VELEZ COLLEGE

COLLEGE OF NURSING
F. Ramos St. Cebu City

NURSING CARE MANAGEMENT 109 RLE:

Care of Mother and Child at Risk or With Problems (Acute and Chronic)
Procedure Study
Procedure Indications Contraindications Results and Nursing Considerations
Implications
OGT Feeding • Nutrition/feeding • Suspected/known Tube misplacement can • Mummy restraints
Nasogastric (NG) tubes or administration basilar skull fracture result in adverse patient effectively contain
Orogastric (OG) tubes are (prematurity, critical • Maxillofacial trauma outcomes including arms and legs
small tubes placed either illness, anatomic • The postoperative severe disability and without causing any
through the nose or the defects) period – any reinsertion death. These risks include: unwarranted
mouth and end with the tip • Medication of a gastric tube • Pneumonitis from pressure on infant
in the stomach. NG/OG tubes administration required following gastric feeds being • Measuring the tube
may be used for feedings, • Evacuation of recent deposited into the lungs ensures that it will be
medication administration, stomach contents • surgery to the mouth, • Intracranial insertion in long enough to enter
or removal of contents from pharynx, oesophagus or infant/child with base of the stomach. If a
the stomach via aspiration, stomach skull disruption tube is passed too
suction, or gravity drainage. • Known structural • Aspiration associated far, it will curl and
Procedure for insertion abnormality e.g. choanal with tube dislodgement end up in the
1. Loosely swaddle the atresia • Trauma to surrounding esophagus; if not
infant using a • Recent caustic ingestion tissues passed for enough it
mummy restraint • Suspected spinal injury • Pneumothorax will also be in the
2. Measure the space • Known or suspected • Spontaneous passage esophagus. Botha
from the infant’s oesophageal varices, through pylorus, causing can lead to aspiration
nose to earlobe to a chronic liver disease or feeding intolerance, in feeding.
point halfway liver failure abdominal pain, poor • Lubrication helps
between the xiphoid • Upper gastrointestinal absorption of medications tube pass the
process and stricture/oesophageal given via tube and esophagus without
umbilicus using a stricture /obstruction diarrhoea. trauma. Never use oil
no.8/no.10 feeding lubricants because it
 tube. If infant is older • Suspected nasal,
than 1 year, measure
from the bridge of the
nose to the earlobe to • Suspected base of skull
xiphoid process.
3. Mark the tube at the • Bleeding disorder.
measured point with
a small clump or tape.
Lubricate tip or
catheter with water.
4. Pass the catheter
with gentle pressure
to the point of clamp
tape. If catheter is
passed to trachea
rather than
esophagus, the infant
usually coughs and
becomes dyspneic. If
this happens,
withdraws replace
catheter.
5. Assess the catheter
for position (confirm
that if it is nit in the
trachea) before
administering the
feeding using a bulb
syringe administer air
through the tubing
and using a feeding to flow by
stethoscope
auscultate and listen
for gangling noise in
the xiphoid process.
6. Aspirate stomach
contents to assess
amount if amount is
small, replace it at the
beginning of feeding.
can pass the trachea
maxillary, oropharyngeal could lead to lipoid
or oesophageal trauma pneumonia.
• Gentle pressure
fractures helps to ensure
comfort and safety
• Assessing proper
placement helps to
ensure that the
feeding will enter the
stomach, not the
infant’s respiratory
tract.
• Assessing stomach
content amounts
aides in determining
if the previous
feeding was
absorbed. Replacing
stomach secretions
rather than
discarding them
helps prevent
electrolyte loss.
• Elevating the infant’s
upper body allows
feeding to flow by
gravity.
• Elevating the infant’s
upper body allows
gravity.
• Excessive elevation
can cause the
feeding to flow too
quickly, filling the
esophagus and
increasing the risk for
aspiration. Hurrying
 If large, replace it feeding by missing
through the tubing the plunger of then
and reduce the syringe or bulb
amount of feeding by attachment to add
amount. pressure that can
7. After being certain lead to aspiration.
that the catheter is in • Clamping the tube
the stomach, attach a before it is
syringe or special withdrawn is
feeding funnel to important to prevent
tube. Elevate the any milk remaining in
infants head and the tube from
chest slightly to flowing out and
encourage fluid to redness risk of
flow downwards to aspiration.
the stomach. • Flushing a tube helps
8. Flush water into the prevent clogging and
tube before adding plugging of the tube
feeding mixture. with feeding
9. Add specific kind and solution. Capping the
amount of feeding tube helps to prevent
prescribed to the air and bacteria from
syringe or funnel and entering.
allow it to flow by • Taping a tube to the
gravity into the forehead can put
infant’s stomach pressure on the
don’t elevate the anterior nan’s,
syringe end of the leading to ulceration.
tube more than 12 • Bubbling helps in
inches above the preventing air
infant’s abdomen. accumulation and
10. When the feeding has regurgitation of
passed through the feeding.
tube, reclamp the • Placing baby in this
tube securely and position helps the
gently and rapidly feeding solution
withdraws it. enjoy pyloric value,
11. If the tube is to be in promoting stomach
place flush it with 1-5 emptying.
 ml of clear water and • Aids in outcome
cap it. evaluation.
12. If the tube is to be left
in place, tape it below
the nose and to the
cheek. Do not tape it
to the forehead.
13. Bubbly baby after
enteral feeding
14. Unswaddle and place
infant on right side
with head slightly
elevated or hold or
rack baby in this
position.
15. Assess infant comfort

References:

Wayne, G. (2018, December 29). Nasogastric Intubation: Insertion procedures & technique. Retrieved March 13, 2021, from https://nurseslabs.com/nasogastric-
intubation/#nursing_considerations

Farrington, M., Lang, S., Cullen, L., & Stewart, S. (2009). Nasogastric tube placement verification in pediatric and neonatal patients. Pediatric Nursing, 35, 17-24.

Marcdante, K. J., & Kliegman, R. (2019). Nelson essentials of pediatrics. Philadelphia, PA, 19103: Elsevier.

Jeffries, L., Ratoni, T., Roberts, D., Stevens, H., & Winskil, R. (2016). Infants and Children Insertion and Confirmation of Placement of Nasogastric and Orogastric
Tubes [Ebook] (1st ed., p. 1-16).

Dartford and Gravesham NHS Trust, 2007. Paediatric enteral feeding guidelines & operational policy (infants & children). 1st ed. p.1-13.