total I. & O. don the Intake and Output flow sheet
C. Record amount of residual feeding aspirated and returned on the IDN’s.
D. In the IDN’s record the placement and patency of the tube, the amount of
residual feeding (if any), the Individual’s reaction to and the tolerance of
feeding, including any cramping, diarrhea or abdominal distention. Also
note the results of blood tests.

REFERENCE: Nutrition Care Manual Feeding and Liquid Supplements