Maribel Belmonte

Justin De Jesus
Anne Malicay
Elisha Miranda
Karen Panganiban

BS NURSING 4-A

NASOGASTRIC TUBE (NGT)

TYPES OF ENTERAL FEEDING

1. Blenderised food - This is used in many developing countries primarily

because it is cheaper than commercially prepared feeds, Patients with
digestion and absorption defects may benefit from predigested nutrients.
2. Polymeric feeds - Polymeric feeds are available with a variety of energy,
protein, fat, mineral, vitamin, fibre, and water contents and are suitable for
those with a normal or near normally functioning bowel.
3. Disease specific feeds - Disease specific feeds generally play little part in
long term enteral nutrition. They can be used in severely ill patients, such as
those with multiple burns or trauma, respiratory failure, advanced cirrhosis, or
acute renal failure.
4. Elemental feeds - Elemental feeds contain either pure amino acids or
predigested protein and provide oligopeptides and amino acids. Amino acid
solutions taste unpleasant and are relatively expensive

Types of Nasogastric Tubes

 The first nasogastric tubes were made of soft rubber. Recently, tubes
have been made of silastic and polyethylene compounds.
 These tubes can be inserted more easily and also cause fewer medical
problems for the patient. There are fewer instances of inflamed tissues.
 With the exception of this change, nasogastric tubes are very much the
same today as they have been for the last three decades.
 The most commonly used nasogastric tube is the Levin tube.

1. Standard Nasogastric Tube

 The standard nasogastric tube may be used for either suctioning gastric
contents or administering tube feedings.

2. Levin Tube
 Levin tube comes in a variety of sizes from 5 French to 18 French. All are
approximately 50 inches long.
 Sizes 5-12 are curstomarily used for children and sizes 12-18 are used for
adults.
 Pediatric-sized nasogastric tubes may be used for some adults, because
they are less irritating than larger tubes.

3. Salem Sump Tube

 The Salem sump tube is especially designed for gastric suctioning.
 The Salem sump tube has a double lumen, with two distinct tubes at the
distal portion.
 The advantage of this tube is that is smaller, open end is open to room air,
allowing equalization of pressure and therefore, continuous, steady
suction without pull on the tissues.

4. Small-Bore Silicone Rubber Feeding Tube

 This type of tube decreases the irritation of nose and throat because it is
soft and small. In addition, the cardiac sphincter closes more tightly
around them, decreasing the possibility of regurgitation and aspiration.

5. Ewald Tube
 This tube has a large lumen which ranges in size from 26 to 30 French. It
is used for lavage, usually for a patient who has ingested poisonous
substances. This tube is also used for diagnostic tests.

6. Cantor Tube
 This tube is a long, single-lumen rubber tube with a rubber bag attached
to its distal tip. Before insertion, the physician will inject 30 ml mercury into
the bag, using a needle and syringe. This tube is usually inserted by a
physician, who uses a topical anesthetic in the nose and posterior
pharynx to make insertion more tolerable for the patient.

7. Miller-Abbott Tube
 This tube is long, double-lumen rubber tube. One lumen leads to a rubber
bag at the tube’s end.
 This lumen can be filled with air or fluid to provide a larger object at the
end so that peristalsis can advance the tube into the small intestine. The
other lumen is used for suction and irrigation.
 Once the tube is in the stomach, the bag is inflated with air or fluid through
its lumen.

DEFINITION

Nasogastric Tube Feeding is done in patients who cannot attain an adequate

oral intake from food, oral nutritional supplements, or who cannot eat and
drink safely.

The goal of this technique is to improve every patient’s nutritional intake and
maintain their nutritional status.

Nasogastric tube or NG tube

A special tube that carries food and medicine to the stomach through the

nose. It can be used for all feedings or for giving a person extra calories.

