Administering a NGT FEEDING

to administer feeding and to supply nutrition to px who are unable to eat by mouth or swallow
Contraindication: neck surgeries, esophageal, nasal throat surgery
1. Verify doctor’s order
2. Perform hand washing
3. Identify patient and explain the procedure
4. Provide privacy throughout the entire procedure
5. Prepare the equipment.
6. Prepare the patient.
a. Position the client with the head of the bed elevated at least 30 degree
angle to 45 degree angle.
b. Spread the towel over the patient's chest
7. Determine placement of feeding tube by:
a. Aspiration of stomach secretions
①Attach the syringe to the end of feeding tube
②Gently pull back on plunger
③Measure amount of residual fluid
④ Return residual fluid to stomach via tube and proceed to feeding. Because it
can disturb the clients electrolyte imbalance
❖Nursing Alert❖
If amount of the residual exceed hospital protocol or Dr.’s order, refer to these
order.
b. Injecting 10-20 mL of air into tube:
① Attach syringe filled with air to tube
② Inject air while listening with stethoscope over left upper quadrant
c. Taking an x-ray or ultrasound
8. Using the syringe:
Feeding the following
a. Clamp the tube. Insert the tip of the large syringe with plunger, or bulb
removed into the gastric tube.
b. Pour at least 30 cc of water to the barrel to clear the tube. Let it flow by gravity.
c. Raise the syringe 12 to 18 inches above the stomach. Open the clamp.
c. Allow feeding to flow slowly into the stomach. Raise and lower the syringe
to control the rate of flow.
d. Add additional formula to the syringe as it empties until feeding is
complete
9. Termination feeding:
a. Terminate feeding when completed.
b. Instill prescribed amount of water (30cc) to clear the tube.
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 c. Keep the client’s head elevated for 20-30minutes.
10. Mouth care:
a. Provide mouth care by brushing teeth
b. Offer mouth wash
c. Keep the lips moist
11. Clean and replace equipment’s to proper place
12. Remove gloves and perform hand hygiene
13. Document date, time, amount of residual, amount of feeding, and client’s
reaction to
feeding. Sign the chart.

When is enteral feeding used?

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Tube feedings may become necessary when you can’t eat enough calories to meet your nutritional needs.

This may occur if you physically can’t eat, can’t eat safely, or if your caloric requirements are increased beyond your ability to eat.

If you can’t eat enough, you’re at risk for malnourishment, weight loss, and very serious health issues. This

may happen for a variety of reasons. Some of the more common underlying reasons for enteral feeding include:

● a stroke, which may impair ability to swallow

● cancer, which may cause fatigue, nausea, and vomiting that make it difficult to eat
● critical illness or injury, which reduces energy or ability to eat
● failure to thrive or inability to eat in young children or infants
● serious illness, which places the body in a state of stress, making it difficult to take in enough nutrients
● neurological or movement disorders that increase caloric requirements while making it more difficult to eat
● GI dysfunction or disease, although this may require intravenous (IV) nutrition instead
Types of enteral feeding

The main types of enteral feeding tubes include:

● Nasogastric tube (NGT) starts in the nose and ends in the stomach.
● Orogastric tube (OGT) starts in the mouth and ends in the stomach.
● Nasoenteric tube starts in the nose and ends in the intestines (subtypes include nasojejunal and nasoduodenal tubes).
● Oroenteric tube starts in the mouth and ends in the intestines.
● Gastrostomy tube is placed through the skin of the abdomen straight to the stomach (subtypes include PEG, PRG, and button
tubes).
● Jejunostomy tube is placed through the skin of the abdomen straight into the intestines (subtypes include PEJ and PRJ tubes).
Procedure for placing the tube

NGT or OGT

Placement of a nasogastric tube or orogastric tube, while uncomfortable, is fairly straightforward and painless. Anesthesia isn’t
required.

Typically a nurse will measure the length of the tube, lubricate the tip, place the tube in your nose or mouth and advance until the
tube is in the stomach. The tube is usually secured to your skin using soft tape.

The nurse or doctor will then pull some gastric juice out of the tube using a syringe. They’ll check the pH (acidity) of the liquid to
confirm that the tube is in the stomach.

In some cases, a chest X-ray may be needed to confirm placement. Once placement is confirmed, the tube may be used
immediately.

Nasoenteric or oroenteric

Tubes that end in the intestines often require endoscopic placement. This means using a thin tube called an endoscope, which has
a tiny camera on the end, to place the feeding tube.

The person placing the tube will be able to see where they’re putting it via the camera on the endoscope.

The endoscope is then removed, and placement of the feeding tube may be confirmed with aspiration of gastric contents and X-ray.

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It’s common practice to wait 4 to 12 hours before using the new feeding tube. Some people will be awake during this procedure,
while others may require conscious sedation. There’s no recovery from the tube placement itself, but it may take an hour or two for
the sedation medications to wear off.

Gastrostomy or jejunostomy

Placement of gastrostomy or jejunostomy tubes is also a procedure that may require conscious sedation, or occasionally general
anesthesia.

An endoscope is used to visualize where the tube needs to go, and then a tiny cut is made in the abdomen to feed the tube into the
stomach or intestines. The tube is then secured to the skin.

Many endoscopists choose to wait 12 hours before using the new feeding tube. Recovery may take five to seven days. Some
people experience discomfort at the tube insertion site, but the incision is so small that it typically heals very well. You may receive
antibiotics to prevent infection.

