GASTRIC FEEDING

Gastric feeding is an artificial method of giving fluids and nutrients through a tube that has passed into the
esophagus and stomach through the nose, mouth or though the opening made on the abdominal wall, when oral
intake is adequate or impossible.

Indication for tube feeding:

1. When the client is unable to take food by mouth. For example unconscious clients.
2. For a client who refuses to eat e.g. client with psychosis.
3. When condition of mouth or esophagus make the swallowing difficult or impossible. For example,
fracture of jaw, paralysis of face.
4. When the client is too weak to swallow food, e.g. severe burns.
5. When the client is unable to retain the food e.g. anorexia nervosa.

Principles involves in gastric gavage:

1. Tube feeding is the process of giving liquid nutrients or medications through a tube into the stomach
when the oral intake is inadequate.
2. A thorough knowledge of the anatomy and physiology of the digestive tract and respiratory tract
ensures safe induction of the tube.
3. Micro-organisms enter the body through food and drink.
4. Introduction of the tube into the mouth or nostrils is frightening situation and the client will resist every
attempt.
5. Systematic ways of working adds to the comfort and safety of the client and help in the economy of
material, time and energy.

General instruction:
1. Tube feeding is given only by doctor’s order.
2. If the client is conscious, explain the procedure and reassure the client to win his confidence and
cooperation.
3. Remove the dentures if any.
4. Lubricate the tube with a suitable lubricant preferably with a water soluble jelly.
5. All the equipment used for feeding should be clean. The food has to be prepared, handled in hygienic
conditions.
6. Every time before giving feed, make sure the tube is in stomach by aspirating a small quantity (5-10 ml)
stomach contents.
7. While removing tube, pinch the tube and pull it out gently and quickly so that the fluid may not trickle
down the trachea.
8. Avoid introducing air into the stomach during each feed.
9. Feedings may be given at intervals of 2, 3 or 4 hours and the amount should not exceed 150 to 300ml
per feed. The total amount in 24 hours varies between 2000 and 3000ml.
10. Intake and output is recorded accurately.
11. Watch for complications such as nausea, vomiting, distension, diarrhea, aspiration pneumonia,
asphyxia, fever, water and electrolyte imbalance. The water and electrolyte imbalance may be reflected
in changes in the skin, thirst, vital signs, intake and output, level of consciousness, body weight,
moisture of the mucus membrane and serum analysis. If the dehydration is not corrected, it may result
in higher fever, disorientation, drying of the mucus membrane etc. clients receiving tube feeding should
receive frequent mouth care.

Nurse’s responsibility in administering a tube feeding:

PRILIMINARY ASSESSMENT:
1. Identify the client with name, bed no., o.p.no., etc.
2. Check the doctor’s orders for any specific precautions if any, regarding the tube feeding, movement of
the client, positioning of the client etc.
3. Check the level of consciousness and ability to follow directions.
4. Check the ability for self-care, ability to move and to maintain a desired position during the insertion of
the tube.
5. Check whether the food is ready at hand.
6. Check the articles available in the client’s unit.
PREPARATION OF THE ARTICLES:
ARTICLES PURPOSE

Feeding cup with water To give mouthwash before and after feed
Kidney tray To protect the garments and bed linen
Mackintosh and towel To clean the nostrils
Cotton tipped applicators
Saline ryles tube To lubricate the tube
Lubricant To fix the tube in position
Adhesive plaster and scissors To wipe the secretions
Rag pieces in a container To collect the wastes
Paper bag To aspirate gastric contents and to give feed
Clean syringe To give feed at body temperature

A glass of feed and bowl of warm water To measure the fluid intake
Ounce glass To test the location of tube
A bowl with water To clear the airway in case of unconscious or
Suction apparatus seriously ill client who vomits and aspirates the
fluid into the respiratory tract
To clamp the tube to prevent the leakage of
gastric contents
Clamp

PREPARATION OF THE CLIENT AND THE UNIT:

1. Explain the sequence and procedure to the client.
2. Provide privacy.
3. Provide a safe and comfortable position for the client. If the general condition of the client permits,
make the client sit on the chair or place him in a fowler’s positi9on. If the general condition of client is
weak, raise the head with extra pillows.
4. Place the mackintosh and face towel across the chest and under the chin to protect the garments.
5. Allow the client to adjust the kidney tray according to his convenience or keep the kidney tray next to
the client ready to use if he vomits.
6. Remove the dentures if any.
7. Give a rag piece in the client’s hand to wipe the face and lips when necessary.
8. Clean the nostrils, using swab stick dipped in saline.