INDICATIONS
 GI decompression
 Gastric Lavage
 Enteral feeding
 Prevention of aspiration

CONTRAINDICATIONS
 Recent esophadeal/gastric surgery
 Base of skull fracture
 Severe facial trauma

ASSESS
1. For any signs of malnutrition
2. For allergies to any food in the feeding
3. For presence of bowel sounds
4. For any problems that suggest lack of tolerance of previous feeding

DETERMINE
1. Type, amount, and frequency of feedings
2. Tolerance of previous feedings

ASSEMBLE EQUIPMENTS NEEDED

1. Correct amount of feeding solution
2. Emesis basin
3. Disposable gloves
4. Asepto Syringe
5. Stethoscope
6. Measuring container/calibrated plastic container
7. Water at room temperature
8. Tray

PROCEDURE

1. Explain to the client what you are going to do, why it is necessary, and how
he can cooperate
2. Wash hands and observe other appropriate infection control procedures
3. Provide for client privacy
4. Check for patency
 Connect the asepto syringe to the clamped proximal end of the
nasogastric tube
 Place the diaphragm of the stethoscop below the xiphoid process
 Administer air into the syringe and check for bubbling/gurgling sound
heard through the stethoscope
5. Administer the feeding
Before administering the feeding:
Check the expiration date of the feeding
Warm the feeding to room temperature

6. Assess residual feeding contents

 Aspirate all the stomach contents, and measure the amount before
administering the feeding
 If 100 ml (or more than half the last feeding) is withdrawn, check with the
nurse in charge or refer to agency policy before proceeding
 Reinstill the gastric contents into the stomach, if this is agency policy or
physician's order
 Remove the syringe bulb or plunger and pour the gastric contents via the
syringe into the naso gastric tube

8. Syringe (Open System)

 Remove the plunger from the syringe, and connect the syringe to a
pinched or clamped nasogastric tube
 Instill water (depends on the doctor's order or agency protocol) to the
syringe barrel
 Add the feeding solution
 Permit the feeding to flow in slowly at the prescribe rate. raise or lower the
syringe to adjust the flow as needed
 Pinch or clamp the tubing to stop the flow for a minute, if the client
experiences discomfort

9. Rinse the feeding tube immediately before all of the formula has through
the tubing

10. Instill 50-100 ml of water through the feeding tube

 Be sure to add the water before the feeding solution has drained the neck
of a syringe, or from the tubing of an administration set

11. Clamp and cover the feeding tube

 Clamp/kink the feeding tube before all of the water is instilled

 Kink and secure the tube

12. Ensure the client comfort and safety

 Pin the tubing to the client's gown
 Ask the client to remain in sitting upright in Fowler's position or in a slightly
elevate right lateral position for at least 30 minutes

13. Dispose equipment appropriately

 If equipment is to be reused, wash it throroughly with soap and water, so
that it is ready for reuse
 Change the equipment every 24 hours or according to agency policy

14. Document all relevant information

 Feeding
 Amount and kind of solution taken
 Duration of the feeding
 Assessment of the client
 Record the volume of the feeding and water administered on the client's
intake and output record
15. Monitor the client for possible complications
 Carefully assess client’s receiving tube feedings for problems.
 To prevent dehydration, give the client supplemental water in addition to
the prescribed tube feeding as ordered.

Nursing Responsibilities

 Provide good oral hygiene at regular and frequent intervals. Offer water or
mouthwash to rinse the mouth every hour. Assist the patient to brush his
teeth at least every 4 hours.
 Keep the nostrils free of accumulations of dried secretions.
 If permissible, apply lubricant such as Vaseline to the lips and nostrils for
the patient’s comfort.
 Encourage the patient to swallow saliva naturally
 Encourage the patient to change position frequently, using care not to pull
on the tube and not to lie on the drainage tubing.
 Follow diet orders exactly.
 Keep accurate intake and output records. Large amounts of fluid and
electrolytes are lost during continuous suction drainage
 Observe the patient frequently when he is asleep, noting the tube marking
at the nostril. The patient may have unknowingly pulled the tube out
partially or completely. If partially out, advance the tube to the required
point and check for drainage. Tape securely. If the tube has been
accidentally removed, notify the nurse or doctor. Reinsert only on order.