Possible complications of enteral feeding

There are some complications that can occur as a result of enteral feeding. Some of the most common include:

● aspiration, which is food going into the lungs

● refeeding syndrome, dangerous electrolyte imbalances that may occur in people who are very malnourished and start receiving
enteral feeds
● infection of the tube or insertion site
● nausea and vomiting that may result from feeds that are too large or fast, or from slowed emptying of the stomach
● skin irritation at the tube insertion site
● diarrhea due to a liquid diet or possibly medications
● tube dislodgement
● tube blockage, which may occur if not flushed properly

There are not typically long-term complications of enteral feeding.

When you resume normal eating, you may have some digestive discomfort as your body readjusts to solid foods.

Who shouldn’t have enteral feeding?

The main reason a person wouldn’t be able to have enteral feeds is if their stomach or intestines aren’t working properly.

Someone with a bowel obstruction, decreased blood flow to their intestines (ischemic bowel), or severe intestinal disease such as
Crohn’s disease would likely not benefit from enteral feedings.

The outlook

Enteral feeding is often used as a short-term solution while someone recovers from an illness, injury, or surgery. Most people
receiving enteral feeds return to regular eating.

There are some situations where enteral feeding is used as a long-term solution, such as for people with movement disorders or
children with physical disabilities.

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In some cases, enteral nutrition can be used to prolong life in someone who is critically ill or an older person who can’t maintain
their nutritional needs. The ethics of using enteral feeding to prolong life have to be evaluated in each individual case.

Feeding Tube Insertion (Gastrostomy)

What is a feeding tube?

A feeding tube is a device that’s inserted into your stomach through your abdomen. It’s used to supply nutrition when you have
trouble eating. Feeding tube insertion is also called percutaneous endoscopic gastrostomy (PEG), esophagogastroduodenoscopy
(EGD), and G-tube insertion.

This treatment is reserved for when you have trouble eating on your own, due to reasons such as the following:

● You have an abnormality of your mouth or esophagus, which is the tube that connects your throat to your stomach.
● You have difficulty swallowing or keeping food down.
● You aren’t getting enough nutrition or fluids by mouth.
Conditions that can cause you to have trouble eating include:

● stroke
● burns
● cerebral palsy
● motor neuron disease
● dementia
If you can’t eat or swallow, you may need to have a nasogastric tube inserted. This process is known as nasogastric (NG)
intubation. During NG intubation, your doctor or nurse will insert a thin plastic tube through your nostril, down your esophagus, and
into your stomach.

Once this tube is in place, they can use it to give you food and medicine. They can also use it to remove things from your stomach,
such as toxic substances or a sample of your stomach contents.

When would you need nasogastric intubation?

NG intubation is most commonly used for the following reasons:

● feeding
● delivering medication
● removing and evaluating stomach contents
● administering radiographic contrast for imaging studies
● decompressing blockages
It’s also used to help treat some premature infants.

Your doctor or nurse can give you food and medicine through an NG tube. They can also apply suction to it, allowing them to
remove contents from your stomach.

For example, your doctor may use NG intubation to help treat accidental poisoning or drug overdose. If you’ve swallowed something
harmful, they can use an NG tube to remove it from your stomach, or to deliver treatments.

For instance, they may administer activated charcoal through your NG tube to help absorb the harmful substance. This can help
lower your chances of a severe reaction.

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Your doctor or nurse can also use an NG tube to:

● remove a sample of your stomach contents for analysis

● remove some of your stomach contents to the relieve the pressure on an intestinal obstruction or blockage
● remove blood from your stomach
What will the procedure involve?

● Your healthcare provider will insert your NG tube while you’re lying down in a bed with the head elevated or sitting in a chair.
Before they insert the tube, they will apply some lubrication to it and likely some numbing medication as well.

● They will likely ask you to bend your head, neck, and body at various angles as they thread the tube through your nostril, down
your esophagus, and into your stomach. These movements can help ease the tube into position with minimal discomfort.

● They may also ask you to swallow or take small sips of water when the tube reaches your esophagus to help it slide into your
stomach.

● Once your NG tube is in place, your healthcare provider will take steps to check its placement. For example, they might try to
draw fluid out of your stomach. Or they might insert air through the tube, while listening to your stomach with a stethoscope.

● To keep your NG tube in place, your care provider will likely secure it to your face with a piece of tape. They can reposition it if it
feels uncomfortable.

What are the benefits of nasogastric intubation?

● If you can’t eat or drink, NG intubation and feeding can help you get the nutrition and medications you need. NG intubation can
also help your doctor treat an intestinal obstruction in ways that are less invasive than intestinal surgery.

● They can also use it to collect a sample of your stomach contents for analysis, which can help them diagnose certain conditions.

What are the risks of nasogastric intubation?

If your NG tube isn’t inserted properly, it can potentially injure the tissue inside your nose, sinuses, throat, esophagus, or stomach.

This is why placement of the NG tube is checked and confirmed to be in the correct location before any other action is performed.

NG tube feeding can also potentially cause:

● abdominal cramping
● abdominal swelling
● diarrhea
● nausea
● vomiting
● regurgitation of food or medicine
Your NG tube can also potentially become blocked, torn, or dislodged. This can lead to additional complications. Using an NG tube
for too long can also cause ulcers or infections in your sinuses, throat, esophagus, or stomach.

If you need long-term tube feedings, your doctor will likely recommend a gastrostomy tube. They can surgically implant a
gastrostomy tube in your abdomen to allow food to be introduced directly into your stomach.

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How can you lower your risk of complications?

To lower your risk of complications from NG intubation and feeding, your healthcare team will:

● ensure the tube is always taped securely to your face

● check the tube for signs of leakage, blockage, and kinks
● elevate your head during feedings and for an hour afterwards
● watch for signs of irritation, ulceration, and infection
● keep your nose and mouth clean
● monitor your hydration and nutrition status regularly
● check electrolyte levels through regular blood tests
● make sure drainage bag is regularly emptied, if applicable