PROCEDURE:
Steps of procedure Reason and Explanation

1. Wash hands To prevent cross infection.

2. Take the tube and check whether it is in good Any blockage should be corrected before
order. Expel the water from the tube and check introducing the tube. If any water is remaining in
the tube for patency. the tube, it can dribble into the trachea and
choke the client.

3. Measure distance on the tube from the bridge of Rough guide to determine approximate length of
the nose to the ear lobe plus the distance from the the tube to reach the stomach.
ear lobe to the tip of the xiphoid process of the
sternum. Mark the distance of the tube.

4. Lubricate the tube for about 6 to 8 inches with the Lubrication of the tube reduces friction between
lubricant, using a rag piece or a paper square. mucus membrane and the tube. If the lubricant is
Lubricant should be applied to the minimum. excessive, it may dribble into the trachea during
 the intubation and cause respiratory distress.

5. Hold the tube coiled in the right hand and Nasal septum is deviated into the right side.
introduce the up into the left nostril.

6. Pass the tube gently but quickly backwards and
downwards. Momentary resistance may occur as
the tube is passed into the nasopharynx. Have a
client to flex the head. Withdraw the tube about
one inch, rotate it side and gently advance the
tube.
Flexing of the head helps to flex the tube at the
naso-pharyngeal junction and the tube enters the
pharynx. Stop if there is marked resistance and
inspect the posterior cavity for coiled tubing.

7. When the tube reaches the pharynx the client may Panting reflexes the pharynx. A brief pause may
gag. Allow him to rest for a moment. Ask him to prevent vomiting.
take panting breaths.

8. Having the client take sips of water and swallow
on command. Advance the tube 3 to 4 inches each
time client swallows. Continue to advance the
tube until it reaches the previously designated
mark.
Swallowing facilities the swallowing of the tube
through the esophagus. Mark on the tube
indicates the tube has reached the stomach.

9. Excessive gasping, coughing and cyanosis are

signs of respiratory distress. The tube may be in
the trachea. Immediately pull it out. Check the
placement of the tube in the stomach.
 Aspirate for gastric contents with a Fluids cannot be freely aspirated from the lungs.
syringe

 Place the end of the tube with a syringe If the tube is in the trachea, air bubbles will
barrel or funnel into the bowl of water coincide with the expiration of each breath.
and note the rhythm of escaping bubbles.

 Ask the client to hum or speak. The client will be unable to hum or speak if the
tube is in the trachea.

10. After the tube is in place, tape it to the side of the Careful fixing of the tube prevents it from being
face and wait for sometime before giving the feed. displaced. A few minutes rest will help to
subside the peristalsis and prevent nausea and
vomiting.

11. Before giving the feed, pour some water through
the funnel and lower the funnel slowly, so as to
expel the air. Then give the feed and the
medicines kept ready for the client. When the feed
is finished, pour a little water and clamp the tube
firmly to prevent leakage of fluids.
Expelling the air from the tube before the feed is
given, not allowing the fluid to run completely,
clamping the tube at the end of each feed, are
some of the measures to prevent the prevent the
entry of the air into the stomach.

After care of the client and articles:

1. Offer a mouthwash. Clean the face and hands and dry them.
2. Remove the mackintosh and towel.
3. Make the client comfortable in bed.
4. In case of unconscious or seriously ill clients, apply suction if secretions are collected in the mouth.
5. Take all articles to the utility room. Discard the wastes and clean the articles with soap and water. Dry
them. Replace them into their proper places.
6. Wash hands.
7. Record the time, date, amount of feed, the nature of the feed, the reaction of the client if any, in the
nurse’s record as well as in the intake and output chart.
8. Remove the tube when the tube feeding is to be stopped.